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Seismic data represent an excellent source of information and can be used to investigate several phenomena such as earthquake nature, faults geometry, tomography etc. These data are affected by several types of noise that are often grouped into two main classes: anthropogenic and environmental ones. Nevertheless instrumental noise or malfunctioning stations detection is also a relevant step in terms of data quality control and in the efficiency of the seismic network. As we will show, visual inspection of seismic spectral diagrams allows us to detect problems that can compromise data quality, for example invalidating subsequent calculations, such as Magnitude or Peak Ground Acceleration (PGA). However, such visual inspection requires human experience (due to the complexity of the diagrams), time demanding and effort as there are too many stations to be checked. That’s why, in this paper, we have explored the possibility of “transferring” such human experience into an artificial intelligence system in order to automatically and quickly perform such detection. The results have been very encouraging as the automatic system we have set up shows a detection accuracy of over 90% on a set of 840 noise spectral diagrams obtained from seismic station records. [ABSTRACT FROM AUTHOR]

Seismic data represent an excellent source of information and can be used to investigate several phenomena such as earthquake nature, faults geometry, tomography etc. These data are affected by several types of noise that are often grouped into two main classes: anthropogenic and environmental ones. Nevertheless instrumental noise or malfunctioning stations detection is also a relevant step in terms of data quality control and in the efficiency of the seismic network. As we will show, visual inspection of seismic spectral diagrams allows us to detect problems that can compromise data quality, for example invalidating subsequent calculations, such as Magnitude or Peak Ground Acceleration (PGA). However, such visual inspection requires human experience (due to the complexity of the diagrams), time demanding and effort as there are too many stations to be checked. That's why, in this paper, we have explored the possibility of "transferring" such human experience into an artificial intelligence system in order to automatically and quickly perform such detection. The results have been very encouraging as the automatic system we have set up shows a detection accuracy of over 90% on a set of 840 noise spectral diagrams obtained from seismic station records. [ABSTRACT FROM AUTHOR]

Using stable isotope analysis of carbon and nitrogen of turtle tissues and putative prey items, we investigated the diet of immature green turtles and hawksbill turtles foraging in the lagoon of Aldabra Atoll, a relatively undisturbed atoll in the southern Seychelles. Aldabra offers a unique environment for understanding sea turtle ecology. Green turtles mostly consumed seagrass and brown algae while hawksbill turtles mainly consumed mangroves and invertebrates. Green turtles showed a dietary shift with size (a proxy for age). There was minimal niche overlap between species and evidence of small-scale foraging site fidelity with turtle tissue reflecting site-specific prey. This highlights the ecological importance of seagrass and mangrove habitats and suggests that turtles play a role in controlling algal biomass at Aldabra. This study is the first to closely examine the foraging ecology of these sympatric turtle species in the Western Indian Ocean, a globally important region for both species. • First study on diet of turtles in Aldabra's undisturbed atoll using stable isotopes. • Evidence of turtle foraging site fidelity. • Minimal niche overlap between species. • Green turtles' diet shifts with age, favoring seagrass and brown algae. • Hawksbill turtles mainly feed on mangroves and invertebrates. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical performance of a new mRNA-based urine test, aiming to avoid unnecessary follow-up cystoscopy in patients under active surveillance (AS) for recurrent NMIBC. Methods: This is a prospective cohort study enrolling patients with history of low-grade (LG) NMIBC, who developed a recurrence during the follow-up and underwent AS. Their urinary samples were analyzed by Xpert BC Monitor (Cepheid, Sunnyvale, CA, USA). The primary endpoint was to investigate if Xpert BC Monitor could avoid unnecessary cystoscopy during the follow-up period. Its sensitivity, specificity, PPVs and NPVs were calculated. A cutoff of 0.4 "linear discriminant analysis" (LDA) was optimized for the AS setting. Results: The cohort consisted of 106 patients with a mean age of 72 ± 9.52 and a median follow-up from AS start of 8.8 (range 0–56.5) months. No statistically significant difference was found for the mean age, smoker status, lesion size, and number of lesions with a cutoff of 0.4. Of 106 patients, 22 (20.8%) were deemed to require treatment because of cystoscopic changes in size and/or number of lesions during the follow-up period. Using a cutoff value of < 0.4, 34 (33.7%) cystoscopies could be avoided due to low LDA value, missing 2/22 (9%) failures, none with high-grade (HG) NMIBC. Further research on larger population remains mandatory before its clinical use. Conclusion: Xpert BC Monitor seems to be a reliable assay, which might avoid unnecessary cystoscopies without missing HG NMIBC when its cutoff is optimized for the AS setting. [ABSTRACT FROM AUTHOR]

Bycatch is one of the key threats to juvenile marine turtles in the Mediterranean Sea. As fishing methods are regional or habitat specific, the susceptibility of marine turtles may differ according to inter- and intra-population variations in foraging ecology. An understanding of these variations is necessary to assess bycatch susceptibility and to implement region-specific management. To determine if foraging ecology differs with region, sex, and size of juvenile loggerhead turtles (Caretta caretta), stable isotope analysis of carbon and nitrogen was performed on 171 juveniles from a range of foraging regions across the central and eastern Mediterranean Sea. Isotope ratios differed with geographical region, likely due to baseline variations in δ13C and δ15N values. The absence of sex-specific differences suggests that within an area, all comparably sized animals likely exploit similar foraging strategies, and therefore, their susceptibility to fisheries threats will likely be similar. The isotope ratios of juveniles occupying the North East Adriatic and North Levantine basin increased with size, potentially due to increased consumption of more prey items at higher trophic levels from a more neritic source. Isotope ratios of juveniles with access to both neritic and oceanic habitats did not differ with size which is consistent with them consuming prey items from both habitats interchangeably. With foraging habitats exploited differently among size classes in a population, the susceptibility to fisheries interactions will likely differ with size; therefore, region-specific management approaches will be needed. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the role of en bloc re-resection (EBRS) in patients who had undergone previous en bloc resection for high-risk non-muscle-invasive bladder cancer (NMIBC). Methods: An international, multicenter, observational retrospective analysis of prospectively collected data. Patients with a high-risk NMIBC who had previously undergone en bloc resection were scheduled for EBRS of the resected area after 40 days. The primary outcome was the presence of residual tumor or recurrence-free survival. Results: Overall, 78 patients underwent EBRS. Only five (6.41%) residual cancers were found: one patient had a pTa G3 (1.28%) cancer and four (5.13%) had a pTis. The detrusor muscle was preserved in all samples. Only one patient had a positive margin on EBRS. No procedure called for a conversion to traditional re-TURBT. No patient experienced bladder perforation or other intra-operative complications. The recurrence rate at the first follow-up cystoscopy (RRFF-C at 3 months) was 3.85% (three patients). The median follow-up period was 30.8 months (range 6.9–76.0 months). In univariate analysis, the only predictor of recurrence was grade. Overall we observed 11 recurrences. Only one tumor progressed to T2 MIBC. Conclusions: The low rates of residual tumor, recurrence, and progression seem to raise doubts about the efficacy of EBRS in patients who have previously undergone en bloc resection. EBRS appears to be a feasible and safe procedure with a low rate of complications. However, further data will be needed before EBRS can be used in clinical trials or recommended as a treatment modality. [ABSTRACT FROM AUTHOR]

Robot-assisted partial nephrectomy (RAPN) is considered a feasible minimally invasive alternative to open partial nephrectomy (OPN) for the surgical treatment of renal tumors. To provide further evidence supporting the effectiveness of RAPN in a contemporary patient population treated at one of three tertiary care centers for robotic surgery and to describe the evolution of RAPN-based technical improvements. The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group prospectively collected data from 635 patients subjected to RAPN for clinically localized kidney cancer between 2010 and 2016 at three high-volume tertiary care centers. RAPN was performed using methods outlined in the supplementary video using either the da Vinci Si or Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Clinical data were collected within a prospectively maintained multi-institutional database. Intra- and postoperative data as well as surgical outcomes were assessed. Descriptive statistical analysis was performed and multivariable logistic regression models were fitted to determine the predictors of surgical outcomes. Mean patient age was 60.7 yr and mean preoperative tumor size was 33 mm. According to the PADUA score, 202 (31.8%) patients had a low-, 235 (37.0%) had an intermediate-, and 198 (31.2%) had a high-complexity tumor. In the majority of patients, a transperitoneal approach was used (n = 447; 70.4%). Mean operative time was 156.3 min and mean estimated blood loss was 171 ml. Overall, 25 (3.9%) patients experienced a significant (Clavien-Dindo >2) complication after surgery. No statistically significant differences between pre- and postoperative creatinine values were observed (p ≤ 0.823). Finally, optimal surgical outcomes defined according to the margin, ischemia, and complication score were achieved in 459 (72.3%) individuals. At a mean follow-up of 26 mo, only two local and two distant recurrences of the disease were observed. Finally, in multivariable logistic regression models, tumor complexity was associated with the risk of not achieving optimal surgical outcomes. RAPN represents an effective minimally invasive alternative to OPN in the treatment of clinically localized renal tumors. We reported contemporary experience with RAPN for the treatment of kidney cancer. RAPN appears to be a safe and effective procedure, resulting in optimal outcomes in the majority of individuals despite tumor complexity. Robot-assisted partial nephrectomy (RAPN) represents an effective minimally invasive alternative to open partial nephrectomy in the treatment of clinically localized renal tumors. RAPN resulted in optimal outcomes in the majority of individuals despite tumor complexity. [ABSTRACT FROM AUTHOR]

Abundance is a key parameter for characterizing animal populations of conservation concern. In sea turtles, annual clutch counts represent the most common population index. When the number of annual nesting females (ANF) is sought, clutch frequency (CF; average number of clutches laid per female) is used as a conversion factor. Here we assess the performance of five current methods for estimating ANF and of two new methods based on the interdependence of nesting activity parameters, investigated through a Monte Carlo approach with generalized additive models. All methods were evaluated on virtual populations and on a unique case of empirical data from a sea turtle population with a known ANF based on genetic identification of clutches (Caretta caretta , Northern Recovery Unit, USA). Results show that current methods produce errors often greater than the simple count of nesting females directly encountered, except for a capture-mark-recapture (CMR) model. One of the new methods takes advantage of both nest count and CMR data and shows the best performance at a wide range of detection probabilities. The second new method is based on nest count data only and can provide at least an approximate estimate of ANF where no CMR data are available. Our findings can dramatically improve sea turtle population abundance estimates worldwide. We recommend abandoning the use of any CF estimate as a direct conversion factor in favor of implementing the CMR model and the new methods to improve current estimates and to provide estimates where limited data have prevented doing so previously. • Current methods produce highly biased estimates of sea turtle population abundance. • Correlation among sea turtle nesting parameters can be exploited to improve methods. • A new robust method that overcomes current limitations is provided. • A second method can even estimate abundance where current methods cannot. [ABSTRACT FROM AUTHOR]

Ten adult male loggerhead sea turtles, captured by trawlers or dip nets, were satellite-tracked from a neritic foraging ground in the Mediterranean in order to investigate adult spatio-temporal distribution and breeding migration. Five individuals migrated to potential breeding sites in Libya and one to Greece. The results complement previous studies and show that: (1) the Tunisian shelf may be more important for turtles from Libyan rookeries than previously thought; (2) male tracks corroborate a conservation hotspot previously identified for juveniles; (3) the north African coast represents a preferred migratory corridor, unless open sea routes are more direct; (4) adult males may exhibit high fidelity to relatively small areas, without evident seasonal differences; (5) adults home ranges were smaller and more neritic than juveniles frequenting the same area; (6) males may frequent multiple courtship areas; (7) the average remigration interval of males frequenting this region is longer than 1 year. [ABSTRACT FROM AUTHOR]

Information on sea turtle population trends is fundamental to assess the population status and the effects of conservation measures, and is considered a priority for sea turtle conservation. To provide insights on trends at sea, we compared by-catch data from long-liners fishing in the Gulf of Taranto in 2 periods: 1978-1979 and 1998-2003. A total of 653 loggerhead sea turtles (Caretta caretta) were captured in 2679 fishing sets targeting swordfish and albacore tuna; catch rates were significantly higher in the second period, while average turtle size was smaller. Although possible effects of sampling techniques cannot be excluded, a negative trend in the number of turtles in the study area and period was unlikely. [ABSTRACT FROM AUTHOR]

Knowledge about migratory routes and highly frequented areas is a priority for sea turtle conservation, but the movement patterns of juveniles frequenting the Adriatic have not been investigated yet, although juveniles represent the bulk of populations. We tracked by satellite six juvenile and one adult female loggerhead from the north Adriatic. The results indicated that loggerhead juveniles (1) can either show a residential behaviour remaining in the Adriatic throughout the year or perform seasonal migrations to other areas, (2) can remain even in the coldest, northernmost area during winter, (3) can frequent relatively small foraging areas, (4) mostly frequent the eastern part of the Adriatic, and (5) follow preferred migratory routes along the western and eastern Adriatic coasts. The movements of the adult turtle also revealed (6) a behavioural polymorphism in Mediterranean adults, which included a lack of area fidelity and connection between distant neritic foraging grounds. [ABSTRACT FROM AUTHOR]

We report seven nesting events by loggerhead sea turtles in Sicily (Italy) in 2011. In comparison to past records, this number is relatively high and may be at least in part due to an awareness campaign carried out in 2011 to solicit such reports. This suggests that Sicily may host a much higher nesting activity than previously thought and higher monitoring effort is recommended, especially in certain coastal tracts. Sand temperatures and incubation periods indicate that the beaches monitored so far in the southern coast are not optimal for development, resulting in low hatching success, and produce a majority of males. Five 2011 nests and two past nests from the same area had mtDNA haplotype CC-A2.1, the most common in the Mediterranean. [ABSTRACT FROM AUTHOR]

The Adriatic Sea is an important foraging area for the loggerhead sea turtle, Caretta caretta, but neritic habitats for this species along the Italian coast were identified in the northern shallow area only. The Gulf of Manfredonia is a relatively wide shallow area in the south-west Adriatic and its features and preliminary information make it a potential foraging ground for turtles. In order to assess sea turtle occurrence in the area, we monitored seven bottom trawlers based in the port of Manfredonia during the period Oct 2010 Jul 2011 through a voluntary logbook programme, resulting in a total of 62 turtle captures during 617 fishing days. Since a turtle capture represents a rare event during such sampling, data were analysed by a zero-inflated Poisson (ZIP) model. Results indicate that: (i) the Gulf is a neritic foraging ground for loggerhead turtles which occur there with a relatively high density comparable to other Mediterranean foraging grounds, (ii) it is frequented by a wide range of size classes, including small juveniles as well as adults, (iii) the highest occurrence is during the period Jun-Dec, (iv) over 1700 turtle captures occur in the Gulf annually. Preliminary findings about recaptured individuals suggest that part of the turtles are resident in the area. The peculiar features of the Gulf of Manfredonia and the collaboration of the fishing fleet, make it a valuable index site for studying current trends of sea turtle populations at sea as well as other aspects of sea turtle biology and conservation. [ABSTRACT FROM AUTHOR]

Sea turtle by-catch data in the Mediterranean were reviewed and analysed with fishing effort. The results indicate over 132 000 captures per year, with probably over 44 000 incidental deaths per year, while many others are killed intentionally. Small vessels using set net, demersal longline or pelagic longline represent most of the Mediterranean fleet and likely cause more incidental or intentional deaths than large vessels typically using bottom trawl or pelagic longline. When interactions, mortality, intentional killing, size (a proxy for reproductive value) and turtle populations are considered, results indicate that Mediterranean green ( Chelonia mydas) and loggerhead turtles ( Caretta caretta) are more affected (i) by fishing gears such as bottom trawlers, demersal longlines and set nets, (ii) by small-scale fisheries, and (iii) by fishing in the eastern basin. Although small-scale fisheries should be the priority target, available measures are easier to implement on the fewer large vessels. Moreover, these measures are few, and they are not implemented yet, while others should still be tested for the Mediterranean fisheries. Thus, measures for reducing captures or mortality through changing gear-specific characteristics may help, but probably a more holistic conservation strategy aimed to an ecosystem-based fishery management for a sustainable fishing would be the only solution for the long-term survival of Mediterranean Sea turtle populations and their habitats. Small-scale fisheries should manage marine resources, including turtles, in a responsible and sustainable way. Turtles may not only benefit from but can also help this process if their non-consumptive value is fully recognized. [ABSTRACT FROM AUTHOR]

Turtle trade in the fish markets of Alexandria was reported up to the late 1990s, motivating conservation initiatives and enforcement of legal protection. To assess the current trade and bycatch levels in Alexandria and other ports we carried out an interview survey of 445 people in 2007, mostly fishermen and fishmongers, in 15 coastal cities and fishing ports along the Mediterranean coast of Egypt. The declared catch rates and official fishing fleet statistics suggest that captures of loggerhead Caretta caretta and green turtles Chelonia mydas are in the order of several thousands per year, possibly > 7,000 per year, mainly from trawling, longlining and set nets. Probably several hundred turtles die each year as a consequence of the high mortality rates typical of these fishing gears. In addition, most fishermen from Alexandria and some fishermen from other regions declared that they kill turtles for meat. Regulations and enforcement appear to be ineffective, as turtles are usually killed and consumed on board or only their meat is landed. Some turtles are still traded on the black market in some Alexandria fish markets. The overall mortality probably represents an unsustainable toll on the Mediterranean loggerhead and green turtle populations, and the perception of fishermen is that turtle numbers are declining. Mitigating the identified threats is thus urgent. In particular, intentional killing should be tackled through its cultural drivers, and measures to reduce bycatch mortality need to be tested and implemented. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the growth rates and age at size of loggerhead turtles, Caretta caretta, in the Mediterranean Sea, through length frequency data. For practical reasons, hatchling size is commonly measured as straight and not curved carapace length and although a curved measurement is by definition longer than a straight one, in hatchlings the difference is minimal. Size distribution showed four evident modes as growth rates decrease with increasing size, ranging from 11.8 centimeters (cm)/year in the first six months of life to 3.6 cm/year at the age of 2.5-3.5 years.

Sea turtle tagging carried out in Italy in the period 1981–2006 resulted in 125 re-encounters of loggerhead turtles ( Caretta caretta) after a mean of 2.5 years, from different marine areas in the Mediterranean. At first finding, turtles ranged 25–83 cm of curved carapace length. Data were analyzed according to size, area, habitat type, season, in order to provide indication of movement patterns. When integrated with other information, results indicate that: (1) a part of turtles in the oceanic stage show a nomad behavior with movements among different oceanic areas; (2) another part show fidelity to an oceanic area; (3) turtles in the neritic stage show fidelity to neritic areas, and once settled to one area, change to other neritic areas is unlikely; (4) nomad oceanic turtles are significantly larger than sedentary ones, and also larger than turtles found in neritic areas; it is hypothesized that these could be Atlantic turtles that eventually leave the Mediterranean; (5) ecological transition from oceanic to neritic habitats occurs at a wide range of sizes, and some turtles may have a very brief oceanic stage; (6) turtles in the oceanic stage are more likely to recruit to neritic areas close to their oceanic areas than to distant ones; (7) part of turtles from some Mediterranean nesting beaches might frequent a relatively limited area range, including both oceanic and neritic areas; (8) in most of the Mediterranean, latitudinal seasonal migrations are unlikely. A general model of movement patterns of loggerhead turtles in the Mediterranean is proposed. [ABSTRACT FROM AUTHOR]

In the north Adriatic Sea on-board observations on midwater and bottom trawlers were carried out during years 1999 and 2000. Results indicate that the north Adriatic Sea, and especially the north–east part, is a very important foraging and overwintering habitat for loggerhead turtles (Caretta caretta). Since the distribution of fishing effort in the area is not known, the total turtle catch by the Italian bottom trawl fleet was conservatively estimated from the lower catch rate observed in the south–west sub-area: 4273 turtle captures/year (95% C.I.=2186–8546). The actual total catch in the whole north Adriatic is likely to be much higher, due both to an unknown Italian trawling effort in the south–west part with multi-gear vessels and to the Italian and Croatian trawling efforts in the north–east part, where catch rate was 15 times greater than in the south–west part. In the south–west sub-area 9.4% of captured turtles were dead and potential mortality (assuming that all comatose turtles would die too) was 43.8%. Hence, trawling in the north Adriatic is likely to represent a serious threat to the populations, and possible conservation measures are discussed. [Copyright &y& Elsevier]

Objective: To separate hormone-dependent from hormonally relapsed prostate cancers, a D3 category has been proposed. The term has become synonymous with a hormone-refractory state with the implication that any further hormonal treatment would not be beneficial. In this review we examine some data on androgen receptor expression, anti-androgen withdrawal syndrome and intermittent androgen deprivation (IAD) in patients with advanced prostate cancer. Materials: The literature on the mechanism of the withdrawal phenomenon in patients with prostate cancer submitted to hormone therapy was reviewed. Experimental and clinical data are reported. Results: The progression of prostate cancer in patients treated with combined androgen blockade (CAB) is associated with the activation of previously androgen-repressed genes, some of which may code for autocrine and paracrine growth factors that substitute for androgens in maintaining the viability of the tumorigenic stem cells. If androgens are replaced before progression begins, the surviving stem cells should give rise to an androgen-dependent tumor, which would be amenable to retreatment by CAB. This theory provides the rationale for intermittent androgen deprivation. We suggest that IAD could be more effective in patients with initial prostate-specific antigen (PSA) progression after radical prostatectomy. Conclusions: Response to withdrawal therapies or second-line treatments is an example of a “hormonal” therapy that may benefit a proportion of patients with hormone-refractory disease, suggesting that the tumor is still androgen-dependent. Whether IAD enhances progression-free survival or overall survival must be verified in randomized clinical trials. Until further studies have been completed, the therapeutic concept of IAD should be treated as experimental. [ABSTRACT FROM AUTHOR]

• Importance of PIT tags for gaining accurate estimates of life-history traits and population parameters for sea turtles. • Excluding PIT tags led to underestimation of reproductive periodicity, reproductive longevity and annual survival. • Female abundance and recruitment to the nesting population were overestimated in the absence of PIT tags. • Flipper tag loss underestimated by a factor of two without the use of PIT tags at Alagadi Beach. Capture-mark-recapture studies rely on the identification of individuals through time, using markers or tags, which are assumed to be retained. This assumption, however, may be violated, having implications for population models. In sea turtles, individual identification is typically based on external flipper tags, which can be combined with internal passive integrated transponder (PIT) tags. Despite the extensive use of flipper tags, few studies have modelled tag loss using continuous functions. Using a 26-year dataset for sympatrically nesting green (Chelonia mydas) and loggerhead (Caretta caretta) turtles, this study aims to assess how PIT tag use increases the accuracy of estimates of life-history traits. The addition of PIT tags improved female identification: between 2000 and 2017, 53% of green turtles and 29% of loggerhead turtles were identified from PIT tags alone. We found flipper and PIT tag losses were best described by decreasing logistic curves with lower asymptotes. Excluding PIT tags from our dataset led to underestimation of flipper tag loss, reproductive periodicity, reproductive longevity and annual survival, and overestimation of female abundance and recruitment for both species. This shows the importance of PIT tags in improving the accuracy of estimates of life-history traits. Thus, estimates where tag loss has not been corrected for should be interpreted with caution and could bias IUCN Red List assessments. As such, long-term population monitoring programmes should aim to estimate tag loss and assess the impact of loss on life-history estimates, to provide robust estimates without which population models and stock assessments cannot be derived accurately. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To develop performance metrics that objectively define a reference approach to a transurethral resection of bladder tumours (TURBT) procedure, seek consensus on the performance metrics from a group of international experts.The characterisation of a reference approach to a TURBT procedure was performed by identifying phases and explicitly defined procedure events (i.e., steps, errors, and critical errors). An international panel of experienced urologists (i.e., Delphi panel) was then assembled to scrutinise the metrics using a modified Delphi process. Based on the panel's feedback, the proposed metrics could be edited, supplemented, or deleted. A voting process was conducted to establish the consensus level on the metrics. Consensus was defined as the panel majority (i.e., >80%) agreeing that the metric definitions were accurate and acceptable. The number of metric units before and after the Delphi meeting were presented.A core metrics group (i.e., characterisation group) deconstructed the TURBT procedure. The reference case was identified as an elective TURBT on a male patient, diagnosed after full diagnostic evaluation with three or fewer bladder tumours of ≤3 cm. The characterisation group identified six procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The metrics were presented to the Delphi panel which included 15 experts from six countries. After the Delphi, six procedure phases, 63 procedure steps, 47 errors, and 41 critical errors were identified. The Delphi panel achieved a 100% consensus.Performance metrics to characterise a reference approach to TURBT were developed and an international panel of experts reached 100% consensus on them. This consensus supports their face and content validity. The metrics can now be used for a proficiency‐based progression training curriculum for TURBT. [ABSTRACT FROM AUTHOR]

A preliminary study published in BJU International explores the potential link between vitamin D levels in urine analysis and the risk of developing urinary tract infections (UTIs) and sepsis. The study analyzed urine samples from 121 subjects and found a significant difference in vitamin D levels between individuals with positive and negative urine analyses, with higher levels detected in the latter group. The study suggests that low urine vitamin D levels may be associated with an increased risk of UTIs. Further research is needed to validate these findings and determine the utility of assessing vitamin D levels in urine as a biomarker for UTI risk. [Extracted from the article]

Purpose: To evaluate the feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation (TPLA) as a new minimally invasive surgical therapy (MIST) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and methods: Under local anesthesia and conscious sedation up to two laser fibers for each prostatic lobe were inserted under US-guidance by a percutaneous approach. TPLA was performed using a continuous wave diode laser (SoracteLite-EchoLaserX4) able to generate a light-induced thermal heating and subsequent coagulative necrosis of the prostatic tissue. Patients were evaluated at 3, 6, and 12 months after TPLA. Results: Twenty-two consecutive patients were prospectively enrolled (median age 61.9 years). All procedures were well tolerated and no procedural complications were recorded. Median catheterization time was 7 days, while the median hospitalization time was 1 day. Three out of twenty-two patients (13.6%) experienced acute urinary retention and two (9.1%) of them urinary tract infection requiring major antibiotic treatment. At 3, 6, and 12 months, median prostate volume significantly decreased by a − 21.3%, − 29%, and − 41%, respectively. At the same time point, median IPSS was 8 (− 63.6%), 5 (− 74%), and 6 (− 75%), while median QoL score was 1 in all the scheduled timepoints of follow-up. The median postoperative Qmax at 3, 6, and 12 months improved by + 57.8%, + 98%, and + 115.8%, respectively. Ejaculatory function was preserved in 21 out of 22 patients (95.5%). Conclusions: TPLA of the prostate appears to be a promising MIST for BPH. Long-term results and comparative studies against standard treatments are warranted before implementations of this technique in the urologist's armamentarium. [ABSTRACT FROM AUTHOR]

Range of occurrence and abundance is a fundamental information that describes an animal population and is particularly important for species of conservation concern such as sea turtles. Although sea turtles lay clutches on land, which helps identifying breeding aggregations, the current knowledge on the distribution of these animals is far from being complete. Traditional ground surveys and more recent aerial surveys bear limitations due to logistic constraints, cost and safety concerns. We tested a novel approach based on high-resolution satellite imagery on a 12-km tract along the Atlantic coast of Florida (USA) by comparing counts from a satellite image with counts from traditional ground surveys. Daily track counts were underestimated in zones with higher human presence, probably due to tracks deleted or confounded by human activity, and overestimated in zones with lower human presence, probably due to persistence of old tracks. Results show that satellite surveys can provide the order of magnitude of nesting level in relatively undeveloped or low-frequented coastal tracts, which represent the main objective of any preliminary survey on sea turtle occurrence. Satellite imagery represents a new complementary tool available to conservationists for filling gaps about sea turtle occurrence, especially in remote or unsafe areas. [ABSTRACT FROM AUTHOR]

Understanding natural movement patterns and ecological roles of marine megafauna is a research priority best studied in areas with minimal human impact. The spatial distribution patterns specifically for immature turtles at foraging grounds have been highlighted as a research gap for effective management and conservation strategies for sea turtle populations. Capture–mark–recapture (CMR) records (n = 2287) of 1672 immature green (Chelonia mydas) (n = 1158) and hawksbill turtles (Eretmochelys imbricata) (n = 514) from a long-term (1981–2021) in-water CMR program at Aldabra Atoll, Seychelles, were analyzed for 10 sites (0.35–25 km apart). Site fidelity was not correlated with either season or turtle size. Green turtles had lower site fidelity than hawksbill turtles. Green turtles showed avoidance (i.e., opposite of fidelity) of three sites, while hawksbill turtles displayed high fidelity to two sites. Sites displaying non-random behavior (avoidance and/or fidelity) did not share the same benthic habitat types. Results indicate that fidelity can be detected at a fine scale with CMR, but that further exploration into the habitat characteristics of the sites and the ecological roles of both species at the atoll is needed. [ABSTRACT FROM AUTHOR]

Background: The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. Methods: A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). Results: In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15–37.8; p = 0.035). Conclusions: mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted. [ABSTRACT FROM AUTHOR]

Migration is one of several marine vertebrate traits increasingly affected by human encroachment. The Adriatic Sea is an important foraging and wintering site for loggerhead turtles (Caretta caretta), and one of the Mediterranean regions where they are most heavily impacted, particularly by fisheries bycatch. Conservation measures concern foraging and wintering areas and nesting grounds, and must, therefore, be informed by the natal origin of individuals in these mixed aggregates. Genetic diversity was investigated among 488 loggerheads found stranded or incidentally captured in fishing gear across the Adriatic and the origin of individuals was assessed through mixed-stock analysis based on comparison of 755 bp of mitochondrial DNA control region sequence. In addition, we highlight the importance of the Gulf of Manfredonia (Apulia, Italy), and of the northeastern Adriatic—a previously genetically undescribed foraging ground. No significant genetic divergence was recorded among sampling areas, between turtles sampled in cold and warm months or between adults and juveniles. The distribution of turtles across the Adriatic Sea appeared not to depend on individual origin. Rookeries in western Greece and Crete provided the most important contributions to the Adriatic mixed stock. In particular, the Greek populations were the most abundant locally in the Gulf of Manfredonia, so they are likely to experience an even greater impact than previously thought because of the severe fishery bycatch levels in this area. This study also provides an example of how substantial increases in sample sizes permit a relatively comprehensive testing of genetic structure across groupings in foraging aggregations. [ABSTRACT FROM AUTHOR]

This article discusses the treatment of low-grade non-muscle-invasive bladder cancer (NMIBC) and the potential for deintensifying treatment to avoid overtreatment while maintaining oncological safety. The study found that the majority of patients with low-grade NMIBC do not experience progression to high-grade disease, suggesting the potential for treatment de-intensification. Factors such as age were associated with an increased risk of high-grade recurrence. The study highlights the need for personalized follow-up and management for patients with low-grade NMIBC and suggests the use of less invasive approaches in selected patients. However, the study has limitations due to its retrospective design and limited sample size. Further research is needed to confirm these findings and provide more robust evidence. [Extracted from the article]

Purpose: To assess the diagnostic performance of microultrasound-targeted biopsy (microUSTBx) and systematic biopsy (SBx) in detecting clinically significant prostate cancer (csPCa) among men with abnormal digital rectal examination (DRE) and suspicious lesions at multiparametric magnetic resonance imaging (mpMRI), and to compare the diagnostic performance of this approach with a mpMRI-guided targeted biopsy (MTBx) plus SBx-based strategy. Methods: Biopsy-naïve men with suspicious lesions at mpMRI and abnormal DRE were prospectively evaluated between October 2017 and January 2023. csPCa detection rate by microUSTBx plus SBx and MTBx plus SBx was assessed and then compared by McNemar's test. The added value of prostate-specific antigen density (PSAd) was also evaluated. Results: Overall, 182 biopsy naïve men were included. MicroUSTBx plus SBx achieved comparable detection rate to MTBx plus SBx in diagnosis of ciPCa and csPCa (ciPCa: 9.3% [17/182] vs 10% [19/182]; csPCa: 63% [114/182] vs 62% [113/182]). MicroUSTBx outperformed MTBx (ciPCa: 5.5% [10/182] vs 6.0% [11/182]; csPCa: 57% [103/182] vs 54% [99/182]). Using microUSTBx plus SBx would have avoided 68/182 (37%) unnecessary mpMRI, while missing only 2/116 (1.7%) csPCa. The decision curve analysis of suspicious microUS plus PSAd ≥ 0.15 ng/ml showed higher net benefit in the ability to identify true positives and reduce the number of unnecessary prostate biopsy in this subcategory of patients. Conclusions: The combination of microUSTBx and SBx showed equal diagnostic performance to an mpMRI-based approach in biopsy-naïve patients with an abnormal DRE. The combination of this approach with PSAd maximize the diagnostic accuracy while lowering the need for unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Investigating biological aspects of migratory marine animals like sea turtles is challenging. The Adriatic Sea is a key Mediterranean foraging ground for loggerhead turtles, yet certain feeding behaviors remain poorly known, including winter feeding and foraging within the neritic area of the Gulf of Manfredonia. With high fishing effort, this area experiences considerable turtle bycatch from trawlers during winter, representing an important conservation issue. Insights on how and to what extent the species interacts with anthropogenic threats such as trawlers and debris can be obtained from diet analysis. We examined feces and gut contents from 57 bycaught or stranded turtles to assess active feeding and digestion time during winter, identify and quantify prey items, evaluate feeding patterns among size classes, and ascertain the anthropogenic impact via debris and fishing discard ingestion. Our findings show that turtles feed actively during winter, primarily on benthic items, starting from a small size (32 cm Curved Carapace Length). No size effect was observed on dietary diversity or biomass percentage. We identified 37 Operational Taxonomic Units (OTUs) across 10 dietary groups, with crustaceans and mollusks being most prevalent. Osteichthyes and cephalopods, likely scavenged from trawl discard, were also common, implying intensive local trawling may attract turtles, increasing bycatch and mortality rates. The frequency of anthropogenic material ingestion was comparable to other Mediterranean regions and its presence in feces suggests non-lethal effects, if any. This study shows how information on seasonal feeding behavior can provide insights into how the relationship of the species with the environment and threats changes over time, ultimately steering conservation efforts. [ABSTRACT FROM AUTHOR]

The increasing diffusion of genetic analysis regarding the pathogenetic variants (PVs) of genes involved in DNA Damage Repair (DDR) mechanisms and the development of Poly ADP ribose polymerase (PARP) inhibitors (PARPis) led to the first valid precision medicine option tailored toward metastatic prostate cancer (mPC). The concept of anticipation in the systemic treatment of mPC was initially adopted for androgen receptor signaling inhibitors (ARSIs) to describe the expansion of their indications, from the setting of the late-stage second-line treatment of metastatic castration-resistant prostate cancer (mCRPC) to first-line therapy in selected cases. There is already mounting evidence in favor of the anticipation of PARPis in the first line of mCRPC therapy, and further evidence in favor of mHSPC is emerging. Many studies have demonstrated the synergism between ARSIs and PARP inhibitors. Recent discoveries regarding the crosstalk between the androgen receptor (AR) and DNA repair mechanisms are disconnecting the use of PARPis from genetic analysis. The new message emerging is that the combination of PARPis with ARSIs may work independently of DDR mutational status. As a matter of fact, most of the recent trials analyzing the combination of PARPis with abiraterone or enzalutamide as a first-line therapy enrolled mCRPC patients irrespective of their mutational status. The PROPEL trial concluded that the advantage of the combination was independent of PV status, despite a higher advantage being reported in the BRCA1/2 mutated subgroup. The MAGNITUDE trial, however, showed a significant advantage only in the DDR mutated subgroup, and the DDR non-mutated cohort was closed for further enrollment. The combination of PARPis with ARSIs represents a significant strategy with a view to the anticipation and intensification of care in mPC. However, it should not nullify the advantages of precision medicine linked to the genetic analysis of DDR genes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI)- and microultrasound (microUS)-guided targeted biopsy (TBx) in detecting prostate cancer (PCa) and clinically significant (cs) PCa among men with Prostate Imaging Reporting and Data System (PI-RADS 5) lesions and to compare this combined TBx (CTBx) strategy with CTBx plus systemic biopsy (SBx). Methods: One hundred and thirty-six biopsy-naïve patients with PI-RADS 5 lesion at multiparametric MRI undergoing CTBx plus SBx were retrospectively evaluated. Analysis of diagnostic performance of microUS-TBx, MRI-TBx, CTBx, SBx and combined CTBx plus SBx was performed. Cost (downgrade, upgrade and biopsy core) to effectiveness (detection rate) was compared. Results: CTBx achieved a comparable detection rate to CTBx plus SBx in diagnosis of PCa and csPCa (PCa: 78.7% [107/136] vs 79.4% [108/136]; csPCa: 67.6% [92/136] vs 67.6% [92/136]; p > 0.05) and outperformed SBx (PCa: 58.8% [80/136]; csPCa: 47.8% [65/136]; p < 0.001). Using CTB would have avoided 41.1% (56/136) unnecessary SBx, without missing any csPCa. The rate of any upgrading or csPCa upgrading was significantly higher by SBx than by CTBx [33/65 (50.8%) vs 17/65 (26.1%) and 20/65 (30.8%) vs 4/65 (6.15%), respectively, p < 0.05]. Considering csPCa detection rate, microUS showed high sensitivity and positive predictive value (94.6%, 87.9%, respectively), with lower specificity and negative predictive value (25.0% and 44.4%, respectively). At multivariable logistic regression models, positive microUS was identified as an independent predictor of csPCa (p = 0.024). Conclusions: A combined microUS/MRI-TBx approach could be the ideal imaging tool for characterizing primary disease in PI-RADS five patients, allowing SBx to be avoided. [ABSTRACT FROM AUTHOR]

Background: T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort. Methods: This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system. Results: One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group. Conclusions: Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. Methods: A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle–Ottawa Scale for case control studies. Results: Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72–0.91). Unplanned readmission was recorded in 3% (95% CI 0.02–0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34–0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48–1, p < 0.05) rates compared to standard protocols. Conclusion: We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients. [ABSTRACT FROM AUTHOR]

Simple Summary: There is a growing trend towards exploring the use of non-invasive liquid biopsy (LB) for prostate cancer (PCa) detection. The primary objective of this study is to identify the rate of patients who accepted and were able to collect seminal fluid. The secondary objective was to evaluate the efficiency of our protocol in collecting prostate-derived cells. Our study shows that only one third (139/356) of patients affected by locally advanced PCa, who accepted to collect their seminal fluid, were able to donate. The main favorable predictors for semen collection were young age and lower prostate volume. Putative cancer cells (PSMA + EpCAMhigh) were 2% of the isolated cells in urine and semen. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters. Liquid biopsy (LB) for prostate cancer (PCa) detection could represent an alternative to biopsy. Seminal fluid (SF) is a source of PCa-specific biomarkers, as 40% of ejaculate derives from the prostate. We tested the feasibility of an SF-based LB by evaluating the yield of semen self-sampling in a cohort of >750 patients with clinically localized PCa. The overall SF collection yield was 18.2% (39% when considering only compliant patients), with about a half of the patients (53.15%) not consenting to SF donation. Independent favorable predictors for SF collection were younger age and lower prostate volume. We implemented a protocol to enrich prostate-derived cells by multi-color flow cytometry and applied it on SF and urine samples from 100 patients. The number of prostate-enriched cells (SYTO-16+ PSMA+ CD45−) was variable, with higher numbers of cells isolated from SF than urine (p value < 0.001). Putative cancer cells (EpCAMhigh) were 2% of isolated cells in both specimens. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters, such as Gleason Score, ISUP, or TNM stage. Hence, enumeration of prostate-derived cells is not sufficient to guide PCa diagnosis; additional molecular analyses to detect patient-specific cancer lesions will be needed. [ABSTRACT FROM AUTHOR]

Background: This prospective single-arm study is designed to compare in parallel 68Ga-PSMA PET/TRUS (transrectal or transperineal) fusion biopsy ("experimental test") with multiparametric MRI (mpMRI)/TRUS fusion prostate biopsy ("standard test") in men with a high suspicion of prostate cancer (PCa) after at least one negative biopsy. The primary objective was to evaluate the diagnostic performance of 68Ga-PSMA PET/TRUS fusion prostate biopsy in comparison to mpMRI/TRUS fusion prostate biopsy analyzed in parallel. Secondarily, we aimed to determine the relationship between the "experimental test" and the histopathological characteristics of the specimen, along with the clinical utility of the "experimental test" compared to the "standard test." Summary: To test the superiority of 68Ga-PSMA PET/CT compared to mpMRI, we will enroll a minimum cohort of 128 patients. Inclusion criteria comprise: age >18 years; blood PSA level >4.0 ng/mL; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive blood samples despite antibiotics; serum blood tests suspicious for PCa; at least one previous negative biopsy; ASAP and/or high-grade PIN; negative digital rectal examination. All eligible patients will undergo 68Ga-PSMA PET/CT and mpMRI scans within 1 month's distance from each other, followed by biopsy session to be completed within 1 month's distance. Targeted TRUS fusion needle biopsy will be performed for all lesions detected with PET and mpMRI. The total duration of the study is 36 months.Key Messages: By comparing the "experimental test" and the "standard test" in parallel, we will be able to determine the superior diagnostic performance of 68Ga-PSMA PET/CT over mpMRI in detecting PCa, and in particular clinically significant PCa, in the specific cohort of patients with a high suspicion of PCa who are candidates to re-biopsy. The clinical impact of the "experimental test" will be subsequently analyzed in terms of the number of prostate biopsies that could be spared, time-consuming, patient friendliness, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Changes in marine ecosystems from human stressors, and concerns over how species will respond to these changes have emphasized the importance of understanding and monitoring crucial demographic parameters for population models. Long-lived, migratory, marine vertebrates such as sea turtles are particularly vulnerable to changes. Life-history parameters like growth-in-body size can be largely influenced by environmental processes which can impact population growth. We analyzed a 40-year (1981–2021) capture-mark-recapture dataset from the protected UNESCO World Heritage Site, Aldabra Atoll, Seychelles, to estimate key population parameters, including body growth, for immature green turtles (Chelonia mydas) and hawksbill turtles (Eretmochelys imbricata). Curved carapace length (CCL) range was 34.3–110.9 cm (mean ± SD: 51.0 ± 11.4 cm, n = 1191) for green turtles and 28.7–89.4 cm (47.7 ± 14.4 cm, n = 538) for hawksbill turtles. Recapture events, with an 11-month minimum period, revealed a mean annual growth rate of 3.2 ± 1.5 cm year−1 for green turtles (n = 75) and 2.8 ± 1.4 cm year−1 for hawksbill turtles (n = 110). Hawksbill turtles exhibited a non-monotonic growth rate while no significant growth-size relationship was detected for green turtles. Green turtle mean annual growth per 10-cm size class was highest in the larger size classes (50‒69.9 cm). Hawksbill turtle growth rate was highest in the larger size classes (50‒69.9 cm) then declined in the largest size class (70‒79.9 cm). Green turtles and hawksbill turtles may spend > 8 and 18 years, respectively, using Aldabra, Seychelles, as a foraging ground. [ABSTRACT FROM AUTHOR]

In sea turtles, somatic growth rates and Age at Sexual Maturity (ASM) are important parameters for investigating population dynamics. Moreover, ASM informs on the time lag needed to observe the effects of past environmental variables, threats and conservation measures acting at nesting beaches on future numbers of clutches or nesting females, that are the most monitored indices. Assessing ASM of mixed populations that share the same foraging areas is difficult, as in the case of the Mediterranean Sea that is frequented by turtles originating from both the Mediterranean and the Atlantic. Here we investigated growth rates of loggerhead sea turtles (Caretta caretta) foraging in the Adriatic Sea, known to be frequented only by individuals of Mediterranean origin. Capture–mark–recapture records of 79 turtles provided growth rates ranging from – 1.1 to 9.6 cm yr−1 which were analyzed through Generalized Additive Models. When integrated with previous data on growth rates in the first years of life, results indicate a non-monotonic growth curve, likely due to an ontogenetic shift from oceanic to neritic areas. Using an integration equation, we estimated mean ASM to be 29.5 or 25.0 year based on mean nester size in Greece (83.4 cm curved carapace length, CCL) or across the Mediterranean (79.7 cm CCL), respectively. Growth rates and size-at-age are similar to the Atlantic population, but Mediterranean turtles mature earlier at a smaller size. The heterogenous growth rates and ASM reported so far in the Mediterranean are probably due, at least in part, to different foraging areas. [ABSTRACT FROM AUTHOR]

Assessing sea turtle movements and connectivity among different areas is pivotal to understanding their biology and implementing efficient conservation actions. In the Adriatic Sea, one of the most important sea turtle foraging areas in the Mediterranean, a total of 311 capture–mark–recapture (CMR) records (mostly bycatch) from 294 loggerhead turtles (Caretta caretta) in the period 1984–2021 were analysed. A general fidelity pattern to Adriatic subareas was indicated by a significantly shorter CMR distance than the potential dispersal distance and by the significantly higher proportion of re-encounters in the same area of release than expected. No seasonal pattern was detected between subareas, and shorter re-encounter distances were observed in turtles released and re-encountered in the same season, suggesting different winter and summer residential areas. Results suggest that turtles frequenting the Adriatic can go anywhere in the Mediterranean basin and may exhibit a wandering behaviour regardless of their size. A substantial connectivity with nesting sites in Greece was observed, confirming with empirical evidence that this is the most important breeding area for turtles foraging in the Adriatic Sea. This study highlights the value of cooperation among different groups and shows a main behavioural pattern of fidelity to neritic foraging grounds. [ABSTRACT FROM AUTHOR]

Simple Summary: The transurethral resection of bladder tumors followed by intravesical Bacillus Calmette-Guerin (BCG) instillations represents the standard treatment for high-risk and selected intermediate-risk non-muscle invasive bladder cancer (NMIBC) patients. We hypothesized that intravesical BCG might be protective against symptomatic SARS-CoV-2 infection, especially in those patients who experienced systemic adverse events during BCG treatment. We tested our hypothesis in a large multicenter cohort of NMIBC patients treated with adjuvant intravesical BCG in the year preceding the first and second waves of the SARS-CoV-2 pandemic at two tertiary urological centers in Northern Italy. We aim to evaluate the potential protective role of intravesical Bacillus Calmette-Guerin (BCG) against SARS-CoV-2 in patients with non-muscle invasive bladder cancer (NMIBC). Patients treated with intravesical adjuvant therapy for NMIBC between January 2018 and December 2019 at two Italian referral centers were divided into two groups based on the received intravesical treatment regimen (BCG vs. chemotherapy). The study's primary endpoint was evaluating SARS-CoV-2 disease incidence and severity among patients treated with intravesical BCG compared to the control group. The study's secondary endpoint was the evaluation of SARS-CoV-2 infection (estimated with serology testing) in the study groups. Overall, 340 patients treated with BCG and 166 treated with intravesical chemotherapy were included in the study. Among patients treated with BCG, 165 (49%) experienced BCG-related adverse events, and serious adverse events occurred in 33 (10%) patients. Receiving BCG or experiencing systemic BCG-related adverse events were not associated with symptomatic proven SARS-CoV-2 infection (p = 0.9) nor with a positive serology test (p = 0.5). The main limitations are related to the retrospective nature of the study. In this multicenter observational trial, a protective role of intravesical BCG against SARS-CoV-2 could not be demonstrated. These results may be used for decision-making regarding ongoing and future trials. [ABSTRACT FROM AUTHOR]

Simple Summary: National cancer registry data showed that segmental ureterectomy is not associated with inferior survival compared to radical nephroureterectomy in upper-tract urothelial carcinoma patients. Segmental ureterectomy provides a valid surgical approach that does not meaningfully sacrifice survival outcomes within appropriately selected patients of upper urothelial carcinoma of the ureter. Given the potential renal functional preservation benefits, segmental ureterectomy should be considered for selected patients, especially if there is an increased probability of requiring adjuvant chemotherapy. Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004–2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan–Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75–0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30–0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67–0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00–1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93–1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients. [ABSTRACT FROM AUTHOR]

Assessing sea turtle movements and connectivity among different areas is pivotal to understanding their biology and implementing efficient conservation actions. In the Adriatic Sea, one of the most important sea turtle foraging areas in the Mediterranean, a total of 311 capture–mark–recapture (CMR) records (mostly bycatch) from 294 loggerhead turtles (Caretta caretta) in the period 1984–2021 were analysed. A general fidelity pattern to Adriatic subareas was indicated by a significantly shorter CMR distance than the potential dispersal distance and by the significantly higher proportion of re-encounters in the same area of release than expected. No seasonal pattern was detected between subareas, and shorter re-encounter distances were observed in turtles released and re-encountered in the same season, suggesting different winter and summer residential areas. Results suggest that turtles frequenting the Adriatic can go anywhere in the Mediterranean basin and may exhibit a wandering behaviour regardless of their size. A substantial connectivity with nesting sites in Greece was observed, confirming with empirical evidence that this is the most important breeding area for turtles foraging in the Adriatic Sea. This study highlights the value of cooperation among different groups and shows a main behavioural pattern of fidelity to neritic foraging grounds. [ABSTRACT FROM AUTHOR]

Herein, we analyze answers achieved, open questions, and future perspectives regarding the analysis of the pathogenetic variants (PV) of DNA damage response (and repair) (DDR) genes in prostate cancer (PC) patients. The incidence of PVs in homologous recombination repair (HRR) genes among men with metastatic PC varied between 11% and 33%, which was significantly higher than that in non-metastatic PC, and BRCA2 mutations were more frequent when compared to other DDR genes. The determination of the somatic or germline PVs of BRCA2 was able to define a tailored therapy using PARP inhibitors in metastatic castration-resistant prostate cancer (mCRPC) progression after first-line therapy, with significant improvements in the radiologic progression-free survival (rPFS) and overall survival (OS) rates. We propose testing all metastatic PC patients for somatic and germline HRR mutations. Somatic determination on the primary site or on historic paraffin preparations with a temporal distance of no longer than 5 years should be preferred over metastatic site biopsies. The prognostic use of DDR PVs will also be used in selected high-risk cases with non-metastatic stages to better arrange controls and therapeutic primary options. We anticipate that the use of poly-ADP-ribose polymerase (PARP) inhibitors in hormone-sensitive prostate cancer (HSPC) and in combination with androgen receptor signaling inhibitors (ARSI) will be new strategies. [ABSTRACT FROM AUTHOR]

Purpose: To prospectively evaluate the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) diagnostic and prognostic predictive value in a stratified population of prostate cancer (PC) cases. Methods: Population was divided based on the clinical and histologic diagnosis in: Group A: benign prostatic hyperplasia (BPH) cases (494 cases); Group B: all PC cases (525 cases); Group B1: clinically significant PC (426 cases); Group B2: non-metastatic PC (416 cases); Group B3: metastatic PC (109 cases). NLR, PLR, and AGR were obtained at the time of the diagnosis, and only in cases with PC considered for radical prostatectomy, determinations were also repeated 90 days after surgery. For each ratio, cut-off values were determined by receiver operating characteristics curve (ROC) analysis and fixed at 2.5, 120.0, and 1.4, respectively, for NLR, PLR, and AGR. Results: Accuracy in predictive value for an initial diagnosis of clinically significant PC (csPC) was higher using PLR (0.718) when compared to NLR (0.220) and AGR (0.247), but, despite high sensitivity (0.849), very low specificity (0.256) was present. The risk of csPC significantly increased only according to PLR with an OR = 1.646. The percentage of cases with metastatic PC significantly increased according to high NLR and high PLR. Accuracy was 0.916 and 0.813, respectively, for NLR and PLR cut-off, with higher specificity than sensitivity. The risk of a metastatic disease increased 3.2 times for an NLR > 2.5 and 5.2 times for a PLR > 120 and at the multivariate analysis. Conclusion: PLR and NLR have a significant predictive value towards the development of metastatic disease but not in relation to variations in aggressiveness or T staging inside the non-metastatic PC. Our results suggest an unlikely introduction of these analyses into clinical practice in support of validated PC risk predictors. [ABSTRACT FROM AUTHOR]

Purpose: To define predictors of malignancy after Testis sparing surgery (TSS) in patients referring to a fertility center with incidental small testicular lesions. Sub analyses were performed to assess predictors of Leydig cell hyperplasia and Leydig cell tumor.Materials and Methods: We performed a retrospective analysis of a single institutional database including patients treated with TSS between 2002 and 2020. All patients who underwent TSS as a first line surgical approach for incidentally detected lesions found during fertility evaluation were included.Results: Data of 64 patients were collected. The median follow up was 58 months and no recurrences were observed. At univariable logistic regression multifocal lesions, hypervascularization, microlithiasis, age and lesion size were significantly associated with malignancy. At multivariable logistic regression lesion dimension, hypervascularization and multifocal lesions were predictors of malignancy. Lesions smaller than 5 mm proved to be benign in 96.6% of the cases (32/33). Intraoperative color of the lesion and US pattern of vascularization were predictors at multivariable logistic regression for Leydig cell hyperplasia and Leydig cell tumor.Conclusion: Ultrasonographic characteristics and intraoperative appearance of the lesion can predict the malignant nature of small testicular lesions, guiding their surgical management in patients referring to a fertility center. Based on our experience, clinicians may safely perform TSS in carefully selected patients. [ABSTRACT FROM AUTHOR]

Abbreviations AS active surveillance BIAS Bladder Cancer Italian Active Surveillance Register DI delayed intervention HG high grade IQR interquartile range LG low grade LMR lymphocyte-to-monocyte ratio (N)MIBC (non-) muscle-invasive bladder cancer NLR neutrophil-to-lymphocyte ratio PLR platelets-to-lymphocyte ratio T2DM Type 2 diabetes mellitus TURBT transurethral resection of bladder tumour Approximately 75% of newly diagnosed bladder cancer are non-muscle-invasive bladder cancers (NMIBCs), and 50% of them are low-risk diseases [[1]]. Similarly, Type 2 diabetes mellitus (T2DM) was found to be associated with a higher risk of recurrence and progression in patients with T1 high-grade (HG) bladder cancer compared to those without T2DM [[5]]. Long-term follow-up and factors associated with active surveillance failure for patients with non-muscle-invasive bladder cancer: the bladder cancer Italian active surveillance (BIAS) experience. [Extracted from the article]

This article examines the relationship between inflammatory markers and Type 2 diabetes mellitus (T2DM) in predicting disease recurrence and progression in patients with low-risk non-muscle-invasive bladder cancer (NMIBC). The study found that these markers and T2DM were not predictive of disease recurrence or progression in low-risk NMIBC. The article also includes a table with clinical, demographic, and histopathological characteristics of the study population, which can be used to analyze predictors of disease recurrence and progression in patients with low-risk NMIBC. [Extracted from the article]

The aim of our meta-analysis is to analyze data available in the literature regarding a possible prognostic value of the albumin to globulin ratio (AGR) in prostate cancer (PC) patients. We distinguished our analysis in terms of PC staging, histologic aggressiveness, and risk of progression after treatments. A literature search process was performed ("prostatic cancer", "albumin", "globulin", "albumin to globulin ratio") following the PRISMA guidelines. In our meta-analysis, the pooled Event Rate (ER) estimate for each group of interest was calculated using a random effect model. Cases were distinguished in Low and High AGR groups based on an optimal cut-off value defined at ROC analysis. Four clinical trials were enclosed (sample size range from 214 to 6041 cases). The pooled Risk Difference for a non-organ confined PC between High AGR and Low AGR cases was −0.05 (95%CI: −0.12–0.01) with a very low rate of heterogeneity (I2 < 0.15%; p = 0.43) among studies (test of group differences p = 0.21). In non-metastatic PC cases, the pooled Risk Difference for biochemical progression (BCP) between High AGR and Low AGR cases was −0.05 (95%CI: −0.12–0.01) (I2 = 0.01%; p = 0.69) (test of group differences p = 0.12). In metastatic PC cases, AGR showed an independent significant (p < 0.01) predictive value either in terms of progression free survival (PFS) (Odds Ratio (OR): 0.642 (0.430–0.957)) or cancer specific survival (CSS) (OR: 0.412 (0.259–0.654)). Our meta-analysis showed homogeneous results supporting no significant predictive values for AGR in terms of staging, grading and biochemical progression in non-metastatic PC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy of a new electronic nose to recognize prostate cancer in urine samples. Methods: A blind, prospective study on consecutive patients was designed. Overall, 174 subjects were included in the study: 88 (50.6%) in prostate cancer group, and 86 (49.4%) in control group. Electronic nose performance for prostate cancer was assessed using sensitivity and specificity. The diagnostic accuracy of electronic nose was reported as area under the receiver operating characteristic curve. Results: The electronic nose in the study population reached a sensitivity 85.2% (95% confidence interval 76.1–91.9; 13 false negatives out of 88), a specificity 79.1% (95% confidence interval 69.0–87.1; 18 false positives out of 86). The accuracy of the electronic nose represented as area under the receiver operating characteristic curve 0.821 (95% confidence interval 0.764–0.879). Conclusions: The diagnostic accuracy of electronic nose for recognizing prostate cancer in urine samples is high, promising and susceptible to supplemental improvement. Additionally, further studies will be necessary to design a clinical trial to validate electronic nose application in diagnostic prostate cancer nomograms. [ABSTRACT FROM AUTHOR]