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Interaction with fishing gears represents the main anthropogenic threat at sea for sea turtles worldwide, and identifying the hotspots of turtle bycatch is a priority knowledge gap.Turtle stranding data represent a source of information about mortality areas at sea that are not fully exploited. This study aims to infer turtle mortality areas of turtles stranded along the Italian Adriatic Coast in the period 2019–2021 (1432 records), through backtrack modelling of carcasses. Specifically, the decomposition process of eight loggerhead carcasses was monitored, and the relationship between floating period (FP), turtle size and sea temperature was modelled through a generalized additive model. Oceanographic information was then used to track the routes of floating carcasses back, knowing their size and decomposition stage, and finally estimate the likely area of mortality. A complementary numerical experiment of connectivity between coastal and offshore areas gave indication that areas of potential mortality are relatively close to the coast, particularly in the northern Adriatic.Stranded turtles probably represent just a small fraction (17%–25%) of total at‐sea mortalities in the study area (Italian Adriatic waters), with decomposition rates, season and distance from shore influencing their stranding likelihood. Hence, strandings can inform only about spatio‐temporal variability of coastal mortality hotspots.Inferred areas of turtle mortality were most likely located in the North and Central Adriatic all over the year and overlap with heatmaps of fishing effort, obtained from vessel monitoring system (VMS) and automatic identification system (AIS) data, in the Gulf of Manfredonia and in the North‐West Adriatic in the cold (September–December) and warm (May–August) periods, respectively. [ABSTRACT FROM AUTHOR]

Background: Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system’s focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs. Methods: We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs. Results: A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51–72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes. Conclusions: We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests. [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]

Background and Objectives: to investigate the impact of age on renal function deterioration after robotic-assisted partial nephrectomy (RAPN) focusing on a decline to moderate and severe forms of chronic kidney disease (CKD). Materials and Methods: This is a single center prospective analysis of patients who underwent RAPN. The outcomes include the development of de novo CKD-S 3a [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2)] and de novo CKD-S 3b (eGFR < 45 mL/min/1.73/m2). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S 3a/b. Kaplan –Meier Analyses (KMA) were fitted for survival assessment. Multivariable linear regression was utilized to identify the predictors of last-eGFR. Results: Overall, 258 patients were analyzed [low age (<50) n = 40 (15.5%); intermediate age (50–70) n = 164 (63.5%); high age (>70) n = 54 (20.9%)] with a median follow-up of 31 (IQR 20–42) months. MVA revealed an increasing RENAL score [Hazard Ratio (HR) 1.32, p = 0.009], age 50–70 (HR 6.21, p = 0.01), age ≥ 70 (HR 10.81, p = 0.001), increasing BMI (HR 1.11, p < 0.001) and preoperative CKD 2 (HR 2.43, p = 0.014) are independent risk factors associated with an increased risk of CKD-S 3a; conversely, post-surgical acute kidney injury was not (p = 0.83). MVA for CKD-S 3b revealed an increasing RENAL score (HR 1.51, p = 0.013) and age ≥ 70 (HR 2.73, p = 0.046) are associated with an increased risk of CKD-S 3b. Linear regression analysis revealed increasing age (Coeff. −0.76, p < 0.001), increasing tumor size (Coeff. −0.31, p = 0.03), and increasing BMI (Coeff. −0.64, p = 0.004) are associated with decreasing eGFR at last follow-up. We compare the survival distribution of our cohort stratified by age elderly patients experienced worsened CKD-S 3a/b disease-free survival (p < 0.001; p < 0.001, respectively). Conclusions: Age is independently associated with a greater risk of significant and ongoing decline in kidney function following RAPN. Recognizing the impact of aging on renal function post-surgery can guide better management practices. Further investigations are required. [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]

This document is a correction notice for an article titled "Value-based preoperative assessment in a large academic hospital" published in the Journal of Anesthesia, Analgesia & Critical Care. The correction addresses an incorrect author name in the original publication and provides the correct information. The original article has been updated to reflect this correction. The corrected author list includes Maurizio Cecconi, Giulia Goretti, Andrea Pradella, Patrizia Meroni, Martina Pisarra, Guido Torzilli, Marco Montorsi, Antonino Spinelli, Alessandro Zerbi, Carlo Castoro, Paolo Casale, Efrem Civilini, Vittorio Quagliuolo, Marco Klinger, Giuseppe Spriano, Domenico Vitobello, Leonardo Maradei, Bernhard Reimers, Federico Piccioni, Maria Rosaria Martucci, Niccolò Stomeo, Elena Vanni, Marco Babbini, Roberta Monzani, Maria Rosaria Capogreco, Michele Lagioia, and Massimiliano Greco. [Extracted from the article]

Introduction and Objectives: 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)., Material and Methods: 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., Results: 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)., Conclusions: 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)