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We aim to evaluate the diagnostic accuracy of PET–CT/MRI in the local and distant staging of patients with muscle invasive bladder cancer (MIBC). Medline, Pubmed and EMBASE were searched for studies evaluating the diagnostic performance of PET–CT/MRI in the primary staging of MIBC patients. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR, respectively) and diagnostic odds ratio (DOR = PLR/NLR) are reported. We retrieved 35 articles. For local staging, a pooled sensitivity and specificity of 88% (95% CI: 81–92%) and 68% (95% CI: 50–82%), respectively, were found. The PLR and NLR are 2.88 (95% CI: 1.71–4.73) and 0.19 (95% CI: 0.12–0.30) resulting in a DOR of 16.60 (95% CI: 5.98–37.50). For regional lymph node staging, the pooled sensitivity and specificity are 57% (95% CI: 5–63%) and 89% (95% CI: 83–3%). The PLR is 5.33 (95% CI: 3.44–8.09) and NLR is 0.48 (95% CI: 0.42–0.55). The corresponding DOR is 11.10 (95% CI: 6.62–17.60). For distant metastases, a pooled sensitivity and specificity of 89% (95% CI: 61–98%) and 95% (95% CI: 80–99%), respectively, were found. The PLR is 23.70 (95% CI: 4.19–72.10) and the NLR is 0.13 (95% CI: 0.02–0.36) with a DOR of 236.00 (95% CI: 38.00–871.00). PET–CT/MRI appears to have higher diagnostic accuracy than CT or MRI for local and distant staging of MIBC but it cannot (yet) be recommended in clinical practice because the quality of the evidence is insufficient and the effects on treatment decisions and patient’s outcome remain unclear.

This umbrella review aims to evaluate the quality, summarize and compare the conclusions of systematic reviews investigating the impact of curative treatment options on health-related quality of life (HRQoL) in muscle-invasive bladder cancer (MIBC). The Cochrane Library, MEDLINE, Embase and Web of Science were searched independently by two authors from inception until 06 January 2020. Systematic reviews and meta-analyses assessing the impact of any curative treatment option on HRQol in MIBC patients were eligible. Risk of bias was assessed using the AMSTAR 2 tool. Thirty-two reviews were included. Robot-assisted RC with extracorporeal urinary diversion and open RC have similar HRQoL (n = 10). Evidence for pelvic organ-sparing RC was too limited (n = 2). Patients with a neobladder showed better overall and physical HRQoL outcomes, but worse urinary function in comparison with ileal conduit (n = 17). Bladder-preserving radiochemotherapy showed slightly better urinary and sexual but worse gastro-intestinal HRQoL outcomes in comparison with RC patients (n = 6). Quality of the reviews was low in more than 50% of the available reviews and most of the studies included in the reviews were nonrandomized studies. This umbrella review gives a comprehensive overview of the available evidence to date.

PURPOSE: To determine the start exercise prescription dose in metastatic castrate-resistant prostate cancer (mCRPC) patients receiving second-line hormone treatment and recommended phase II exercise prescription. METHODS: Patients were enrolled in a 3 + 3 dose escalation phase I trial of aerobic, resistance, and flexibility exercises to evaluate dose-limiting tolerance and safety. Tolerance was defined as Borg score ≤ 16 and safety (pain) as a visual analogue scale score (VAS) ≤ 3 and CTCAE grade 3 during resistance training and/or flexibility training. No tolerance issues were observed in the two dosing cohorts. The optimal start exercise prescription dose was set at dose level 1 due to safety issues at dose level 2. CONCLUSION: Our findings suggest that exercise is perceived tolerable in mCRPC patients receiving second-line hormone therapy. Caution is indicated on safety during performance of the exercises.

Patients with oligometastatic prostate cancer (PC) may benefit from metastasis-directed therapy (MDT), delaying disease progression and the start of palliative systemic treatment. However, a significant proportion of oligometastatic PC patients progress to polymetastatic PC within a year following MDT, suggesting an underestimation of the metastatic load by current staging modalities. Molecular markers could help to identify true oligometastatic patients eligible for MDT. Patients with asymptomatic biochemical recurrence following primary PC treatment were classified as oligo- or polymetastatic based on 18F-choline PET/CT imaging. Oligometastatic patients had up to three metastases at baseline and did not progress to more than three lesions following MDT or surveillance within 1 year of diagnosis of metastases. Polymetastatic patients had > 3 metastases at baseline or developed > 3 metastases within 1 year following imaging. A model aiming to prospectively distinguish oligo- and polymetastatic PC patients was trained using clinicopathological parameters and serum-derived microRNA expression profiles from a discovery cohort of 20 oligometastatic and 20 polymetastatic PC patients. To confirm the models predictive performance, it was applied on biomarker data obtained from an independent validation cohort of 44 patients with oligometastatic and 39 patients with polymetastatic disease. Oligometastatic PC patients had a more favorable prognosis compared to polymetastatic ones, as defined by a significantly longer median CRPC-free survival (not reached versus 38 months; 95% confidence interval 31–45 months with P

This study addresses the effects of negative attainability feedback on the shift from engagement to disengagement from a career goal. It was hypothesized that negative attainability feedback regarding study choice may lead to both goal engagement and goal disengagement and that this relation is mediated by self-efficacy, motivational beliefs, and by the perceived accuracy of feedback. Results confirmed that negative feedback led to goal disengagement and, to a lesser extent, to continued engagement. Perceived accuracy of feedback was an important mediator, as was motivation. Self-efficacy did not predict either goal management strategies.

OBJECTIVES: To investigate risk factors for retinopathy of prematurity (ROP) in a newly established ROP screening and management programme in Rwanda, Africa. METHODS: In this multi-centre prospective study 795/2222 (36%) babies fulfilled the inclusion criteria (gestational age (GA) 30 weeks and BW > 1500 g, one of whom required treatment. In univariate analysis the following were associated with any ROP: increasing number of days on supplemental oxygen (OR 2.1, CI 1.5-3.0, P

The goal of this work was to investigate the oncological outcome of whole pelvis radiotherapy (wpRT) in pathologic pelvic lymph node-positive (pN1) prostate cancer (PCa), evaluate the location of relapse, and identify potential prognostic factors. All patients undergoing pelvic lymph node dissection (PLND) since the year 2000 at a single tertiary care center were evaluated. A total of 154 patients with pN1 PCa were treated with wpRT (39 in an adjuvant setting) and 2–3 years of androgen deprivation therapy (ADT). Kaplan–Meier analysis was performed to estimate biochemical recurrence-free survival (bRFS), clinical progression-free survival (cPFS), and prostate cancer-specific survival (CSS). Uni- and multivariate regression analyses were performed to identify prognostic factors. Estimated bRFS was 67%, cPFS was 71%, and CSS was 96% at 5 years. Median follow-up was 55 months (interquartile range 25–87). Multivariate analysis identified having only 1 positive lymph node, a shorter time between diagnosis and PLND, and older age as independent favorable prognostic factors for biochemical and clinical recurrence. The number of positive lymph nodes was prognostic for CSS (hazard ratio [HR] 1.34, 95% confidence interval 1.17–1.54) and OS (HR 1.22, 95% confidence interval 1.10–1.36). Bone metastases were the most frequent location of PCa relapse (n = 32, 64%). Patients with pN1 PCa treated with wpRT and 2–3 years ADT have an encouraging 5‑year CSS. Understaging of the disease extent may be the most important enemy in definitive pN1 PCa treatment.

Searching for sustainable cropping systems has often focused on the optimization of system sustainability, yield or ideally both. It is important to also include wheat quality characteristics like grain protein concentration (GPC) and bread-making quality (loaf volume). The effect of placement and timing of nitrogen (N) fertilizer on performance and quality of the bread wheat cultivar Navojoa, was tested in two tillage systems under furrow irrigation: conventionally tilled beds (CTB; new beds formed after disc ploughing and residue incorporation) and permanent beds (PB; only furrows reshaped and residues retained on the surface). N fertilizer (120 kg N ha−1 as urea) was broadcast, applied in furrows or disk-banded on top of beds. The timing treatments were all fertilizer applied before planting or split between pre-planting and first node. Permanent beds had the highest yield and grain quality was highest with split bed and furrow application. Averaged over four years, N use efficiency and GPC were significantly higher in CTB (24.5 kg kg−1 and 10.1 %, respectively) than in PB (22.2 kg kg−1 and 9.9 %, respectively) indicating the necessity in PB for optimal N management to obtain stable yields and acceptable grain quality. A reduced number of cold hours and solar radiation negatively affected grain yield. Broadcast fertilizer application reduced grain quality and N use efficiency. N fertilizer management in furrow-irrigated wheat cropping systems should combine splitting the N dose and disking it on the bed pre-planting and in the furrow later in the season, depending on the crop needs at the application time.

A new, Holland-based Interest Inventory is proposed, intended to facilitate the transition from secondary to tertiary education. Specific interest items were designed to grasp activities that are prevalent during tertiary studies, including an Academic-track-scale to assist in the choice between academic and vocational-oriented programs. Interest profile descriptions are complemented by a list of matching study programs. Data from 3,962 students were analyzed to evaluate the underlying circumplex structure, the criterion validity of the Academic-track-scale and the study program RIASEC codes. It is concluded that the assessment and feedback tools are promising instruments to facilitate the transition to tertiary education.

To analyse the characteristics of prostate cancers (PrCa) detected following negative multiparametric magnetic resonance imaging (mpMRI).Eight hundred and thirty patients with elevated prostate-specific antigen (mean 11.9 μg/l) underwent mpMRI of the prostate at 1.5 Tesla with endorectal coil. The characteristics of all PrCa detected within 2 years after a negative mpMRI were analysed. Primary Gleason grade 4 or any grade 5 PrCa were considered high-grade (HG), Gleason score 3 + 4 intermediate grade (IG) and Gleason score ≤3 + 3 low-grade (LG). Tumour size was considered 'small' when1 cm on radical prostatectomy specimen or limited to ≤2 cores on prostate biopsy.mpMRI was negative in 391 patients (47.1 %). In 124 patients (31.7 %) PrCa was detected within 2 years. Eighty-four (67.7 %) were LG, 22 (17.7 %) IG and 18 (14.5 %) HG. 119 (96.0 %) of the missed PrCa were organ-confined. The negative predictive value was 95.4 % (373/391) for HG PrCa. Among the 18 missed HG PrCa, 15 (83.3 %) were organ-confined and 12 (66.6 %) were small.The majority of missed tumours on mpMRI were low grade and organ-confined. In patients with elevated PSA and a negative mpMRI, consideration could be given to continued surveillance rather than immediate biopsy.• The majority of missed prostate cancers were low grade and organ-confined. • In patients with a negative mpMRI a biopsy may be postponed. • mpMRI had a negative predictive value of 95.4 % for high-grade prostate cancer.

The use of engineered nanoparticles (NP) is widespread and still increasing. There is a great need to assess their safety. Newly engineered NP enter the market in a large variety; therefore safety evaluation should preferably be in a high-throughput fashion. In vitro screening is suitable for this purpose. TiO 2 NP exist in a large variety (crystal structure, coating and size), but information on their relative toxicities is scarce. TiO 2 NP may be inhaled by workers in e.g. paint production and application. In mice, inhalation of TiO 2 NP increases allergic reactions. Dendritic cells (DC) form an important part of the lung immune system, and are essential in adjuvant activity. The present study aimed to establish the effect of a variety of TiO 2 NP on DC maturation in vitro. Two NP of different crystal structure but similar in size, uncoated and from the same supplier, were evaluated for their adjuvant activity in vivo. Immature DC were differentiated in vitro from human peripheral blood monocytes. Exposure effects of a series of fourteen TiO 2 NP on cell viability, CD83 and CD86 expression, and IL-12p40 and TNF-α production were measured. BALB/c mice were intranasally sensitized with ovalbumin (OVA) alone, OVA plus anatase TiO 2 NP, OVA plus rutile TiO 2 NP, and OVA plus Carbon Black (CB; positive control). The mice were intranasally challenged with OVA. OVA-specific IgE and IgG1 in serum, cellular inflammation in bronchoalveolar lavage fluid (BALF) and IL-4 and IL-5 production in draining bronchial lymph nodes were evaluated. All NP dispersions contained NP aggregates. The anatase NP and anatase/rutile mixture NP induced a higher CD83 and CD86 expression and a higher IL-12p40 production in vitro than the rutile NP (including coated rutile NP and a rutile NP of a 10-fold larger primary diameter). OVA-specific serum IgE and IgG1 were increased by anatase NP, rutile NP, and CB, in the order rutile

In the psychology and educational science programs at Ghent University, only 36.1 % of the new incoming students in 2011 and 2012 passed all exams. Despite availability of information, many students underestimate the scientific character of social science programs. Statistics courses are a major obstacle in this matter. Not all enrolling students master the basic mathematical skills needed to pass statistics courses. Therefore, we propose a test that measures these skills. Our aim is to examine the predictive validity of the test with regard to the statistics course and also as to overall academic success. The results indicate that a test of very basic mathematics skills helps identify at-risk students at and before the start of the academic year. The practical implications of these results are discussed. The test aids the efficient use of means for remedial interventions and supports future students in choosing a higher education program that suits their potential.

The biological response to four well-characterized amorphous silica nanoparticles was investigated in RAW 264.7 macrophages in view of their potential application as drug carriers to sites of inflammation. All silica nanoparticles-induced cell membrane damage, reduced metabolic activity, generated ROS and released various cytokines, but to different extents. Two silica nanoparticles of 34 nm (A and B) with different zetapotentials were more cytotoxic than (aggregated) 11 and 248 nm nanoparticles, while cytokines were mostly induced by the (aggregated) 11 nm and only one of the 34 nm nanoparticles (34A). The results indicate that specific silica nanoparticles may have counterproductive effects, for example when used as carriers of anti-inflammatory drugs. The physicochemical properties determining the response of nanoparticles vary for different responses, implying that a screening approach for the safe development of nanoparticles needs to consider the role of combinations of (dynamic) physicochemical properties and needs to include multiple toxicity endpoints.

In unterschiedlichen Arbeiten wurde bisher prinzipiell die Machbarkeit einer laparoskopischen Zystektomie gezeigt. Der Sinn dieser Vorgehensweise wird aber vor allem aufgrund langerer Operationszeiten und einer fraglichen Tumorkontrolle in Frage gestellt. Nach Etablierung der radikalen Prostatektomie (n=650) beschreiben wir unsere Erfahrungen und Ergebnisse mit der DaVinci-Zystektomie. Insgesamt 27 Patienten (24 Manner), die von Januar 2004 bis Dezember 2006 mit dem DaVinci-System operiert wurden, konnten in der aktuellen Arbeit berucksichtigt werden. Die Indikation zur Operation bestand aufgrund eines muskelinvasiven Tumorwachstums (n=24) oder nach Radiatio einer tumortragenden Blase mit konsekutiver Schrumpfblase (n=4). Bei allen Patienten erfolgte eine pelvine Lymphadenektomie. Als Harnableitung erfolgte bei 19 Patienten die Anlage eines Ileumconduits, 8 Patienten erhielten eine Ileumneoblase. Die mittlere Operationszeit lag bei 340 min (Spanne: 150–450 min), bei einem durchschnittlichen Blutverlust von 301 ml (Spanne: 50–550 ml). Die Anzahl an entnommenen Lymphknoten wurde mit 23 bestimmt. Bei einem Patienten ergab die histologische Untersuchung einen positiven Schnittrand. Nach einem mittleren Follow-up von 10,2 Monaten wurden 2 perioperative Komplikationen (Anastomosenlekage, Adhasionen) und 3 postoperative Komplikationen (Ileus, Dunndarmfistel) festgestellt. Nach nerverhaltender Operation berichteten 6/7 Patienten uber eine zufriedenstellende postoperative Erektion. Kontinent waren nach durchschnittlich 3,5 Monaten 7/8 Patienten. Die roboterunterstutzte laparoskopische Zystektomie ist eine sichere und komplikationsarme Operationsmethode. Bei akzeptablen Operationszeiten konnen exzellente funktionelle und onkologische Ergebnisse erreicht werden.

In-line skating has been reported to cause severe head injury. Basilar skull fracture (BSF) is associated with a high risk of complication. We report two children who had bacterial meningitis following seemingly trivial in-line skating injuries. In both, anterior BSF was diagnosed retrospectively following occurrence of Streptococcus pneumoniae meningitis. The clinical signs indicating BSF depend on the fracture location. Plain skull radiography and computed tomography (CT) are not sensitive enough to detect thin fractures in the anterior cranial fossa. We argue that high resolution multiple-plane CT and coronal T2-weighted magnetic resonance imaging are indicated to diagnose BSF.

During recent years many urologists have been convinced of the advantages of robot-assisted, minimally invasive urological procedures. Because microscope-assisted vasovasostomy is a rather uncommon procedure, most urologists lack microsurgical experience. Use of the da Vinci robotic system (Intuitive Surgical, Mountain View, CA, USA) virtually eliminates the microsurgical challenge of tremor, limited dexterity, and miniaturized instrumentation. Different centres have investigated the use of robotic assistance in vasovasal anastomosis in animal and human ex-vivo models. According to the current literature we are the first European centre to report a successful in-vivo robot-assisted vasovasostomy using the da Vinci robotic system.