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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]

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]

In a sample of 567 loggerhead turtles ( Caretta caretta ) from the central Mediterranean, debris occurrence varied according to methods and turtle source, and was up to 80% in pelagic turtles. Frequencies of plastic types, size and color are also reported. These results and a critical review of 49 studies worldwide indicate that: (i) the detected occurrence of plastic (% turtles) is affected by several factors (e.g., necropsy/feces, ecological zone, type and date of finding, captivity period for feces collection), (ii) mixed dataset and opportunistic approaches provide results which are biased , not comparable, and ultimately of questionable value, (iii) only turtles assumed to have had a normal feeding behaviour at the time of capture or death should be considered, (iv) turtle foraging ecology and possible selectivity may undermine the use of turtles as indicator species for monitoring marine litter, as recently proposed for the Mediterranean. [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]

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]

• 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]

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]

• Nerve-sparing is not recommended in patients with high risk of extraprostatic disease. • Microultrsound has shown a promising role in prostate cancer staging. • We developed a microultrasound-based nomogram predicting extra-prostatic extension. • The model showed an accuracy of 84.1% in the prediction of extraprostatic disease. • Microultrasound-based nomogram could aid urologists whether to perform nerve sparing. To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing. All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them. We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results. [ABSTRACT FROM AUTHOR]

Background: There is a high demand for bladder sparing therapies in patients who do not respond to bacillus Calmette-Guérin (BCG).Objective: To report the mid-term results of intravesical gemcitabine in non-muscle-invasive bladder cancer (NMIBC) patients, who failed BCG and who were unwilling to undergo radical cystectomy (RC).Material& Methods: This is an extended confirmatory open-label, single-arm study, which enrolled consecutive patients who failed BCG or were BCG intolerant and unwilling to undergo the RC (histologically confirmed Tis (CIS), T1 high grade or multifocal Ta high grade of the urinary bladder). Intravesical gemcitabine was administered once a week for 6 consecutive weeks and once a month for 12 months. The primary outcome was disease-free survival (DFS) defined as the lack of tumor on cystoscopy and negative urine cytology. The secondary endpoint was safety, defined according a grading of side effects. overall survival, progression-free survival and DFS were described with Kaplan-Meier method at 12, 24, and 36 months.Results and Limitations: Overall 46 patients were enrolled. The mean follow-up was 40 months. The DFS was 69.05% at the end of induction phase and 32.69% at 36 months. The progression-free survival at 36 months was 65.38%. The overall survival and cancer specific survival were 66.97% (95% confidence interval 47.25%-80.70%) and 78.71% (95% confidence interval 59.16%-89.66%), respectively. There was no life-threatening event or treatment related death (grade 4 or 5). The most common mild and moderate adverse events reported were urinary symptoms (lower urinary tract symptoms) and fatigue (G1-G2).Conclusion: Intravesical gemcitabine seemed to represent a valid and safe alternative at 3 years follow-up for patients who failed BCG and were unwilling to undergo RC. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) has been proposed as a staging tool for bladder cancer (BC), but its use has been limited by its high costs and limited availability. Microultrasound (mUS) is a novel technology capable of providing high-resolution images of the prostate. To test the feasibility of high-resolution mUS in patients diagnosed with BC and its ability to differentiate between non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC). This is an observational prospective study performed in 23 patients with a diagnosis of primary BC scheduled for an endoscopic treatment. Micro-US was performed before transurethral resection of bladder tumor using the ExactVu system with an EV29L 29-MHz side-fire transducer (Exact Imaging, Markham, Canada). The endpoints were to test the feasibility, describe the normal bladder wall anatomy, identify the lesions, and compare the mUS findings with the histopathological results. Micro-US was accurate in differentiating the three layers of the bladder wall in all cases. Bladder cancers were clearly identified as heterogeneous structures protruding from the normal bladder wall. In 14 cases the lesions appeared confined to the lamina propria, and in all cases NMIBC was confirmed by the final pathological report. In the other patients, the lesions seemed to extend into the muscular layer, but MIBC was confirmed in five out of seven cases (71.4%) from the pathologist. The small sample size was the main limitation of the current study. Our findings showed that mUS is able to differentiate the bladder wall layers and identify the bladder cancer stage. Further studies with a larger population and imaging correlation with MRI are warranted before its introduction in clinical practice. In this report, a new imaging technique was tested for the characterization of bladder cancer. Microultrasound appears to be feasible and capable of discriminating between superficial and invasive tumors. Microultrasound appears to be capable of accurately identifying the different bladder wall layers and differentiating between non-muscle-invasive and muscle-invasive bladder cancers. Further studies are warranted before its introduction in clinical practice. [ABSTRACT FROM AUTHOR]

There have been efforts around the globe to track individuals of many marine species and assess their movements and distribution, with the putative goal of supporting their conservation and management. Determining whether, and how, tracking data have been successfully applied to address real-world conservation issues is, however, difficult. Here, we compile a broad range of case studies from diverse marine taxa to show how tracking data have helped inform conservation policy and management, including reductions in fisheries bycatch and vessel strikes, and the design and administration of marine protected areas and important habitats. Using these examples, we highlight pathways through which the past and future investment in collecting animal tracking data might be better used to achieve tangible conservation benefits. The value of animal tracking data to inform policy is illustrated by case studies from around the world and with a broad range of taxa. Application of tracking data to policy and management can take various pathways, and engagement with stakeholders might often not be made by the original data collectors. The impact of tracking data on policy and management can be improved if data collection and analyses target specific needs for management outcomes. Early engagement among the data collectors and the stakeholders involved in policy development and implementation is important to help translate tracking data into conservation outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe our "en bloc" technique for nonmuscle invasive bladder cancer (NMIBC), assess the quality of resection, and report the midterm oncological outcome.Materials and Methods: This is an observational prospective longitudinal study, from June 2010 to February 2014, enrolling patients with clinically NMIBC, having tumors of ≤3 cm and ≤4 lesions who underwent electrical en bloc bladder resection. The primary study end point was recurrence-free survival. Secondary outcomes were feasibility, safety, the presence of detrusor muscle, and the recurrence rate at the first follow-up cystoscopy (3 months). Statistical analysis was complemented with multivariable analysis.Results: Of 87 enrolled patients, 2 showed a nonurothelial carcinoma and 11 showed muscle invasive bladder carcinoma at the definitive pathology. The study cohort consisted of 74 transitional cell carcinoma NMIBC cases, mean age 71 years ± 8, presenting with a mean tumor diameter of 1.98 ± 0.59 cm and a median number of resected tumors per patients of 1 (range 1-4). The 2-year recurrence-free survival was 85.59%. All the en bloc resection of bladder tumor samples showed the presence of detrusor muscle and the recurrence rate at the first follow-up cystoscopy (3 months) was 5.4% (4/74). An extraperitoneal bladder perforation occurred in only one patient. At multivariable analysis, only gender and the presence of carcinoma in situ were independent predictors of recurrence. The midterm follow-up and the absence of a control group are the main limitations.Conclusion: Our findings confirmed the feasibility and safety of en bloc resection of bladder tumor, with a recurrence-free survival of 85% after 2 years. [ABSTRACT FROM AUTHOR]

Introduction: Magnetic Resonance Imaging (MRI) has emerged as the most accurate diagnostic tool, showing a high sensitivity in the diagnosis of clinically significant prostate cancer (csCaP). However only a minority of patients with a PI-RADS 3 lesion at multiparametric magnetic resonance imaging (MRI) are diagnosed with csCaP. The aim of the current study was to assess whether high resolution micro-ultrasound (microUS) could help in sub-stratifying the risk of csCaP in this specific population.Material and Methods: We retrospectively analyzed the records of 111 consecutive patients scheduled for a prostate biopsy with at least 1 PI-RADS 3 lesions at MRI. We excluded patients with a PIRADS >3 lesion, even if they had a coexisting PIRADS 3 lesions. MicroUS was performed in all patients before prostate biopsy by an operator blind to MRI results. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was used to assess the risk of CaP and csCaP. All patients received both targeted and systematic biopsies. The primary endpoint was to determine the diagnostic accuracy of microUS in detection of csCaP in patients with a PI-RADS 3 lesion at MRI. Specifically, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of microUS were determined. Multivariable logistic regression models (MLRMs) were fitted to identify predictors of CaP. The diagnostic accuracy was reported as area under the receiver operator characteristic (ROC) curve.Results: Overall, 43 patients (38.7%) harboured CaP and 22 (20%) csCaP. MicroUS showed a high sensitivity and negative predictive value (100%), while its specificity and positive predictive value were 33.7% and 27.2%, respectively. Among patients without lesions at microUS, 25 (83.3%) did not harbour CaP, while 5 (16.7%) patients were diagnosed with a Gleason score 6 CaP, with no patients harbouring csCaP. Using microUS, the csCaP detection would have remained 100%, while reducing the detection of insignificant CaP of a 23.8% extent (n = 5). In MLRMs, lesion identified at microUS and continuously-coded PSAd were independent predictors of CaP. The accuracy of a model including PRI-MUS score, digital rectal examination (DRE), PSA density, age and family history was 0.744 (95% CI: 0.645 - 0.843).Conclusion: In our single-institutional retrospective study, microUS was potentially capable to stratify the presence of CaP in patients with an equivocal MRI. Further prospective studies on larger populations are needed to validate our results. [ABSTRACT FROM AUTHOR]

In the Mediterranean Sea, bottom trawl, bottom longline and set nets are the fishing gears with the highest impact on marine turtle populations. These demersal gear types are characterised by a variety of métiers (fishing operations targeting a specific assemblage of species, using specific gear, during a precise period of the year and/or within a specific area). Data on fishing methods, target species and turtle bycatch were collected through interviews in three different study areas in the central Mediterranean. The results show that, even in the same fishing area, different métiers of the same gear can have a different impact on turtles. These findings have several implications. First, traditional turtle bycatch estimations and comparisons based on a fishing gear as a whole may be spatially or temporally biased by spatial and temporal differences in métier composition, respectively. Second, the efficiency of conservation measures may be different according to the métiers involved and caution is needed when measures developed in small areas with certain métiers are exported to a wider scale with possibly very different métiers. Third, conservation measures may induce shifts among métiers that may have an impact on other species, but such shifts are difficult to detect. All this suggests that, in the Mediterranean, a métier -based approach is needed to provide realistic estimates of turtle bycatch, to increase the efficiency of conservation measures by targeting only the most relevant métiers and to predict the changes in target species and effort distribution that can be driven by conservation measures. The variability of fishing methods and métiers implies that the most effective management strategies should be identified at relatively small geographical scales. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the diagnostic accuracy of a [-2]proPSA derivative, namely, the prostate health index (PHI), to predict the presence of prostate cancer (PCa) in individuals with high total prostate-specific antigen (tPSA) levels is lacking. We tested the hypothesis that these markers could assist clinicians in the biopsy decision path of patients with tPSA>10ng/ml.Methods: The primary endpoint was to evaluate the sensitivity, specificity, and diagnostic accuracy of PHI in determining the presence of PCa at biopsy in comparison to tPSA, free PSA, and % of free to total PSA. We calculated the number of prostate biopsies that could have been spared by using this marker to decide whether or not to perform a biopsy. A secondary endpoint was to determine the relationship between PHI and PCa characteristics.Results: The PCa was diagnosed in 136 of 262 patients (51.9%). Total PSA and PHI values were significantly higher (P<0.005) and % of free to total PSA values significantly lower (P<0.0001) in patients with PCa relative to those with a negative biopsy. In multivariable logistic regression models, PHI achieved the independent predictor status and significantly increased the accuracy of the base multivariable model by an extent of 8.2% (P = 0.0005). The inclusion of PHI in the biopsy decision path would decrease the number of unnecessary biopsies by an extent of 50.0%, while missing only few cases with clinically significant PCa. Finally, Gleason score was significantly related to PHI levels.Conclusions: The results of our study support the diagnostic effectiveness of PHI even in patients with tPSA >10ng/ml. Further validation studies with larger sample size are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to test the hypothesis that preoperative prostate health index (PHI) levels could help to predict early biochemical recurrence (BCR) in a contemporary population of patients with prostate cancer treated with robot-assisted radical prostatectomy (RARP). Methods The study population consisted of 313 patients treated with RARP for clinically localized prostate cancer at a single institution between 2010 and 2011. Patients subjected to neoadjuvant or adjuvant therapies and patients with a follow-up of<2 years were excluded. BCR was defined as a postoperative level of total prostate-specific antigen≥0.2 ng/ml and elevating after RARP. The minimum P -value method was used to determine the most significant PHI cutoff value to discriminate between patients with and without BCR. The Kaplan-Meier method was used to determine BCR-free survival rates. Finally, Cox regression models were fitted to determine the predictors of BCR, and the predictive accuracy (area under the curve) of each predictor was determined with the Harrell concordance index. Results Mean total prostate-specific antigen and mean PHI levels were 5.76 ng/ml (interquartile range: 4.2–8.7) and 46.0 (35–62), respectively. Biopsy Gleason score was 6 in 173 (55.3%), 7 in 121 (38.7%), and≥8 in 19 (6.1%) patients. At final pathology, extracapsular extension was observed in 59 (18.8%), seminal vesicle invasion in 24 (7.7%), and lymph node invasion in 11 (3.5%) patients, whereas 228 (72.8%) patients had organ-confined disease. The 2-year BCR-free survival rate was 92.5% in the overall population and was 96.7% in patients with organ-confined disease. The most significant PHI cutoff value to discriminate between patients with and without BCR was 82. Specifically, the 2-year BCR-free survival rate was 97.7% in patients with a preoperative PHI level<82 relative to 69.7% in patients with a PHI level≥82 (log-rank test: P <0.001). Finally, in multivariable Cox regression analyses, PHI level emerged as an independent predictor of BCR in both the preoperative and the postoperative settings and was more accurate than several established BCR predictors were. Conclusions Preoperative PHI levels may discriminate between patients who are at a high risk vs. low risk of BCR after RARP. External validation of our findings within a larger population with a longer follow-up time is needed. [ABSTRACT FROM AUTHOR]