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The present study investigated the longitudinal associations of self-control and parental involvement with prosociality and internalizing problems from early to mid-to-late adolescence, within a risk and resilience and a developmental cascade framework. We used a panel design (i.e., four measurement times at 2-year intervals from 2008 onwards) to examine data on 1523 Swiss adolescents when they were aged about 11, 13, 15, and 17. A cross-lagged analytical approach was used to respond to our purpose. Results showed that parental involvement promotes later levels of prosociality from early to mid-to-late adolescence. Furthermore, we observed that parental involvement predicted later improvements in self-control and that prosociality and internalizing problems mutually and positively predicted each other during the same period. Our findings suggest that interventions aimed at promoting positive parental involvement with their offspring may contribute to later adolescent prosociality and self-control and that health professionals should consider encouraging a healthy balance between self-interest and concern for others. [ABSTRACT FROM AUTHOR]

Electron backscatter diffraction (EBSD) is a powerful tool for determining the orientations of near-surface grains in engineering materials. However, many ceramics present challenges for routine EBSD data collection and indexing due to small grain sizes, high crack densities, beam and charge sensitivities, low crystal symmetries, and pseudo-symmetric pattern variants. Micro-cracked monoclinic hafnia, tetragonal hafnon, and hafnia/hafnon composites exhibit all such features, and are used in the present work to show the efficacy of a novel workflow based on a direct detecting EBSD sensor and a state-of-the-art pattern indexing approach. At 5 and 10 keV primary beam energies (where beam-induced damage and surface charge accumulation are minimal), the direct electron detector produces superior diffraction patterns with 10x lower doses compared to a phosphor-coupled indirect detector. Further, pseudo-symmetric variant-related indexing errors from a Hough-based approach (which account for at least 4%-14% of map areas) are easily resolved by dictionary indexing. In short, the workflow unlocks fundamentally new opportunities to characterize materials historically unsuited for EBSD. • A novel EBSD workflow allows to characterize low-symmetry, charge-sensitive ceramics. • DED yields superior EBSP quality at low keV compared to traditional detectors. • DED yields high-resolution maps revealing fine microstructural features as twins. • At low keV, dictionary indexing surpasses Hough indexing in orientation accuracy. • Hough indexing errors in hafnia vary with voltage due to pseudo-symmetric variants. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has spread rapidly, forcing some drastic changes not only in our daily lives, but also in our clinical and surgical activities. Given our extensive Italian experience, we hereby describe how our surgical unit activity has changed and how, in some cases, it was necessary to modify surgical strategies. We hope our experience can be shared with our global colleagues who are suffering under similar condition. [ABSTRACT FROM AUTHOR]

A plastic packaging residue provided by a central Italy recycling facility was the subject of study of the present paper. The aim is to propose the valorization of plastic film residue (PFR) through a pyrolysis process. The PFR was thermo-chemically characterized through heating value, proximate and ultimate analysis. Fourier transformed infrared measurements have shown that PFR is constituted by 92–95 mass% of polyethylene (PE) film, around 5 mass% of PP, polystyrene (PS) < 1 mass%, PET < 1 mass% and traces of foreign materials. The extremely high percentage (98.7 mass%) of volatile matter and the low content of ash (2.1 mass%), humidity (0.6 mass%) and chlorine (0.1 mass%) make PFR an optimum candidate as load of a pyrolytic reactor. Thermogravimetry (TG) experiments were carried out at five different heating rates (2, 5, 7, 10, 12 K min−1) to determine the kinetic parameters of pyrolysis (activation energy E, pre-exponential factor A and the reaction model). No significant variation of activation energy, calculated by an integral isoconversional method proposed by Vyazovkin, is observed with increasing the degree of conversion. An average value of 264 ± 5 kJ mol−1 was estimated. Then, the Coats–Redfern method and the compensation effect were used to determine the lnA versus α data (being 41.9 the average value within the 0.25 < α < 0.85 range) and the reaction mechanism (R2 contracting cylinder model). Furthermore, the minimum energy required to pyrolyze 1 kg of PFR, about 2.27 MJ, was estimated by differential scanning calorimetry. It corresponds to about 5.5% of the exploitable energy of the input material. [ABSTRACT FROM AUTHOR]

Single-crystal magnesium micropillars (5 µm diameter) have been fabricated using focused ion beam (FIB) milling and loaded in compression along the [ 2 1 ¯ 1 ¯ 0 ] direction at cryogenic temperature (T = 184 K) at three different strain rates: 10-4, 5 × 10-3 and 10-1 s-1. The stress-strain curves and post-mortem analyses reveal the predominance of { 10 1 ¯ 2 } twinning. The critical stress required for twinning is detected to be significantly higher compared with that previously reported at higher temperatures for the same strain rates. From the experimental data, the temperature dependence of the strain rate sensitivity and activation volume for twinning is unveiled and observed to be constant and linearly dependent with T , respectively. By considering the activation energy (Q) in terms of stress-dependent dislocation motion using the rate equation proposed by Schoeck, for { 10 1 ¯ 2 } twinning, Q is determined to be 174 kJ mol-1 for T < 273 K and 72 kJ mol-1 above. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • The evolution of the twinning mechanism was experimentally investigated from low to high strain rates at the micron-scale. • The competition of twinning dislocations and pyramidal dislocations allows the evolution of the twin boundary along a non-invariant twin plane. • At high strain rates, the prismatic to basal plane conversion resulting in a 90° lattice reorientation governs the entire twin process. • The 3D reconstruction of the twins allows to fully assess the spatial geometry of the twin boundaries. • The boundary lateral to the shear direction of deformation twins was investigated at different strain rates at the micron-scale. We present a systematic investigation of { 10 1 ¯ 2 } extension twinning mechanism in single crystal magnesium micropillars deformed over seven orders of magnitude of strain rate, from 10–4 to 500 s−1, revealing how the accommodation of newly formed twins evolves with and depends on the kinetic compatibility of interfacial processes when high deformation rates are imposed. By combination of post-mortem 3D Electron Backscattered Diffraction, Transmission Kikuchi Diffraction and Transmission Electron Microscopy techniques, this work unveils the progressive evolution of the accommodating twin mechanisms from low to high strain rate, correlating differences in mechanical behavior with differences in twin crystallography. Away from quasi–static conditions, simple considerations of twinning shear do not suffice to describe unconventional twin morphologies, requiring the competition between newly activated dislocations and lattice distortions for allowing the evolution of the twin boundary along non–invariant twin planes. Under shock compressions, the basal/prismatic transformation establishing a lattice misorientation of 90° entirely governs the parent → twin conversion. The results illustrated here confirm that some of the recent interpretations deduced by particular twin morphologies are not universally valid and that deformation twinning is not only stress- but also strongly time–controlled. [ABSTRACT FROM AUTHOR]

Sometimes commercial RBC sets for the screening of irregular antibodies contain Wr(a+) cells. The aim of this study was to define the usefulness of employing RBC sets for the screening of irregular antibodies containing Wr(a+) cells in pre-transfusion tests. Anti-Wr is a relatively common naturally occurring antibody in candidates to blood transfusion, although the risk of receiving a non-compatible unit is low. We have studied both the incidence of Wr antibodies and the effects of having a Wr(a+) cell in the screening test on routine work in an unselected population of 787 patients requiring RBC transfusion and in 151 new blood donors. Irregular antibodies were found in 64 sera, 58 of which were specific for Wr, 46 (5·8%) and 12 (7·9%) in patients and donors, respectively. The positive tested sera contained specific IgM in 16 cases, IgM + IgG in 13 cases and IgG in 27 cases. Anti-Wr can usually be detected during cross-match procedures; therefore, the presence of Wr(a+) cells in pre-transfusion screening of blood recipients is not justified and it causes an undue increase in cost and time to unit release. Moreover, because of the rare association between anti-Wr and haemolytic transfusion reaction, the use of Wr(a+) RBC-containing sets is also questionable in the countries that do not perform pre-transfusion cross-match tests. [ABSTRACT FROM AUTHOR]

An SEM in situ uniaxial tensile testing setup allowing HR-EBSD acquisition during deformation was used to study the extension twinning mechanism in magnesium (Mg) at the micron scale. Structures were fabricated with two different crystal orientations, respectively perfectly aligned with, and at 5° to, the [0001] axis. Limited { 10 1 ¯ 2 } twin formation was identified in the former case, while twinning was found to largely accommodate the plastic deformation in the latter case. These two different mechanisms are explained by the activation of basal slip when loading at 5° to the c-axis, which triggers { 10 1 ¯ 2 } twin nucleation and favors twin growth and propagation. The other orientation shows the activation of pyramidal slip together with only limited { 10 1 ¯ 2 } twin growth. The critical resolved shear stress for { 10 1 ¯ 2 } twinning has been determined to be ten times higher than in bulk material. 3D HR-EBSD mapping enabled reconstruction of the three dimensional twin structure after deformation. From this, the interaction between the dislocations located ahead of the incoming twin and a pre-existing twin boundary was investigated, where the GND distribution and the local shear stress were determined. The results show plastic accommodation up to ~11% of strain, revealing higher ductility than usually reported for bulk materials. Unlabelled Image • In situ HR-EBSD was used to map the sequence of events that occur during micro-tensile loading of single crystal Mg. • Extension twins occur at the micron-scale when loaded off the c-axis, while limited twins form when loaded along the c-axis. • The critical resolved shear stress for { 10 1 ¯ 2 } twinning has been determined to be ten times higher than in bulk material. • Basal slip triggers { 10 1 ¯ 2 } twin nucleation and strongly favors twin growth and propagation. • The 3D structure of the twins was obtained by FIB tomography and HR-EBSD allows associated stress and dislocations analyses. [ABSTRACT FROM AUTHOR]

The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55–69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening. A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening. Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p <0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (p int =0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p =0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p <0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found. Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening. [ABSTRACT FROM AUTHOR]

The proportion of men undergoing expectant management for low-risk prostate cancer increased dramatically from 2010 to 2020. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. The management of prostate cancer (PCa) has evolved from a paradigm of "treat when caught early" to "treat only when necessary". Despite inconsistency in its use, active surveillance has evolved over the past two decades into the gold standard for management of low-risk PCa. Our objective was to investigate whether the use of expectant management (active surveillance, watchful waiting, no treatment) as a first-line approach for low-risk PCa has increased over the past decade. We queried the US National Cancer Data Base for men diagnosed with localized PCa between 2010 and 2020. Two multivariable logistic regression models with different two-way interaction terms (year of diagnosis × D'Amico risk classification, and year of diagnosis × International Society of Urological Pathology [ISUP] grade group) were fitted to predict the probability of undergoing expectant management versus active treatment. The predicted probability of expectant management increased from 13.7% in 2010 to 64.4% in 2020 for men with low-risk PCa, and from 12.9% in 2010 to 61.6% in 2020 for ISUP grade group 1 PCa (both p interaction < 0.001). The frequency of expectant management for low-risk PCa has increased dramatically during the past decade. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. We examined the use of expectant management for prostate cancer between 2010 and 2020 in a large hospital-based registry from the USA. We found that the proportion of men receiving expectant management for low-risk prostate cancer is increasing. We conclude that growing awareness of the harms of overtreatment has profoundly affected trends for prostate cancer treatment in the USA. [ABSTRACT FROM AUTHOR]

This pilot study is the first to examine whether a novel curriculum based on the Reference Framework of Competences for Democratic Culture (RFCDC) could increase children's endorsement and knowledge of children's rights. We conducted a pre-test-post-test design with an intervention and a comparison school. Pupils (n = 172) from Bulgaria, Italy, Norway, Romania, and Spain attended schools in which the curriculum was taught, whereas pupils in the comparison group (n = 120) attended schools in the same city where the curriculum was not taught. Both groups were tested on their endorsement and knowledge of rights before and at the end of the intervention. Children in the intervention group increased in endorsing children's rights at post-test more than did children in the intervention group. Most children believed that children had rights. Children in the intervention group showed modest increases in their knowledge of rights. Future ways of implementing the RFCDC are suggested. [ABSTRACT FROM AUTHOR]

Simple Summary: People are more likely to develop cancer as they become older, and as people live longer, the number of older adults with cancer is steadily increasing. Managing cancer in older adults is challenging because they often have long-term conditions and wider needs that complicate treatment decisions and outcomes. However, the care of older adults with cancer is not formally taught during undergraduate medical education or postgraduate training in the United Kingdom. In this review, we provide an overview of the current education that medical students and training trainee doctors receive to prepare them for caring for older adults with cancer and highlight where challenges exist. We summarise the research conducted and strategies implemented internationally and use this knowledge to provide recommendations which may improve the education and training of doctors to meet the needs of older adults with cancer. Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors are a new class of anticancer therapies that amplify T-cell-mediated immune responses against cancer cells. Immune checkpoint inhibitors have shown important benefits in phase 3 trials, and several agents have been approved for specific malignancies. Although adverse events from immune checkpoint inhibitors are a common occurrence, cardiotoxic effects are uncommon, but are often serious complications with a relatively high mortality. Most cardiotoxic effects appear to be inflammatory in nature. Clinical assessment of a combination of biomarkers, electrocardiography, cardiac imaging, and endomyocardial biopsy can be used to confirm a possible diagnosis. In this Review, we discuss the epidemiology of immune checkpoint inhibitor-mediated cardiotoxic effects, as well as their clinical presentation, subtypes, risk factors, pathophysiology, and clinical management, including the introduction of a new surveillance strategy. [ABSTRACT FROM AUTHOR]

Twinning is an important deformation mode in plastically deformed hexagonal close-packed materials. The extremely high twin growth rates at the nanoscale make atomistic simulations an attractive method for investigating the role of individual twin/matrix interfaces such as twin boundaries and basal-prismatic interfaces in twin growth kinetics. Unfortunately, there is no single framework that allows researchers to differentiate such interfaces automatically, neither in experimental in-situ transmission electron microscopy analysis images nor in atomistic simulations. Moreover, the presence of alloying elements introduces substantial noise to local atomic environments, making it nearly impossible to identify which atoms belong to which interface. Here, with the help of advanced machine learning methods, we provide a proof-of-concept way of using the local stress field distribution as an indicator for the presence of interfaces and for determining their types. We apply such an analysis to the growth of twin embryos in Mg-10 at.% Al alloys under constant stress and constant strain conditions, corresponding to two extremes of high and low strain rates, respectively. We discover that the kinetics of such growth is driven by high-energy basal-prismatic interfaces, in line with our experimental observations for pure Mg. [Display omitted] • Applied ML to atomistic simulations of twin embryo growth in Mg alloy. • Identified and tracked twin-matrix interfaces using stress components. • Low strain rate: growth driven by low-energy twin boundaries. • High strain rate: growth driven by high-energy basal-prismatic interfaces. • Results are experimentally validated for later twin growth stages. [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]

Considering the current geopolitical situation that has hindered the gas supply gas from Russia, Europe's main supplier, it is necessary to find alternative routes to guarantee the Italian gas stocks in winter at a reasonable cost. Such energetic strategies should consider the environmental sustainability of the different available options, fitting the targets of the EU environmental policy. With the aim of supplying a quantitative tool to support the European green transition, this paper reports the entire life cycle assessment (LCA) of three different options for the production and supply of natural gas/methane in Italy: the production of biomethane from biogas (considering a real-scale plant in Italy), the use of liquefied natural gas (LNG) supplied by Qatar by vessel, and the use of compressed gas delivered from Algeria via pipeline. The application of the LCA standardized method allowed for the quantification of the environmental benefit provided by the first option, against all the considered impact categories, thanks to a combination of several advantages: (a) its low-impact anaerobic production, (b) its exploitation of a waste product from the food/agriculture industries, and (c) its production of valuable by-products, which can be considered environmental credits. The results proved the possible environmental gain resulting from an integrated energy supply system that would be able to enhance the economic fabric of specific areas. [ABSTRACT FROM AUTHOR]

We sought to develop a preoperative nomogram called NODESAFE (NODE SAFEty) to predict nodal involvement (NI) at time of surgery or subsequent follow up in localized renal cell carcinoma (RCC), as the role of lymphadenectomy in localized RCC remains controversial. We conducted a multicenter retrospective analysis of RCC patients who underwent primary surgical resection. Patients with clinical metastasis at presentation were excluded. NI was defined as presence of histological RCC with lymphadenectomy at time of surgery, or subsequent development histologically proven NI. The dataset was divided into training (70%) and testing subsets to facilitate model evaluation which was constructed through a stepwise multivariable logistic regression (MLR) model. Accuracy was tested with receiver operator characteristic estimated area under the curve (AUC). Total 3308 patients (2221 [67.1%] male) met inclusion criteria. During follow-up 25 patients (0.76 %) experienced nodal recurrence, and 22/25 were preoperatively classified as cN0. In our cohort, 112 (3.4%) patients had clinical lymphadenopathy preoperatively (cN1), and 34/112 were pN1. The following covariates were found to be statically significant on a MLR model: hypertension (Odds ratio [OR] 3.35, <.001), Charlson Comorbidity Index ≥ 5 (OR 1.93 P =.025), tumor size ≥ 6 cm (OR 2.63, P =.001), tumor necrosis at CT scan (OR 1.83, P =.036), cN1 (OR 5.59, P <.001) and CRP ≥ 8.5 mg/L (1.96, P =.018). Testing the prediction performance of the model in the validation set AUC of the model was 0.89. NODESAFE demonstrated a sensitivity of 83.9%, specificity of 86.1% and 99.1% negative predictive values using a 4% threshold probability. Combining clinical features, serum biomarkers and radiographic findings, we developed a model capable of predicting NI with high degree of accuracy. NODESAFE may refine clinical decision making with respect to the performance of lymphadenectomy at the time of surgery, postsurgical surveillance, and spur consideration for adjuvant therapy. We designed and internally validate a preoperative nomogram (NODESAFE) combining clinical features, serum biomarkers and radiographic findings, which predict loco regional lymph node involvement at time of surgery resection or subsequent locoregional nodal recurrence. [ABSTRACT FROM AUTHOR]

• Combined micro-US and mpMRI-target biopsy optimally identified prostate cancer in discordant lesions. • Addition of systematic biopsy allowed to increase the detection of clinically insignificant prostate cancer. • Given that the addition of nontargeted systematic biopsies did not identify any additional patients with clinically significant prostate cancer, the necessity of SBx in csPCa detection might be worth reevaluating. Multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro–US-guided targeted biopsy (micro–US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx). We analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57–70), median prostate-specific antigen level was 7 ng/mL (IQR, 5–9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35–64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa. Micro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26–46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36–50), resulting in a -8% difference (95% CI: −10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a −3% difference (95% CI: −2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004). In conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US's role in reducing unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Objectives: To assess and compare peri‐operative outcomes of patients undergoing robot‐assisted partial nephrectomy (RAPN) for imperative vs elective indications. Patient and Methods: We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien–Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. Results: After propensity‐score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien–Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day‐1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). Conclusion: We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications. [ABSTRACT FROM AUTHOR]

Background: The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. Methods: In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. Results: IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18–1.92); 90-day mortality, HR: 1.54 (95% CI 1.25–1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33–2.51) and 90-day mortality HR: 1.66 (95% CI 1.23–2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406–772] vs 600 [452–842] mg/dL, median [Q1–Q3], p = 0.007). Conclusions: In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122, Clinicaltrial.gov, registered 30 June 2008 [ABSTRACT FROM AUTHOR]

Objective: To predict intra‐operative (IOEs) and postoperative events (POEs) consequential to the derailment of the ideal clinical course of patient recovery. Materials and Methods: The Vattikuti Collective Quality Initiative is a multi‐institutional dataset of patients who underwent robot‐assisted partial nephectomy for kidney tumours. Machine‐learning (ML) models were constructed to predict IOEs and POEs using logistic regression, random forest and neural networks. The models to predict IOEs used patient demographics and preoperative data. In addition to these, intra‐operative data were used to predict POEs. Performance on the test dataset was assessed using area under the receiver‐operating characteristic curve (AUC‐ROC) and area under the precision‐recall curve (PR‐AUC). Results: The rates of IOEs and POEs were 5.62% and 20.98%, respectively. Models for predicting IOEs were constructed using data from 1690 patients and 38 variables; the best model had an AUC‐ROC of 0.858 (95% confidence interval [CI] 0.762, 0.936) and a PR‐AUC of 0.590 (95% CI 0.400, 0.759). Models for predicting POEs were trained using data from 1406 patients and 59 variables; the best model had an AUC‐ROC of 0.875 (95% CI 0.834, 0.913) and a PR‐AUC 0.706 (95% CI, 0.610, 0.790). Conclusions: The performance of the ML models in the present study was encouraging. Further validation in a multi‐institutional clinical setting with larger datasets would be necessary to establish their clinical value. ML models can be used to predict significant events during and after surgery with good accuracy, paving the way for application in clinical practice to predict and intervene at an opportune time to avert complications and improve patient outcomes. [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]

The role of lymphadenectomy in upper tract urothelial carcinoma (UTUC) remains controversial. We sought to develop a preoperative nomogram to predict nodal tropism (NT) defined as nodes invasion at the histological report (NI) or presence of nodes metastasis (NM) at follow up. We conducted a retrospective analysis of the ROBUUST database of UTUC patients who underwent robotic nephroureterectomy. NI was defined as presence of positive nodes at final histological report, while NM was defined as the emergence of newly detected retroperitoneal lymphadenopathy (>10 mm) during the follow-up period. Patients who underwent neoadjuvant or adjuvant chemotherapy were excluded from analysis. Primary objective was to develop a predictive model for NT. The model was developed through a stepwise multivariable logistic regression (MLR).;;Secondary outcomes pertain to internal validation though cross validation analysis. Accuracy of the model was tested with receiver operator characteristic/area under the curve (AUC), and calibration plot. 1,117 were analyzed [755(64.1%) male and 422(35.8%) female]. On MVR cN+[Odds ratio(OR) 8.19, p<0.001];;cT4 vs cTa (OR 10.38, p=0.012);;history of bladder cancer (OR 6.66, p<0.001) high-grade cytology (OR 2.90, p<0.001), platelets lymphocyte ratio≥130 (OR 1.77, p=0.021), diabetes mellitus (OR 1.90, p=0.023), and symptoms at diagnosis (OR 2.16, p=0.008) were independent predictors for NT. A nomogram was developed based on the MVL (Figure 1). AUC of the model was 0.83 (Figure 2). AUC after internal validation was 0.81 (95% confidence interval 0.76-0.87;;Figure 2). A 7% threshold probability demonstrated 80.2% sensitivity, 75.4% specificity and 97.5% negative predictive value. By integrating patient characteristics and serum biomarkers, we've engineered a predictive model for node tropism. This model has the potential to improve clinical choices, with respect to the performance of lymphadenectomy at the time of surgery, post-surgery monitoring, and may spur considerations;for supplementary treatment.;Further investigation is requisite. [ABSTRACT FROM AUTHOR]

• Main drivers of acute kidney injury are male sex, ASA III to IV, hypertension, RENAL score, preoperative eGFR and radical nephrectomy. • Main drivers of functional decline at eGFR threshold of 45 ml/min/1.73 m2 are age, diabetes-mellitus, preoperative eGFR <60 ml/min/1.73 m2 (but > 45 ml/min/1.73 m2) and radical nephrectomy. • Postoperative AKI is not associated with renal functional decline at eGFR threshold of 45 ml/min/1.73 m2, while its impact seems relegated to less severe form of renal functional decline (eGFR<60 ml/min/1.73 m2). To create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer. Primary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m2), through stepwise logistic regression. Secondary outcomes include elucidation of the relationship between AKI and de novo CKD≥3a (<60 ml/min/1.73m2). Accuracy was tested with receiver operator characteristic area under the curve (AUC). AKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (OR = 1.3, P = 0.02), ASA score (OR = 1.3, P < 0.01), hypertension (OR = 1.6, P < 0.001), R.E.N.A.L. score (OR = 1.2, P < 0.001), preoperative eGFR<60 (OR = 1.8, P = 0.009), and RN (OR = 10.4, P < 0.0001) as predictors for AKI. Age (OR 1.0, P < 0.001), diabetes mellitus (OR 2.5, P < 0.001), preoperative eGFR <60 (OR 3.6, P < 0.001) and RN (OR 2.2, P < 0.01) were predictors for CKD≥3b. AUC for RENSAFE AKI was 0.80 and 0.76 for CKD≥3b. AKI was predictive for CKD≥3a (OR = 2.2, P < 0.001), but not CKD≥3b (P = 0.1). Using 21% threshold probability for AKI achieved sensitivity: 80.3%, specificity: 61.7% and negative predictive value (NPV): 88.1%. Using 8% cutoff for CKD≥3b achieved sensitivity: 75%, specificity: 65.7%, and NPV: 96%. RENSAFE models utilizing perioperative variables that can predict AKI and CKD may help guide shared decision making. Impact of postsurgical AKI was limited to less severe CKD (eGFR<60 ml/min 71.73m2). Confirmatory studies are requisite. [ABSTRACT FROM AUTHOR]

• Shift to aggressive prostate cancer post-2012 USPSTF recommendation. • Impact of 2018 USPSTF recommendation and COVID-19 studied. • COVID-19 likely enhances aggressive prostate cancer shift. • Limited impact of 2018 USPSTF recommendation, possibly due to pandemic. • Need to assess 2018 USPSTF recommendation's long-term effects postpandemic. Early 2010s data suggest a reverse stage and grade migration towards more aggressive prostate cancer (PCa) at diagnosis, accelerated by the 2012 US Preventive Services Task Force recommendation against PSA screening. Using the National Cancer Database, we investigated the impact of the 2018 USPSTF recommendation and the COVID-19 outbreak on this shift. We hypothesized that the COVID-19 outbreak would further contribute to a stage and grade migration towards more aggressive disease. We identified men with localized PCa diagnosed between 2010 and 2020. We analyzed the shift in the proportion of PCa stratified according to D'Amico risk classification. We used multivariable logistic regression models to assess the association between year of diagnosis and dichotomous variables related to clinical stage and grade of PCa. Predicted probabilities with 95% CI were computed through marginal effect analyses. We identified 910,898 men with localized PCa. The proportion of low-risk PCa almost halved from 34.9% in 2010 to 17.7% in 2020 (P < 0.001). Compared to 2010, we found in each year increased odds of: PSA≥10 ng/dL starting from 2012 (aOR2012 1.05; 95% CI, 1.02–1.08); cT3–T4 starting from 2015 (aOR2015 1.10; 95% CI, 1.03–1.17); ISUP GG 3–5 starting from 2011 (aOR2011 1.06; 95% CI, 1.03–1.08); and consequently, D'Amico intermediate/high-risk class starting from 2011 (aOR2011 1.03; 95% CI, 1.01–1.05). Fluctuations in the probabilities of PSA≥10 ng/dL and cT3–T4 at diagnosis were observed over time (all P < 0.001). The probability of PSA≥10 ng/dL peaked at 29.0% (95% CI, 28.0%–29.0%) in 2018, while the probability of cT3–T4 peaked at 3.7% (95% CI, 3.6%–3.8%) in 2020. All other outcome variables demonstrated a consistent upward shift (all P < 0.001), with the highest probabilities in 2020 for ISUP GG 3–5 (42.3%, 95% CI, 41.9%–42.6%) and D'Amico intermediate/high-risk (81.3%, 95% CI, 81.0%–81.6%). Our study confirms an enduring shift towards a higher proportion of aggressive PCa at diagnosis, likely influenced by the COVID-19 pandemic. The impact of the 2018 USPSTF PCa screening recommendation on the proportion of aggressive PCa seems restricted and likely affected by the pandemic outbreak. Future investigations should evaluate the long-term effects of the 2018 USPSTF recommendations in the postpandemic setting. [ABSTRACT FROM AUTHOR]

Metallic glasses can exhibit a wide range of local atomic arrangements which are determined by their processing history, and which control their mechanical properties. While recent studies show that thermally stable thin film metallic glasses with high strength and plasticity can be synthesized using physical vapor deposition, they often differ in terms of their structure and mechanical performance from bulk metallic glasses. In that aspect, two different fabrication methods – physical vapor deposition and arc melting – were utilized to fabricate compositionally similar Zr-based glasses in thin-film and bulk form. The as-fabricated samples were characterized in terms of oxygen concentration, element composition, and atomic structure. The mechanical response of the thin film metallic glass (TFMG) and the bulk metallic glass (BMG) was examined using in situ micropillar compression in a scanning electron microscope over a temperature range of room temperature to 500 °C. While the two glasses show overall similar failure characteristics, the TFMG exhibits higher strength together than the BMG without sacrificing plasticity at all testing temperatures. At elevated temperatures, the deformation mechanism changes to homogenous deformation above glass transition temperature (T g). The higher strength and thermal stability of the TFMG is associated with a much higher oxygen concentration in the thin film compared to the BMG. The enhanced mechanical performance of the TFMG compared to the BMG highlights the potential of oxygen in the thermal stability characteristics and deformation capacity of Zr-based thin film metallic glasses. • Investigated mechanical response & thermal stability of thin film & bulk Zr-based metallic glasses via in-situ micro-pillar compression. • Oxygen concentration, degree of crystallization and free volume content were correlated to mechanical properties at various temperatures. • Higher oxygen in TFMG contributes to superior mechanical properties, thermal stability while maintaining plasticity across all temperatures. [ABSTRACT FROM AUTHOR]

A letter to the editor discussing the effect of autoimmune haemolytic anaemia (AIHA) on the intravenous immunoglobulins in a patient with ovarian teratoma is presented.

Aim To compare clinical and radiographic outcomes of implants with a Laser-Lok®-microtextured collar to implants with a resorbable blast textured ( RBT) collar after a 5-year follow-up period. Materials and methods Thirty-four implants with a Laser-Lok®-microtextured collar (test group [ TG]) and 31 implants with an RBT collar (control group [ CG]) were placed in 45 non-smoking, periodontally healthy patients. The full-mouth plaque score, full-mouth bleeding score, number of sites with plaque, and the number of sites with bleeding on probing ( BOP) were recorded at baseline, and at 1-, 2-, 3-, 4-, and 5-year follow-up. Probing depth ( PD) and mucosal recession were assessed at baseline and after the 5-year follow-up period. The radiographic marginal bone loss ( MBL) was calculated by subtracting the bone level at the time of crown insertion from the bone level at the 5-year follow-up. Results An implant survival rate of 94% and of 90% was reported for the TG and the CG, respectively. No statistical differences were found between the study groups for presence of plaque (10.1% vs. 25%) or for number of sites with BOP (10.3% vs. 23%). The differences between both study groups were statistically significant for mean MBL (0.81 ± 0.24 vs. 2.02 ± 0.32 mm), mean PD (2.32 ± 0.44 vs. 4.25 ± 0.87 mm), and mean mucosal recession (0.16 ± 0.3 vs. 0.22 ± 0.3 mm). Conclusions Within the limitations of this study, results suggest that the laser-microtextured implant collar surface may provide more favorable conditions for the attachment of hard and soft tissues, and reduce the level of MBL. [ABSTRACT FROM AUTHOR]

Background Several reports have shown that patients who undergo minimally invasive radical prostatectomy have a lower chance of undergoing pelvic lymph node dissection (PLND), irrespective of the disease characteristics. Objective We evaluated the rate and extension of PLND in patients who underwent robot-assisted radical prostatectomy (RARP). We tested the adherence of the indication for PLND to the European Association of Urology (EAU) guidelines. Design, setting, and participants Our study was a multi-institutional retrospective analysis of prospectively collected data on 2985 consecutive patients who underwent RARP at five high-volume European institutions. Patients were stratified according to preoperative cancer risk group. Intervention RARP. Outcome measurements and statistical analysis The rate and extent of PLND across different institutions were analyzed. Univariable and multivariable logistic regression models evaluated the association between preoperative variables and the probability of receiving PLND, as well as the presence of lymph node invasion (LNI). Finally, the probability of LNI was calculated for each patient, and the indication for PLND was compared with the EAU guidelines’ indications. Results and limitations A lymph node dissection was performed in 1777 patients (59.7%; 34.5% of low-risk patients, 64.9% of intermediate-risk patients, and 91.2% of high-risk patients). These rates were different across institutions: 5.0–41.4% in low-risk patients ( p < 0.001), 31.3–81.4% in intermediate-risk patients ( p < 0.001), and 84.6–96.4% in high-risk patients ( p = 0.06). The mean and median number of nodes removed was 10.8, and 122 patients (4.1%) had nodal metastases. At multivariable analysis, the institution represented an independent predictor of PLND ( p < 0.001). Of patients with current indication for PLND (EAU guidelines), 77.8% actually received the procedure. Limitations were the retrospective study design with different pathologic assessment and lack of follow-up data. Conclusions PLND is performed in a high proportion of patients undergoing RARP in high-volume centers in Europe for whom the procedure is indicated by the EAU guidelines, but significant differences exist among institutions. An effort toward a more rigorous standardization of PLND is advocated. Patient summary In this paper, we investigated the indication for and extension of pelvic lymph node dissection (PLND) in different institutions in Europe. Despite PLND being widely performed, significant variations with regard to PLND do exist among different institutions. Therefore, a thrust toward more rigorous attention to PLND is advocated. [ABSTRACT FROM AUTHOR]

Abstract: Background: Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients. Objective: We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and oncologic outcomes. Design, setting, and participants: A retrospective chart review was performed for 183 patients who underwent RAPN at four centers between 2006 and 2008. Surgical procedure: RAPN was performed using methods outlined in the supplemental video material. Though operative technique was similar across all institutions, there were minor variations in trocar placement and hilar control. Measurements: Perioperative parameters, including operative time, warm ischemic time, blood loss, and perioperative complications were recorded. In addition, we reviewed functional and oncologic outcomes. Results and limitations: Mean age at treatment was 59.3 yr. Mean tumor size was 2.87cm. Mean total operative time was 210min while mean ischemic time was 23.9min. Calyceal repair was required in 52.1% of procedures. Mean estimated blood loss was 131.5ml. Sixty-nine percent of excised tumors were malignant, of which 2.7% exhibited positive surgical margins. The incidence of major complications was 8.2%. At up to 26 mo follow-up, there have been no documented recurrences and no significant change in serum creatinine (1.03 vs 1.04mg/dl, p =0.84) or estimated glomerular filtration rate (eGFR) from baseline (82.2 vs 79.4mg/ml per square meter, p =0.74). The study is limited by its retrospective nature, and the outcomes are likely influenced by the robust prior laparoscopic renal experience of each of the surgeons included in this study. Conclusions: RAPN is a safe and efficacious approach for NSS, offering short ischemic times, as well as perioperative morbidity equivalent to other standard approaches. Moreover, RAPN is capable of providing patients with excellent functional and oncologic outcomes. [Copyright &y& Elsevier]

The article reports the preliminary results obtained in a pilot plant that treats a spent tetramethylammonium hydroxide (TMAH) solution, a typical chemical compound used in the microelectronics industry and massively present in wastewaters. The plant is based on three aerobic bioreactors in series, fed by a real TMAH solution effluent from the semiconductor industry. The plant ran for 14 days in continuous operating mode with a flow rate of 5 L/h; then, the plant switched to batch mode. The microbial population was analyzed to determine if microbial population changes occurred. The results indicated that TMAH degradation only occurred during the batch operation mode. The TMAH reduction was about 80% in the first reactor and complete (100%) in the second and third bioreactors. At the same time, the microorganisms increased their mass by 338%, 58%, and 1% in the first, second, and third bioreactor, respectively. The degradation intermediates confirmed the efficiency of the process and the possible reuse of water, which closes the water loop's circularity. Furthermore, a nitrate concentration of 150–250 mg/L was found in the last two bioreactors: this implies a significant presence of ammonium-oxidizing bacteria. Community genomic analysis was conducted to detect changes in the microbial community due to changes in operating conditions that could cause reactor failure if methylotrophs were washed out or outcompeted by unspecific bacteria. [ABSTRACT FROM AUTHOR]

According to the International Energy Agency (IEA), only a tiny fraction of the full potential of energy from biomass is currently exploited in the world. Biogas is a good source of energy and heat, and a clean fuel. Converting it to biomethane creates a product that combines all the benefits of natural gas with zero greenhouse gas emissions. This is important given that the methane contained in biogas is a more potent greenhouse gas than carbon dioxide (CO2). The total amount of CO2 emission avoided due to the installation of biogas plants is around 3380 ton/year, as 1 m3 of biogas corresponds to 0.70 kg of CO2 saved. In Russia, despite the huge potential, the development of bioenergy is rather on the periphery, due to the abundance of cheap hydrocarbons and the lack of government support. Based on the data from an agro-industrial plant located in Central Russia, the authors of the article demonstrate that biogas technologies could be successfully used in Russia, provided that the Russian Government adopted Western-type measures of financial incentives. [ABSTRACT FROM AUTHOR]