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In stage-specific analyses of 98,142 renal cell carcinoma patients, married status independently predicted higher nephrectomy rates in males and females. In stage IV, married status predicted higher systemic therapy rate in males, but not in females. Married males exhibited lower cancer specific mortality across all stages; married females only in stages I and III (all P ≤ .02). Introduction: The association between treatment rates and cancer specific mortality (CSM) according to married status in male and female clear cell renal cell carcinoma (ccRCC) patients across all stages is unknown. Patient and Methods: Using the Surveillance, Epidemiology, and End Results database (2004-2020), ccRCC patients were stratified according to married status (married vs. unmarried). Logistic regression models addressed treatment rates; Cox regression models addressed CSM rates. Results: Of 98,142 patients, 43,999 (72%) males and 20,287 (55%) females were married. In stage-specific analyses, married status independently predicted higher nephrectomy rates in males and females (all P ≤ .03). In stage IV, married status predicted higher systemic therapy rate in males (P < .001), but not in females. In survival analyses, married males exhibited lower CSM rates relative to unmarried males (all P ≤ .02). Conversely, married females exhibited lower CSM rates only in stages I and III (all P ≤ .02), but not in stages II and IV. In subgroup analyses of T1aN0M0 patients, married status was associated with higher partial nephrectomy rates in both males and females (all P ≤ .005). Conclusion: In ccRCC, married status invariably predicts higher rates of guideline recommended surgical management (nephrectomy and partial nephrectomy). Moreover, even after adjustment for treatment type, married status independently predicted lower CSM rates in males across all stages. However, the effect of married status in females is only operational in stages I and III. Lack of association between married status in stages II and IV may potentially be explained by stronger association with treatment assignment which reduces the residual effect on survival. [ABSTRACT FROM AUTHOR]

We tested for the prognostic significante of radiographic N-stage in metastatic renal cell carcinoma (mRCC) patients with low metastatic burden (single metastatic site). After multivariable adjustment, radiographic N1 status was an independent predictor of higher cancer-specific mortality (CSM). In consequence, consideration of radiographic lymph node invasion might be of great value in this specific population of mRCC patients. Purpose: To test the prognostic significance of radiographic cN-stage in metastatic renal cell carcinoma (mRCC) patients with low metastatic burden (1 site of metastasis), relying on the Surveillance, Epidemiology, and End Results database (SEER 2010-2020). Methods: Included were mRCC patients with 1 site of metastasis, treated with systemic therapy without cytoreductive nephrectomy (CN). Kaplan-Meier plots and multivariable Cox-regression models addressed cancer-specific mortality (CSM) according to radiographic cN-stage (ccN1 vs. ccN0). Separate subgroup analyses were performed, addressing radiographic N-stage in patients with distinct histology (clear-cell vs. RCC not otherwise specified [RCC NOS]). Results: Of 1756 mRCC patients, 545 (31%) were radiographic cN1. Overall, the median CSM-free survival of the cohort was 11 months. Median CSM-free survival was 8 vs. 14 months in radiographic cN1 vs. cN0 mRCC patients (HR 1.49, P < .0001). In multivariable Cox regression analyses, radiographic cN1 status was an independent predictor of higher CSM (HR 1.39; P = .01). In subgroup analyses, addressing patients with clear-cell histology and patients with RCC NOS separately, radiographic cN1 status remained independently associated with a higher CSM in both groups (clear-cell: HR 1.36; P = .03; RCC NOS: HR 2.06; P = .009). Conclusion: In mRCC patients with low metastatic burden, presence or absence of radiographic lymph node invasion results in a clinically meaningful discrimination between those with poor prognosis and others. In consequence, consideration of radiographic lymph node invasion might be of great value in this specific population of mRCC patients. [ABSTRACT FROM AUTHOR]

In clear-cell metastatic renal cell carcinoma (ccmRCC) patients, intensified treatment (systemic therapy [ST] + cytoreductive nephrectomy [CN]) does not result in higher other-cause mortality (OCM), than when ST is used alone. Conversely, a strong association with lower cancer-specific mortality was recorded in ST + CN patients, relative to their ST alone counterparts, even after strictest statistical adjustments. Background: The effect of treatment intensification (systemic therapy [ST] + cytoreductive nephrectomy (CN) vs. ST alone) is unknown regarding rates of other-cause mortality (OCM) in clear-cell metastatic renal cell carcinoma (ccmRCC). We hypothesized that intensified treatment (ST + CN) may result in higher OCM, than when ST is used alone. Methods: Within the Surveillance, Epidemiology, and End Results database, all ccmRCC patients treated 2010-2018 either with ST + CN or ST alone were identified. Propensity score matching (PSM), cumulative incidence plots, multivariable competing risks regression analyses and 6 months' landmark analyses addressed OCM and cancerspecific mortality (CSM) according to treatment status. Results: Of 2271 ccmRCC patients, 1233 (54%) were treated with ST + CN vs 1038 (46%) with ST alone. After 1:1 PSM, OCM was 5.3 vs. 4.6 % (P = .5) and CSM was 73.4 vs. 88.4% (P < .001) in ST + CN vs. ST alone patients. In multivariable competing risks regression, the combination of ST and CN was not associated with higher OCM (HR 1.3; 95% CI 0.8-2.1; P = .4), vs. ST alone. However, the combination of ST and CN was independently associated with lower CSM (HR 0.5; 95% CI 0.5-0.6; P < .001), vs. ST alone. After 6 months' landmark analyses, these multivariable associations remained unchanged. Conclusions: The current study indicates no OCM-disadvantage in ST + CN ccmRCC patients, relative to their ST alone counterparts. Conversely, a strong association with lower CSM was recorded in ST + CN patients, relative to their ST alone counterparts. These associations are robust and remained unchanged after strictest statistical adjustment including control for immortal time bias. [ABSTRACT FROM AUTHOR]

The prognostic significance of specific visceral sites of metastases in prostate cancer patients is not well established, as well as the interaction between visceral and nonvisceral metastatic sites. Prostate cancer patients with visceral metastases limited to lung have the best prognosis, especially if associated with concomitant nonvisceral lymph node metastases. Patients with visceral liver and/or brain metastases have invariably dismal survival, regardless the type of concomitant nonvisceral metastases. Introduction: It is unknown whether specific locations of visceral metastatic sites affect overall survival (OS) of metastatic prostate cancer (mPCa) patients. We tested the association between specific locations of visceral metastatic sites and OS in mPCa patients. Materials and Methods: Within Surveillance, Epidemiology and End Results database (2010-2016), survival analyses relied on specific locations of visceral metastases: lung only vs. liver only vs. brain only vs. ≥2 visceral sites. Kaplan-Meier plots and Cox regression models were fitted. Results: Of 1827 patients, 1044 (57%) harbored lung only visceral metastases vs. 457 (25%) liver only vs. 131 (7%) brain only vs. 195 (11%) ≥2 visceral sites. Median OS was 22 months in all patients vs. 33 months in lung only vs. 15 months in liver only vs. 16 months in brain only vs. 15 months in patients with ≥2 visceral sites. Highest OS was recorded in lung only visceral metastases patients, especially when concomitant nonvisceral metastases were located in lymph nodes only (median OS 57 months) vs. bone only (26 months) vs. lymph nodes and bone (28 months). Liver only, brain only or ≥2 visceral sites exhibited poor OS, regardless of concomitant nonvisceral metastases type (median OS from 13 to 19 months). Conclusion: In mPCa patients, lung only visceral metastases, especially when associated with lymph node only nonvisceral metastases, portend the best prognosis. Conversely, visceral metastatic sites other than lung portend poor prognosis, regardless of concomitant nonvisceral metastases type. [ABSTRACT FROM AUTHOR]

We tested within a large population-based and matched analyses if previously described advantages in othercause mortality (OCM) for clear cell metastatic renal cell carcinoma (ccmRCC) patients undergoing partial cytoreductive nephrectomy (PCN) still apply, relative to radical cytoreductive nephrectomy (RCN). We confirm the existence of OCM advantage after PCN vs. RCN in contemporary ccmRCC patients and PCN may continue being considered as a valuable alternative to RCN, when technically feasible. Background: It is unknown whether previously reported other-cause mortality (OCM) advantage of partial cytoreductive nephrectomy (PCN) vs. radical cytoreductive nephrectomy (RCN) still applies to contemporary clear cell metastatic renal cell carcinoma (ccmRCC) patients. Materials and Methods: We relied on the Surveillance, Epidemiology and End Results (SEER) database (2004-2019) to identify ccmRCC patients treated with PCN and RCN. Temporal trends of PCN rates within the SEER database were tabulated. After propensity score matching (PSM), cumulative incidence plots depicted 5-year OCM and cancer-specific mortality (CSM) of PCN and RCN patients. Multivariable Cox regression models tested for differences between PCN vs. RCN. Results: Of 5149 study patients, 237 (5%) underwent PCN vs. 4912 (95%) RCN. In the SEER database 2004 to 2019, rates of PCN in ccmRCC patients increased from 3.0% to 8.0% (estimated annual percent change [EAPC]: 3.0%; P = .04). After PSM, 5-year OCM rates were 2.4 vs. 7.5% for respectively PCN vs. RCN patients (P = .036). 5-year CSM rates were 50.8 vs. 53.6% for respectively PCN and RCN patients (P = .57). In multivariable Cox regression models, PCN was associated with lower OCM (Hazard Ratio (HR): 0.39; 95% confidence interval (CI): 0.18-0.84; P = .02) but did not affect CSM rates (HR: 0.99; 95% CI: 0.76-1.29; P = .96). Conclusions: We confirm the existence of OCM advantage after PCN vs. RCN in contemporary ccmRCC patients. [ABSTRACT FROM AUTHOR]

It is not clear whether cancer specific mortality (CSM) differences exist in radical prostatectomy (RP) treated prostate cancer (PCa) patients with specimen-confined (pT2) stage according to presence of lymph node invasion (LNI). Overall, 32,258 patients with pT2 PCa at RP + LND were identified. Of these, 448 (1.4%) patients harbored LNI. In multivariable Cox-regression models pN1 independently predicted higher CSM (HR: 4.4, P < .001). In sensitivity analyses addressing pT2 pN1 patients, 5-year CSM-free estimates were 99.3, 100 and 84.4% for ISUP GG 1-3 vs. 4 vs. 5, respectively (P < .001). These findings might be of value for clinical decision making, as well as for individual patient counseling. Purpose: To test cancer-specific mortality (CSM) differences in specimen-confined (pT2) prostate cancer (PCa) at radical prostatectomy (RP) with lymph node dissection (LND) according to lymph node invasion (LNI). Methods: RP + LND pT2 PCa patients were identified (surveillance, epidemiology, and end results 2010-2015). CSM-FS rates were tested in Kaplan-Meier plots and multivariable Cox-regression (MCR) models. Sensitivity analyses respectively addressing patients with 6 or more lymph nodes analyzed and pT2 pN1 patients were performed. Results: Overall, 32,258 patients with pT2 PCa at RP + LND were identified. Of these, 448 (1.4%) patients harbored LNI. Five-year CSM-1free estimates were 99.6% for pN0 vs. 96.4% for pN1 (P < .001). In MCR models, pN1 (HR: 3.4, P < .001) independently predicted higher CSM. In sensitivity analyses addressing patients with 6 or more lymph nodes analyzed (n = 15,437), 328 (2.1%) pN1 patients were identified. In this subgroup, 5-year CSM-free estimates were 99.6% for pN0 vs. 96.3% for pN1 (P < .001) and, in MCR models, pN1 independently predicted higher CSM (HR: 4.4, P < .001). In sensitivity analyses addressing pT2 pN1 patients, 5-year CSM-free estimates were 99.3, 100 and 84.8% for ISUP GG 1-3 vs. 4 vs. 5, respectively (P < .001). Conclusions: In patients with pT2 PCa a small proportion harbor LNI (1.4%-2.1%). In such patients, CSM rate is higher (HR 3.4-4.4, P < .001). This higher CSM risk seems to virtually exclusively apply to ISUP GG5 patients (84.8% 5-year CSM-free rate). [ABSTRACT FROM AUTHOR]

We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States. Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used. In 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12%-31% for age 40+), race/ethnicity (5%-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24%-43% vs. 14-24% vs. 3%-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87%-96%) and RPLND status (12%-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84%-97%) and RPLND (11%-32%). Unadjusted 5-year CSM rates ranged from 7.1% to 23.3%. Finally in multivariable analyses addressing CSM, 2 registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both P =.004). We identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management. Our study analyzed regional variations in patient demographics, tumor prognostics, and treatment outcomes among stage III nonseminoma germ cell tumor patients using the SEER database. It found significant differences in systemic therapy and retroperitoneal lymph dissection rates, as well as cancer-specific mortality across regions, suggesting potential disparities in care quality or expertise. [ABSTRACT FROM AUTHOR]

Unmarried status has been associated with higher proportions of locally advanced stage and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused on the association between unmarried status and advanced stage (T 3-4 N 0-2) at presentation and lower nephroureterectomy (RNU) and systemic therapy (ST) rates in non-metastatic upper tract urothelial carcinoma (UTUC) patients. Using the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, all non-metastatic UTUC patients were identified. Multivariable logistic regression models (LRMs) tested for differences in stage at presentation and treatment (RNU and ST) according to marital status (married vs unmarried), in a sex-specific fashion. Of all 8544 non-metastatic UTUC patients, 4748 (56%) were male vs 3190 (44%) were female. Of all 4748 male UTUC patients, 1191 (25%) were unmarried. Of all 3190 female UTUC patients, 1608 (50%) were unmarried. In multivariable LRMs predicting RNU, unmarried status was an independent predictor of lower RNU rates in male (Odds Ratio [OR]: 0.56; P <.001), but not in female (OR: 0.81; P =.1) non-metastatic UTUC patients. In multivariable LRMs predicting ST exposure, unmarried status was an independent predictor of lower ST rates in both male (OR:0.73; P =.03) and female (OR:0.64; P <.001) UTUC patients. In multivariable LRMs predicting locally advanced stage (T 3-4 N 0-2), unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male (OR: 0.95; P =.5) or female (OR: 0.99; P =.9) UTUC patients. Unmarried male UTUC patients appear at risk of less being able to access RNU, relative to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Conversely, unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male or female UTUC patients. Among 8,544 non-metastatic UTUC patients identified within the SEER database 2000-2020, unmarried status was independently associated with lower nephroureterectomy (RNU) rates in males (Odds Ratio [OR]: 0.56; P <.001) but not females (OR: 0.81; P =.1) and with lower systemic therapy rates in both male (OR:0.73; P <.001) and female (0.64; P <.001). However, unmarried status did not correlate with an increased risk of locally advanced stage at presentation in either gender. Unmarried male UTUC patients may face challenges accessing RNU compared to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. [ABSTRACT FROM AUTHOR]

• Regional differences in patient, tumor, and treatment characteristics of UTUC patients may affect survival. • Inter-regional differences in patients, tumor, and treatment characteristics of UTUC patients exist. • Overall mortality rates of UTUC patients were different according to SEER Registry. • Even after adjusting for patients, tumor and treatment characters, OM differences were recorded. It is unknown whether regional differences in patient, tumor, and treatment characteristics of upper tract urothelial carcinoma (UTUC) patients exist and may potentially result in regional overall mortality (OM) differences. We tested for inter-regional differences, according to Surveillance, Epidemiology, and End Results (SEER) registries. Using SEER database 2000 to 2016, patient (age, sex, race/ethnicity), tumor (location, grade) and treatment (nephroureterectomy, systemic therapy [ST]) characteristics of UTUC patients of all-stages were tabulated and graphically depicted in a stage-specific fashion (T 1-2 N 0 M 0 vs. T 3-4 N 0 M 0 vs. T any N 1-2 M 0 /T any N any M 1). Multivariable Cox regression (MCR) models tested for inter-regional differences in OM. Regarding T 1-2 N 0 M 0 patients, statistically significant differences existed for race/ethnicity (Caucasian 71 vs. 98%), location (renal pelvis: 55 vs. 67%), grade (high 60 vs. 83%) and ST (5.5 vs. 13.9%). In MCR models, registries 3 (Hazard ratio [HR]:1.39; P < 0.001) and 4 (HR:1.31; P = 0.01) independently predicted higher OM and Registry 8 (HR:0.64; P = 0.001) lower OM. Regarding T 3–4 N 0 M 0 patients, statistically significant differences existed for race/ethnicity (Caucasian 70 vs. 98%), location (renal pelvis: 67 vs. 76%), grade (high 84 vs. 94%) and ST (18.7 vs. 29.5%). In MCR models, registries 3 (HR:1.42; P < 0.001) and 4 (HR:1.31; P = 0.009) independently predicted higher OM. Regarding T any N 1–2 M 0 /T any N any M 1 patients, statistically significant differences existed for location (renal pelvis: 63 vs. 82%), grade (high 92 vs. 98%) and ST (53.4 vs. 58.8%). In MCR models, Registry 3 (HR:1.37; P = 0.004) independently predicted higher OM and Registry 2, (HR:0.78; P = 0.02) lower OM. Inter-regional differences were recorded in patients, tumor, and treatment characteristics. Even after adjustment for these characteristics, OM differences persisted which may be indicative of regional differences in quality of care or expertise in UTUC management. [ABSTRACT FROM AUTHOR]

• Unmarried status was associated with an increased risk of locally advanced stage. • Unmarried female PUC patients more frequently harbored advanced stage at presentation. • Unmarried status was associated with lower rates of bi-/trimodal therapy. • Unmarried male PUC patients less likely to benefit from bi-/trimodal therapy. Unmarried status has been associated with advanced stage at presentation and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused of the association of unmarried status with locally advanced stage (T 3-4 N 0-2) at presentation and lower bi-/trimodal therapy rates in primary urethral carcinoma (PUC) patients. To address these knowledge gaps, we relied on the Surveillance, Epidemiology, and End Results (SEER) database. Within the SEER database 2000 to 2020, all non-metastatic PUC patients were identified. Logistic regression models (LRMs) tested for differences in stage at presentation and treatment modality in the overall cohort and then in a sex-specific fashion, according to marital status (married vs unmarried). Of all 1,430 non-metastatic PUC patients, 1,004 (70%) were male vs 426 (30%) were female. Of 1,004 male PUC patients, 272 (27%) were unmarried. Of all 426 female PUC patients, 239 (56%) were unmarried. In multivariable LRMs predicting T 3-4 N 0-2 , unmarried status was independently associated with an increased risk of locally advanced stage at presentation in the overall cohort (odds ratio [OR]:1.31; P = 0.03) and in female patients (OR:1.62; P = 0.02), but not in male PUC patients (P = 0.6). In multivariable LRMs predicting bi-/trimodal therapy, unmarried status was an independent predictor of lower bi-/trimodal therapy rates in the overall cohort (OR:0.73; P = 0.02) and in male patients (OR:0.60; P = 0.007), but not in female PUC patients (P = 0.6). Unmarried female PUC patients more likely harbored locally advanced stage at presentation. Conversely, unmarried male PUC patients are less likely to benefit from bi-/trimodal therapy. [ABSTRACT FROM AUTHOR]

• Primary urethral carcinoma is a rare malignancy, accounting for <1% of GU malignancies. • Married status independently predicted lower CSM in the entire cohort of PUC patients. • Married status was associated with lower CSM in female but not in male PUC patients. It is unknown whether married status may be associated with lower cancer-specific mortality (CSM) rates in primary urethral carcinoma (PUC) patients. To test for differences in CSM rates, according to marital status, we relied on the Surveillance, Epidemiology, and End Results (SEER) database 2000–2020. Patient (age, sex, race/ethnicity, marital status), tumor (stage, histology), and treatment (surgery, systemic therapy) characteristics of PUC patients were tabulated. Then, Kaplan–Meier plots, as well as univariable and multivariable Cox regression (MCR) models tested for differences in CSM rates according to marital status in overall cohort and then in sex-specific subgroup analyses. Of all 1,571 PUC patients, 70% were male vs. 30% female. Females were statistically significantly younger (68 vs. 73 years), more frequently unmarried (54 vs. 28%), non-Caucasian (43 vs. 24%), more frequently harbored T 3-4 N 0 M 0 (39 vs. 18%) and less frequently T 1-2 N 0 M 0 (53 vs. 69%) or T any N 1-2 M 0 /T any N any M 1 (8 vs. 13%), relative to males. Moreover, we recorded differences in histotype proportions in females vs. males (urothelial 30 vs. 64%; squamous 24 vs. 22%; adenocarcinoma 36 vs. 7%; others 10 vs. 6%) and surgical treatment (none 22 vs. 17%; excisional biopsy 22 vs. 36%; partial urethrectomy 14 vs. 16%; radical urethrectomy 42 vs. 31%). In MCR models focusing on the entire cohort, married status independently predicted lower CSM (hazard ratio [HR]:0.82; P = 0.02). Similarly, in MCR models focusing on females, married status independently predicted lower CSM (HR:0.73; P = 0.03). Conversely, in MCR models focusing on males, married status failed to independently predict lower CSM (HR:0.89; P = 0.3). Married status was associated with lower CSM in PUC patients. However, this benefit applies to female PUC patients, but not to their male counterparts. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms represent a significant public health problem worldwide, impairing patients' quality of life, especially in elderly people. Among LUTS, nocturia is assessed as the most experienced entity related to several disorders such as sleep disorders and/or obstructive sleep apnea syndrome (OSAS). Among OSAS patients, nocturia stands as a bothersome symptom that increases alongside with the OSAS severity. However, despite the nocturia and OSAS shared a long-acknowledged link, the causes, and the pathophysiology for development of nocturia in OSAS have remained largely unexamined. Generally, the patients with OSAS experienced nocturia due to easy waking or increased bladder filling. However, nor the effect of treatment on management of nocturia in OSAS patients are well-established. [ABSTRACT FROM AUTHOR]

Biohydrogen and biomethane production offers many advantages for environmental protection over the fossil fuels or the existing physical-chemical methods for hydrogen and methane synthesis. The aim of this study is focused on the exploitation of several samples from the composting process: (1) a mixture of waste vegetable materials (“ Mix ”); (2) an unmatured compost sample (ACV15); and (3) three types of green compost with different properties and soil improver quality (ACV1, ACV2 and ACV3). These samples were tested for biohydrogen and biomethane production, thus obtaining second generation biofuels and resulting in a novel possibility to manage renewable waste biomasses. The ability of these substrates as original feed during dark fermentation was assayed anaerobically in batch, in glass bottles, in order to determine the optimal operating conditions for hydrogen and/or methane production using “ Mix ” or ACV1, ACV2 or ACV3 green compost and a limited amount of water. Hydrogen could be produced with a fast kinetic in the range 0.02–2.45 mL H 2 g −1 VS, while methane was produced with a slower kinetic in the range 0.5–8 mL CH 4 g −1 VS. It was observed that the composition of each sample influenced significantly the gas production. It was also observed that the addition of different water amounts play a crucial role in the development of hydrogen or methane. This parameter can be used to push towards the alternative production of one or another gas. Hydrogen and methane production was detected spontaneously from these matrices, without additional sources of nutrients or any pre-treatment, suggesting that they can be used as an additional inoculum or feed into single or two-stage plants. This might allow the use of compost with low quality as soil improver for alternative and further applications. [ABSTRACT FROM AUTHOR]

The hybrid systems composed by [FeFe]-hydrogenase anchored to the surface of three distinct types of TiO 2 (anatase) have been investigated using Electron Paramagnetic Resonance (EPR) spectroscopy in dark and under illumination. The three supports were bare TiO 2, nitrogen doped TiO 2 (N-TiO 2 ) and a sub-stoichiometric form of the same oxide (TiO 2−x ) exhibiting blue color. EPR spectroscopy has shown that the electrons photogenerated by irradiation of the supports are stabilised by the solid forming Ti 3+ paramagnetic ions while, in the case of the hybrid systems electrons are scavenged by the anchored protein becoming available for H + reduction. The ability of the three hybrid systems in hydrogen production under solar light illumination has been compared. The formation of H 2 is higher for the system containing N-TiO 2 (yellow) with respect to that based on the bare oxide (white) indicating that the visible light absorbed, due to the presence of N states, is actually exploited for hydrogen production. The system containing reduced blue TiO 2 , in spite of its deep coloration, is less active suggesting that a specific type of visible light absorption is needed to produce photoexcited electrons capable to interact with the anchored protein. [ABSTRACT FROM AUTHOR]

A conserved cysteine located in the signature motif of the catalytic center (H-cluster) of [FeFe]-hydrogenases functions in proton transfer. This residue corresponds to C298 in Clostridium acetobutylicum CaHydA. Despite the chemical and structural difference, the mutant C298D retains fast catalytic activity, while replacement with any other amino acid causes significant activity loss. Given the proximity of C298 to the H-cluster, the effect of the C298D mutation on the catalytic center was studied by continuous wave (CW) and pulse electron paramagnetic resonance (EPR) and by Fourier transform infrared (FTIR) spectroscopies. Comparison of the C298D mutant with the wild type CaHydA by CW and pulse EPR showed that the electronic structure of the center is not altered. FTIR spectroscopy confirmed that absorption peak values observed in the mutant are virtually identical to those observed in the wild type , indicating that the H-cluster is not generally affected by the mutation. Significant differences were observed only in the inhibited state H ox –CO: the vibrational modes assigned to the CO exo and Fe d -CO in this state are shifted to lower values in C298D, suggesting different interaction of these ligands with the protein moiety when C298 is changed to D298. More relevant to the catalytic cycle, the redox equilibrium between the H ox and H red states is modified by the mutation, causing a prevalence of the oxidized state. This work highlights how the interactions between the protein environment and the H-cluster, a dynamic closely interconnected system, can be engineered and studied in the perspective of designing bio-inspired catalysts and mimics. [ABSTRACT FROM AUTHOR]

Abstract: [FeFe]-hydrogenases are the enzymes responsible for high yield H2 production during dark fermentation in bio-hydrogen production plants. The culturable bacterial population present in a pilot-scale plant efficiently producing H2 from waste materials was isolated, classified and identified by means of 16S rDNA gene analysis. The culturable part of the mixed population consists of nine bacterial species that include non-hydrogen producers (Lactobacillus, Enterococcus and Staphylococcus) and several Clostridium that are directly responsible for H2 production. An extensive analysis of the expression of [FeFe]-hydrogenases in the three best producer strains was achieved by RT-PCR, covering the complete set of known genes for each species. This revealed that during H2 production there are several different [FeFe]-hydrogenases simultaneously expressed, with genes belonging to the same phylogenetic and structural classification sharing similar transcriptional profiles. [Copyright &y& Elsevier]

• Current guideline recommendations are in favor of routine loco-regional lymphadenectomy in nonmetastatic adrenocortical carcinoma (nmACC). • Lymphadenectomy provides a prognostic benefit in nmACC patients and identifies pN1 patients with dismal prognosis • Lymph node count cut-off ≥4 identifies those with particularly favorable prognosis. The role of lymphadenectomy and the optimal lymph node count (LNC) cut-off in nonmetastatic adrenocortical carcinoma (nmACC) are unclear. Within the Surveillance, Epidemiology, and End Results (SEER) database, surgically treated nmACC patients with T 2-4 stages were identified between 2004 and 2020. We tested for cancer-specific mortality (CSM) differences according to pathological N-stage (pN0 vs. pN1) and two previously recommended LNC cut-offs (≥4 vs. ≥5) were tested in pN0 and subsequently in pN1 subgroups in Kaplan-Meier plots and multivariable Cox regression models. Of 710 surgically treated nmACC patients, 185 (26%) underwent lymphadenectomy and were assessable for further analyses based on available LNC data. Of 185 assessable patients, 152 (82%) were pN0 and 33 (18%) were pN1. In Kaplan-Meier analyses, CSM-free survival was 74 vs. 14 months (Δ 60 months, P ≤ 0.001) in pN0 vs. pN1 patients, respectively. In multivariable analyses, pN1 was an independent predictor of higher CSM (HR:3.13, P < 0.001). In sensitivity analyses addressing pN0, LNC cut-off of ≥4 was associated with lower CSM (multivariable hazard ratio [HR]: 0.52; P = 0.002). In sensitivity analyses addressing pN0, no difference was recorded when a LNC cut-off of ≥5 was used (HR:0.60, P = 0.09). In pN1 patients, neither of the cut-offs (≥4 and ≥5) resulted in a statistically significant stratification of CSM rate, and neither reached independent predictor status (all P > 0.05). Lymphadenectomy provides a prognostic benefit in nmACC patients and identifies pN1 patients with dismal prognosis. Conversely, in pN0 patients, a LNC cut-off ≥4 identifies those with particularly favorable prognosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of YouTube™ videos on placenta accreta and to investigate if they can be used as a reliable source of information.Methods: We queried YouTube™ with terms related to placenta accreta. Patient Education Materials Assessment Tool for audio-visual content (PEMAT A/V), Global Quality Score (GQS), DISCERN score and Misinformation tool were used to assess videos' quality content.Results: Sixty-four videos were suitable for the analyses. Of those, 42 (65.6%) and 22 (34.4%) were produces by healthcare works and others, respectively. The median PEMAT A/V Understandability and Actionability score was 75 and 66.7%, respectively. According to GQS, 31.2 and 45.3% videos were excellent or good and generally poor or poor, respectively. The median DISCERN score of section 1 was 27 (out of 40), of section 2 was 16 (out of 35) and of section 3 was 2 (out of 5). According to Misinformation tool, the worst described aspect was the one regarding the possible risk factor associated to placenta accreta. Performing the quality assessment according to video authoring entity, videos produced by healthcare workers harbored a higher quality content, relative to the others.Conclusions: Currently, the overall consideration of YouTube™ video content on placenta accreta is low. Societies should invest new sources in producing higher quality videos to provide a helpful tool for physician during the counselling with patients. [ABSTRACT FROM AUTHOR]

• In patients with solitary organ-specific metastatic sites, solitary bone metastases portend the most favorable overall survival (OS) vs. solitary liver metastases portend the most unfavorable OS. • Increasing number of organ-specific metastatic sites is associated with worse OS. • In patients with combinations of 2 or 3 different organ-specific metastatic sites OS is very poor, regardless of the type of combination. The prognostic significance of number and location of organ-specific metastatic sites in treated metastatic clear cell renal carcinoma (ccmRCC) patients is object of debate. The current study aimed to test the association between number and location of organ-specific metastatic sites and overall survival (OS) in ccmRCC. Within Surveillance, Epidemiology and End Results database (2010–2018), all ccmRCC patients treated with cytoreductive nephrectomy and/or systemic therapy were identified. Kaplan-Meier plots and Cox regression models focused on: A). number of organ-specific metastatic sites: solitary vs. 2 vs. 3 or more; B). solitary organ-specific metastatic sites (lung vs. bone vs. liver vs. brain); C). combinations of 2 and 3 or more different organ-specific metastatic sites. Of 4,527 patients (median OS: 19 months), 3,054 (67%) harbored solitary organ-specific metastatic sites (27 months) vs. 1,153 (25%) combinations of 2 different organ-specific metastatic sites (12 months) vs. 320 (8%) combinations of 3 or more different organ-specific metastatic sites (7 months). In patients with solitary organ-specific metastatic sites, bone metastases portended the longest median OS (median OS: 31 months) vs. liver metastases portended the shortest median OS (16 months). Both were independent predictors of OS (multivariable hazard ratio, bone: 0.87; liver: 1.21). Median OS was similarly poor in patients with combinations of 2 different organ-specific metastatic sites (9–13 months), regardless of their location. The same pattern applied to patients with combinations of 3 or more different organ-specific metastatic sites (6–7 months). Solitary organ-specific metastatic sites portend the most favorable OS (16–31 months). Solitary bone metastases yield the longest vs. liver metastases the shortest OS. Invariably poor OS applies to combinations of 2 (9–13 months), as well as 3 or more different organ-specific metastatic sites (6–7 months), regardless of their location. [ABSTRACT FROM AUTHOR]

• Stage III testis cancer prognosis is associated to first years of survival. • Longer disease-free interval duration is associated with better overall survival. • The magnitude of the survival advantage is specific to prognosis groups. • Stronger protective effect is recorded in more unfavorable prognosis groups. In many primaries other than non-seminoma testis cancer, the risk of death due to cancer decreases with increasing disease-free interval duration after initial diagnosis and treatment. This effect is known as conditional survival and is relatively unexplored in stage III non-seminoma patients, where it may matter most in clinical decision-making. We examined the effect of disease-free interval duration on overall survival in stage III non-seminoma patients. Within the Surveillance, Epidemiology, and End Results Database (2004–2018), stage III non-seminoma patients were identified. Multivariable Cox regression analyses and conditional survival models were applied. Of 2,092 surgically treated stage III non-seminoma patients, 385 (18%) exhibited good vs. 558 (27%) intermediate vs. 1,149 (55%) poor prognosis. In multivariable Cox regression models, poor prognosis group independently predicted overall mortality (HR 3.3, P < 0.001). In conditional survival analyses based on 36 months' disease-free interval duration, 5-year overall survival estimates were as follows: good prognosis patients 96 vs. 89% at initial diagnosis without accounting for disease-free interval duration (Δ=+7); intermediate prognosis patients 94 vs. 85% at initial diagnosis without accounting for disease-free interval duration (Δ=+9); poor prognosis patients 94 vs. 65% at initial diagnosis without accounting for disease-free interval duration (Δ=+29). Conditional survival estimates based on 36 months' disease-free interval duration provide a more accurate and more optimistic outlook for stage III non-seminoma patients than predictions defined at initial diagnosis, without accounting for disease-free interval duration. [ABSTRACT FROM AUTHOR]

• Adenocarcinoma of the bladder (ACB) represents ∼2% of all bladder cancers. • Radical cystectomy favorably impacts cancer specific mortality of ACB. • The survival benefit remains unchanged after control for immortal time bias. To evaluate the association between radical cystectomy (RC) and cancer-specific mortality (CSM) in patients diagnosed with adenocarcinoma of the bladder (ACB). Moreover, to directly compare the survival advantage of RC between ACB vs. urothelial bladder cancer (UBC). Non-metastatic muscle-invasive ACB and UBC patients were identified within Surveillance, Epidemiology, and End Results database (SEER 2000–2018). All analyses were stratified between RC vs. no-RC, in either organ-confined (OC: T 2 N 0 M 0) or non-organ-confined (NOC: T 3-4 N 0 M 0 or T any N 1-3 M 0) stages. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, and 3 months' landmark analyses were performed. Overall, 1,005 ACB and 47,741 UBC patients were identified, of whom 475 (47%) and 19,499 (41%) were treated with RC, respectively. After PSM, comparison between RC vs. no-RC applied to 127 vs. 127 OC-ACB, 7,611 vs. 7,611 OC-UBC, 143 vs. 143 NOC-ACB, and 4,664 vs. 4,664 NOC-UBC patients. 36-month CSM rates in RC vs. no-RC patients were 14 vs. 44% in OC-ACB, 18 vs. 39% in OC-UBC, 49 vs. 66% in NOC-ACB, and 44 vs. 56% in NOC-UBC patients. In CRR analyses, the effect of RC on CSM yielded a hazard ratio of 0.37 in OC-ACB, of 0.45 in OC-UBC, of 0.65 in NOC-ACB and of 0.68 in NOC-UBC patients (all P values<0.001). Landmark analyses virtually perfectly replicated the results. In ACB, regardless of stage, RC is associated with lower CSM. The magnitude of this survival advantage was greater in ACB than in UBC, even after control for immortal time bias. [ABSTRACT FROM AUTHOR]