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This article discusses the management of refractory chyle leak after retroperitoneal lymph node dissection (RPLND), a surgical procedure used in the treatment of germ cell malignancy. Chyle leak, the accumulation of chyle in the peritoneal cavity, can lead to complications such as delayed wound healing and malnutrition. The article presents a case study of a patient who developed chyle leak after RPLND and outlines the treatment strategies used, including glue embolization and drainage. The authors propose a management algorithm for refractory chyle leak and provide recommendations for preventing chyle leak during RPLND. [Extracted from the article]

Objective To identify clinicopathological or radiological factors that may predict a diagnosis of upper urinary tract urothelial cell carcinoma (UTUC) to inform which patients can proceed directly to radical nephroureterectomy (RNU) without the delay for diagnostic ureteroscopy (URS). Patients and Methods All consecutive patients investigated for suspected UTUC in a high-volume UK centre between 2011 and 2017 were identified through retrospective analysis of surgical logbooks and a prospectively maintained pathology database. Details on clinical presentation, radiological findings, and URS/RNU histopathology results were evaluated. Multivariate regression analysis was performed to evaluate predictors of a final diagnosis of UTUC. Results In all, 260 patients were investigated, of whom 230 (89.2%) underwent URS. RNU was performed in 131 patients (50.4%), of whom 25 (9.6%) proceeded directly without URS - all of whom had a final histopathological diagnosis of UTUC - and 15 (11.5%) underwent RNU after URS despite no conclusive histopathological confirmation of UTUC. Major surgery was avoided in 77 patients (33.5%) where a benign or alternative diagnosis was made on URS, and 14 patients (6.1%) underwent nephron-sparing surgery. Overall, 178 patients (68.5%) had a final diagnosis of UTUC confirmed on URS/RNU histopathology. On multivariate logistic regression analysis, a presenting complaint of visible haematuria (hazard ratio [HR] 5.17, confidence interval [CI] 1.91-14.0; P = 0.001), a solid lesion reported on imaging (HR 37.8, CI = 11.7-122.1; P < 0.001) and a history of smoking (HR 3.07, CI 1.35-6.97; P = 0.007), were predictive of a final diagnosis of UTUC. From this cohort, 51 (96.2%) of 53 smokers who presented with visible haematuria and who had a solid lesion on computed tomography urogram had UTUC on final histopathology. Conclusion We identified specific factors which may assist clinicians in selecting which patients may reliably proceed to RNU without the delay of diagnostic URS. These findings may inform a prospective multicentre analysis including additional variables such as urinary cytology. [ABSTRACT FROM AUTHOR]

Wastewater has been widely reclaimed to irrigate crops where freshwater resources are scarce. Therefore, predicting the impacts of wastewater irrigation on soil moisture and soil salinity is critical for sustainable wastewater irrigation management. In this study, the denitrification‐decomposition (DNDC) model was modified to couple wastewater irrigation with a water balance equation (SALT‐DNDC). Secondly, the SALT‐DNDC model was verified against the measured soil moisture, temperature, and nitrous oxide emission during the barley‐growing season at Lethbridge, Alberta, Canada. Third, the SALT‐DNDC model was used to predict the effects of one‐time and split wastewater irrigation with varying quantity and quality on transpiration and soil salinity. The results showed that split irrigation of wastewater with an electrical conductivity of 6 dS m−1 reduced the peak soil salinity from 52–55 dS m−1 to a range of 8–20 dS m−1, compared to one‐time irrigation. Therefore, the split irrigation of wastewater could substantially reduce peak soil salinity. In this regard, optimal split wastewater irrigation with elevated salt concentration can limit soil salinity to acceptable salt tolerance levels for crop growth. The SALT‐DNDC model can simulate dynamics of split irrigation wastewater and offers a new tool for assessing the effects of wastewater reuse on soil salinity. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to establish a robust and reliable metaproteomics protocol for an in‐depth characterization of marine particle‐associated (PA) bacteria. To this end, we compared six well‐established protein extraction protocols together with different MS‐sample preparation techniques using particles sampled during a North Sea spring algae bloom in 2009. In the final optimized workflow, proteins are extracted using a combination of SDS‐containing lysis buffer and cell disruption by bead‐beating, separated by SDS‐PAGE, in‐gel digested and analysed by LC–MS/MS, before MASCOT search against a metagenome‐based database and data processing/visualization with the in‐house‐developed bioinformatics tools Prophane and Paver. As an application example, free‐living (FL) and particulate communities sampled in April 2009 were analysed, resulting in an as yet unprecedented number of 9354 and 5034 identified protein groups for FL and PA bacteria, respectively. Our data suggest that FL and PA communities appeared similar in their taxonomic distribution, with notable exceptions: eukaryotic proteins and proteins assigned to Flavobacteriia, Cyanobacteria, and some proteobacterial genera were found more abundant on particles, whilst overall proteins belonging to Proteobacteria were more dominant in the FL fraction. Furthermore, our data points to functional differences including proteins involved in polysaccharide degradation, sugar‐ and phosphorus uptake, adhesion, motility, and stress response. [ABSTRACT FROM AUTHOR]

In this study, the low velocity impact properties of rotationally molded skin–foam–skin sandwich structures were investigated experimentally since there is a need for a greater understanding of the impact behavior of these composites in service to extend the range of their applications. Polyethylene rotationally molded sandwich structures were manufactured at various skin and core layer thickness combinations and tested using an instrumented low velocity drop weight impact testing machine at 20–100 J impact energy levels, at room temperature. This allowed the identification of the impact response, failure mode, and the effects of the skin and core layer thickness on impact resistance. Force–deflection curves, maximum force, contact time, maximum deflection versus impact energy curves were analyzed. Samples were seen to fail due to the indentation dart piercing the upper and lower skins, with crushing and consolidation seen in the core foamed layer. Delamination at the core/skin interface was not observed. It was found that fracture initiates from the lower skin and then continues to grow to the upper skin via the foamed core layer. The impact resistance was noted to increase with increasing skin and core layer thickness; though an increase in skin layer thickness had a greater contribution than an increase in the core layer thickness. POLYM. ENG. SCI., 60: 387–397, 2019. © 2019 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Abstract: Long‐term cattle grazing may degrade grassland soils, but how soil CO2, CH4 and N2O fluxes respond to long‐term cattle grazing is poorly understood. Therefore, we quantified soil CO2, CH4 and N2O fluxes in response to four levels (none, light, heavy, very heavy) of long‐term (>65 years) cattle grazing on a rough fescue grassland in the foothills of the Rocky Mountains, Canada over three grazing seasons. The grazed grassland soils emitted 37 to 51% more CO2 than non‐grazed soils. Grazed grassland soils were small CH4 sinks and small N2O sources each season, and their cumulative fluxes were significantly affected by a cattle stocking rate × year interaction, indicating the grazing effect was influenced by environmental conditions. Soil CH4 uptake was negatively correlated with soil moisture (r = −0·59). The 2013 grazing season had about 41% greater precipitation than average and grazing significantly decreased CH4 uptake 31 to 38% compared with non‐grazed soils. The N2O emissions were 122 to 179% greater with heavy and very heavy grazing than none in the wet season, unaffected by grazing in the normal precipitation season and 72% lower with light grazing than none in the dry season. Predicting trace gas fluxes from grazed grassland soils across space and time is difficult because of interactions among weather conditions, edaphic properties and grazing intensity. However, long‐term cattle grazing increased soil CO2 fluxes, while the grazing effect on CH4 uptake depended on precipitation and the soil N2O flux responded as a function of grazing intensity and precipitation. © 2016 Her Majesty the Queen in Right of Canada. Land Degradation & Development Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

In this work, the fracture toughness of rotationally molded polyethylene (PE) and polypropylene (PP) was measured using J integral methods at static loading rates and at room temperature. Two different commercially available rotational molding grades PE and PP were tested in this study which have been used in various rotationally molded products such as small leisure craft, water storage tanks, and so on. Scanning electron microscope (SEM), optical microscope, differential scanning calorimetry (DSC), solid-state nuclear magnetic resonance (solid-state NMR), and X-ray scattering were used to investigate the microstructure, fracture surfaces, and compare toughness properties of these materials. In PE, higher molecular weight and broader molecular weight distribution, larger amorphous and crystal region thicknesses are found to be related to higher toughness values. High molecular weight favors higher number of entanglements that improve fracture energy and broader distribution increases long chain branching of higher molecular weight fractions which creates higher entanglements at the branch sites. Larger amorphous regions promote microvoiding more easily compared to thinner amorphous regions, leading to greater plastic deformation and energy absorption. Higher crystal thickness also contributes to microvoiding in the amorphous region. For PP, greater plastic deformation observed in the fracture surfaces is related to higher fracture toughness values. POLYM. ENG. SCI., 58:63-73, 2018. © 2017 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Urease and/or nitrification inhibitors applied to urine patches or pastures may increase N retention in the soil-plant system, but how N2O emissions respond to these N stabilizers in semiarid regions is poorly understood. The objectives of this research were (i) to quantify N2O emissions and the associated emission factors, based on the percentage of applied urine-N emitted as N2O-N, from beef cattle urine patches (urine) and (ii) to test the N2O reduction potential of three N stabilizers [2-chloro-6(trichloromethyl) pyridine (nitrapyrin), N-(n-butyl)-thiophosphoric triamide (NBPT), and NBPT plus dicyandiamide (DCD)] on a semiarid tame pasture over two grazing seasons in western Canada. A deionized water control was also included. Nitrapyrin reduced cumulative N2O emissions by 39% and the N2O emission factor by 50% compared with untreated urine in a dry grazing season and reduced cumulative N2O emissions by 58% and the N2O emission factor by 68% compared with untreated urine in a grazing season with normal precipitation. The NBPT and NBPT + DCD had similar cumulative N2O emissions compared with untreated urine patches. The N2O emission factors ranged from 0.03 to 0.08% over 103 d in 2015 and from 0.06 to 0.21% over 119 d in 2016, all lower than the 2% Intergovernmental Panel on Climate Change default 365-d value. Extrapolating over 1 -yr periods, N2O emission factors ranged from 0.11 to 0.64%. Based on the N stabilizers tested, nitrapyrin most effectively reduced N2O emissions from beef cattle urine patches on a tame pasture in a nonirrigated semiarid region of Canada. [ABSTRACT FROM AUTHOR]

Service users' involvement in mental health service research is increasingly acknowledged as important, yet, whilst involving users of mental health services as research participants is commonplace, seeking out their experience and indeed their 'expertise' to facilitate the development of tools to be used within mental health services is in its infancy. This article describes the involvement and views of service users in the development of a nursing metric-the Therapeutic Engagement Questionnaire. It presents their role in the three stages of development: generation, statement reduction and authentication. [ABSTRACT FROM AUTHOR]

Limited information is available about soil nitrous oxide (N2O) fluxes, N2O emission factors (EFs), and yield-scaled N2O emissions for biogas residues used to fertilize crops in semiarid regions. To address this knowledge gap, a 4-yr field experiment was conducted in a semiarid climate to determine growing season N2O fluxes from soil receiving (i) anaerobically digested solid beef cattle manure (digestate), (ii) separated solids from the digestate (separated solids), and (iii) undigested solid beef cattle manure (cattle manure) applied to target one and two times the recommended rates (200 and 400 kg total N ha-1) for barley (Hordeum vulgare L.) forage, assuming 50% of N was annually plant available. Nitrous oxide fluxes were determined using vented static chambers. Over the four growing seasons, 95, 80, and 81% of the N2O flux occurred within 36 d of applying digestate, separated solids, and cattle manure, respectively. The cumulative N2O emissions with digestate were 4.7 and 4.1 times the values of the separated solids and cattle manure, respectively. The digestate N2O EF was 13.6 and 10.6 times the values of the separated solids and cattle manure, respectively, but the N2O EF based on applied mineral N was similar for all amendments. The yield-scaled N2O emissions with digestate were 4.3 and 3.6 times the values of the separated solids and cattle manure, respectively. In the semiarid region of southern Alberta, liquid biogas residues have a higher risk for N2O emissions than both the separated solid fraction of the biogas residues and undigested cattle manure. [ABSTRACT FROM AUTHOR]

Solid beef cattle manure is a good anaerobic digestion feedstock for methane production, but more research is needed to determine how co-products of the anaerobically digested manure may be used in crop production, while limiting the risk of nutrient loss to the environment. Over four growing seasons, we measured the N and P supplied to barley (Hordeum vulgare L.) forage test crops from (i) anaerobically digested solid beef cattle manure (digestate), (ii) separated solids from the digestate (separated solids), (iii) pelletized separated solids (pellets), and (iv) undigested solid beef cattle manure (manure) that were applied to target 1x (260 kg N ha-1) and 2x (520 kg N ha-1) the recommended N rates. Non-amended soil was the control. Digestate led to 31 to 50% greater barley forage yield than the other amendments. The apparent N recovery from digestate (19%) was much greater than pellets (2%) and about double that of the separated solids (9%) and cattle manure (10%). The barley N uptake derived from digestate was 41%, which was significantly greater than manure (22%), separated solids (17%), and pellets (2%). Digestate increased P uptake, while significantly reducing soil-test P accumulation compared with the other coproducts and cattle manure when applied at N-based rates. Our results confirmed that management practices for solid beef cattle feedlot manure may be used for separated solids, but not digestate. Pelletized separated solids may be an effective slow release fertilizer, while also supplying C, but determination of its nutrient release patterns is required. [ABSTRACT FROM AUTHOR]

Limited information about how cover crop management impacts the agronomic performance of succeeding annual crops in semiarid regions constrains cover crop utilization. Therefore, over 2 yr we quantified how cover crop species (fall rye [Secale cereale L. 'AC Remington'] or oilseed radish [Raphanus sativus L. 'Tillage radish']) and nutrient source (compost or inorganic fertilizer) affected cover crop biomass and N uptake, soil nitrate N (NO3-N) and ammonium N (NH4-N), and the agronomic performance of the succeeding spring wheat (Triticum aestivum L.) test crop. Fall rye reduced pre-plant NO3-N by 2 to 18 times compared with oilseed radish, and reduced spring wheat grain yields by 38 to 58% compared with amended soils with no cover crop and oilseed radish. Inorganically fertilized soils led to 21% greater pre-plant soil NO3-N concentrations than the compost-amended soil in 2013-2014 but nutrient source did not significantly affect NO3-N concentrations in 2014-2015. A quadratic function explained 93% of the variability between pre-plant soil NH4-N plus NO3-N (0-7.5-cm depth) and spring wheat grain yield in 2014, indicating that the N supply limited spring wheat grain yield. We conclude that fall rye scavenged residual NO3-N better than oilseed radish during the non-growing season, particularly during the spring period when this perennial species assimilates N, but under semiarid conditions it may decompose and mineralize too slowly to supply N at the right time for the subsequent crop, while oilseed radish tended to boost spring wheat grain yield. [ABSTRACT FROM AUTHOR]

Cover crops retain post-harvest nutrients but how they impact non-growing season nitrous oxide (N2O) emissions is unclear. Therefore, we quantified how cover crop type (fall rye [Secale cereale L.] or oilseed radish [Raphanus sativus L.]) and fertilizer source (compost or inorganic fertilizer) affected N2O emissions, soil water-extractable organic C (WEOC) and nitrate (NO2) dynamics over two non-growing seasons. A treatment with no fertilizer or cover crop was also included. Weekly, N2O fluxes were determined using vented static chambers; soil WEOC and NO3-N concentrations were measured monthly. Each non-growing season, mean N2O fluxes were 74 to 450% greater in the winter (21 December-20 March) than spring (21 March-20 June) or fall (22 September-20 December). In winter 2014-2015, oilseed radish increased the mean N2O flux by 39 and 323% compared with fall rye and no cover crop, respectively, while the mean N2O fluxes were strongly correlated to the pre-winter (16 Dec. 2014) NO3 concentrations (r = 0.96; P < 0.001), indicating NO3 levels < 6 mg NO3-N kg-1 limited N2O fluxes. In 2014-2015, fall rye and oilseed radish had 76 and 154% greater cumulative N2O emissions than amended soils with no cover crop, respectively. Across both winters, an exponential model explained 67% of variability between the pre-winter WEOC to NO3 ratio and N2O fluxes, indicating that organic C and NO3 controlled over-winter N2O fluxes. Non-legume cover crops increased non-growing season N2O emissions, suggesting that cover crops concentrate denitrification substrates in root-associated soil to enhance N2O fluxes. [ABSTRACT FROM AUTHOR]

As biogas production expands, digestates from that industry are increasingly available as potential nutrient sources for crop production, but their agronomic value is poorly understood. Thus, a 5-yr field experiment was conducted to determine the agronomic values of anaerobically digested solid beef cattle feedlot manure (ADM) and the separated solids (SS) from ADM under a semiarid reduced-tillage dryland barley (Hordeum vulgare L.) forage cropping system. Three organic amendments, ADM, SS and undigested solid beef cattle feedlot manure (CM), were applied annually at 200 or 400 kg total N ha-1 for 4 yr, while the residual effect was examined in the fifth year. The higher N and P availability in ADM translated into greater barley forage yields, total N uptake, amendment-derived N uptake, and apparent N recovery (ANR) from ADM-amended soil than SS- and CM-amended soils, while there were no significant differences between soils receiving SS or CM. The ANR was 22% for ADM but only 12% for CM and 9% for SS. In contrast, P uptake, the fraction of amendment-derived P uptake, and apparent P recovery were similar among all amendments. Similar yields, ANR, post-harvest soil NH4, NO3 and Olsen-P concentrations between SS- and CM-amended soils suggest that they have a comparable agronomic value. Less residual Olsen-P in soil receiving ADM than SS or CM suggests that ADM is a lower risk for P accumulation when applied at N-based rates. We recommend that current agronomic values for cattle feedlot manure could be applied to SS but not ADM. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical and pathological trends, over a 10-year period, in robot-assisted laparoscopic prostatectomy ( RALP) in a UK regional tertiary referral centre. Patients and Methods In all, 1 500 consecutive patients underwent RALP between October 2005 and January 2015. Prospective data were collected on clinicopathological details at presentation as well as surgical outcomes and compared over time. Results The median (range) age of patients throughout the period was 62 (35-78) years. The proportion of preoperative high-grade cases (Gleason score 8-10) rose from 4.6% in 2005-2008 to 18.2% in 2013-2015 ( P < 0.001). In the same periods the proportion of clinical stage T3 cases operated on rose from 2.4% to 11.4% ( P < 0.001). The median prostate-specific antigen ( PSA) level at diagnosis did not alter significantly. Overall, 11.6% of men in 2005-2008 were classified preoperatively as high-risk by National Institute for Health and Care Excellence criteria, compared with 33.6% in 2013-2015 ( P < 0.001). The corresponding proportions for low-risk cases were 48.6% and 17.3%, respectively. Final surgical pathology showed an increase in tumour stage, Gleason grade, and nodal status over time. The proportion of pT3 cases rose from 43.2% in 2005-2008 to 55.5% in 2013-2015 ( P < 0.001), Gleason score 9-10 tumours increased from 1.8% to 9.1% ( P < 0.001) and positive nodal status increased from 1.6% to 12.9% ( P < 0.001) between the same periods. Despite this, positive surgical margin rates showed a downward trend in all pT groups across the different eras ( P = 0.72). Conclusion This study suggests that the patient profile for RALP in our unit is changing, with increasing proportions of higher stage and more advanced disease being referred and operated on. However, surgical margin outcomes have remained good. [ABSTRACT FROM AUTHOR]

Soil test indicators are needed to predict the contribution of soil organic N to crop N requirements. Labile organic matter (OM) fractions containing C and N are readily metabolized by soil microorganisms, which leads to N mineralization and contributes to the soil N supply to crops. The objective of this study was to identify labile OM fractions that could be indicators of the soil N supply by evaluating the relationship between the soil N supply, the C and N concentrations, and C/N ratios of water extractable OM, hot-water extractable OM, particulate OM, microbial biomass, and salt extractable OM. Labile OM fractions were measured before planting spring wheat ( Triticum aestivum L.) in fertilized soils and the soil N supply was determined from the wheat N uptake and soil mineral N concentration after 6 weeks. Prior to the study, fertilized sandy loam and silty clay soils received three annual applications of 90 kg available N (ha · y)−1 from mineral fertilizer, liquid dairy cattle manure, liquid swine manure or solid poultry litter, and there was a zero-N control. Water extractable organic N was the only labile OM fraction to be affected by fertilization in both soil types ( P < 0.01). Across both test soils, the soil N supply was significantly correlated with the particulate OM N ( r = 0.87, P < 0.001), the particulate OM C ( r = 0.83, P < 0.001), and hot-water extractable organic N ( r = 0.81, P < 0.001). We conclude that pre-planting concentrations of particulate OM and hot-water extractable organic N could be early season indicators of the soil N supply in fertilized soils of the Saint Lawrence River Lowlands in Quebec, Canada. The suitability of these pre-planting indicators to predict the soil N supply under field conditions and in fertilized soils from other regions remains to be determined. [ABSTRACT FROM AUTHOR]

Manuring soil alters mineralizable N pools and organic matter fractions, but the magnitude is manure-type and soil-texture specific, complicating prediction of N mineralization. Our objective was to determine the responses of residual soil mineralizable N parameters to manure-type and evaluate their relationships to initial organic C and N fractions, C/N ratios, and mineral N concentrations in sandy loam and silty clay soils after three annual spring applications of manure. Manure types were liquid swine manure (LSM), liquid dairy cattle manure (LCM), or solid poultry manure (SPM), all applied at 90 kg available N ha-1 yr-1. Mineral fertilizer (NPK) and a zero-N control (CTL) were also included. Composite soil samples collected (0- to 20-cm depth) before manure application were aerobically incubated at 25°C for 48 wk. Both soils mineralized N linearly over 48 wk (r2 = 0.96-0.99) and the silty clay soil did not converge to nonlinear, first-order kinetics. Pool I (N mineralized in first 2 wk) was the only mineralizable N pool affected by manure-type, which was depleted by SPM in the sandy loam and increased by LCM in the silty clay. Salt extractable organic N was significantly correlated to Pool I in both soil textures. Only Pool I was significantly correlated with N mineralized over 48 wk in the sandy loam and silty clay soils (r = 0.92 and 0.64, respectively). Overall, readily mineralizable N (Pool I) was the most sensitive and robust indicator of mineralizable N after three annual manure applications to agricultural soils from a humid temperate region. [ABSTRACT FROM AUTHOR]

Quality nursing plays a central role in the delivery of contemporary health and social care, with a positive correlation being demonstrated between patient satisfaction and the quality of nursing care received. One way to ensure such quality is to develop metrics that measure the effectiveness of various aspects of care across a variety of settings. Effective mental health nursing is predicated on understanding the lived experiences of service users in order to provide sensitively-attuned nursing care. To achieve this, mental health nurses need to establish the all-important therapeutic relationship, showing compassion and creating a dialogue whereby service users feel comfortable to share their experiences that help contextualize their distress. Indeed, service users value positive attitudes, being listened to, and being able to trust those who provide care, while mental health nurses value their ability to relate through talking, listening, and expressing empathy. However, the literature suggests that within mental health practice, a disproportionate amount of time is taken up by other activities, with little time being spent listening and talking to service users. The present study discusses the evidence relating to the therapeutic relationship in acute mental health wards and explores why, after five decades, it is not recognized as a fundamental metric of mental health nursing. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Endoscopic management of small, low-grade, non-invasive upper tract urothelial cell carcinoma (UTUC) is a management option for selected groups of patients. However, the long-term survival outcomes of endoscopically-managed UTUC are uncertain because only four institutions have reported outcomes of more than 40 patients beyond 50 months of follow-up. Moreover, there is significant variance in the degree of underlying UTUC pathology verification in some of these reports, which precludes an analysis of disease-specific survival outcomes. The present study represents one of the largest endoscopically managed series of patients with UTUC, with a long-term follow-up. The degree of verification of underlying UTUC pathology is one of the highest, which allows a grade-stratified analysis of different outcomes, including upper-tract recurrence-free survival, intravesical recurrence-free survival, renal unit survival and disease-specific survival. These outcomes provide further evidence suggesting that endoscopic management of highly selected, low-grade UTUC can provide effective oncological control, as well as renal preservation, in experienced centres. OBJECTIVE To report the long-term outcomes of patients with upper tract urothelial cell carcinoma (UTUC) who were treated endoscopically (either via ureteroscopic ablation or percutaneous resection) at a single institution over a 20-year period., PATIENTS AND METHODS Departmental operation records were reviewed to identify patients who underwent endoscopic management of UTUC as their primary treatment., Outcomes were obtained via retrospective analysis of notes, electronic records and registry data., Survival outcomes, including overall survival (OS), UTUC-specific survival (disease-specific survival; DSS), upper-tract recurrence-free survival, intravesical recurrence-free survival, renal unit survival and progression-free survival, were estimated using Kaplan-Meier methods and grade-stratified differences were analyzed using the log-rank test., RESULTS Between January 1991 and April 2011, 73 patients underwent endoscopic management of UTUC with a median age at diagnosis of 67.7 years., All patients underwent ureteroscopy and biopsy-confirmation of pathology was obtained in 81% ( n= 59) of the patients. In total, 14% ( n= 10) of the patients underwent percutaneous resection., Median (range; mean) follow-up was 54 (1-223; 62.8) months., Upper tract recurrence occurred in 68% ( n= 50). Eventually, 19% ( n= 14) of the patients proceeded to nephroureterectomy., The estimated OS and DSS were 69.7% and 88.9%, respectively, at 5 years, and 40.3% and 77.4%, respectively, at 10 years. The estimated mean and median OS times were 119 months and 107 months, respectively. The estimated mean DSS time was 190 months., CONCLUSIONS The present study represents one of the largest reported series of endoscopically-managed UTUC, with high pathological verification and long-term follow-up., Upper-tract recurrence is common, which mandates regular ureteroscopic surveillance., However, in selected patients, this approach has a favourable DSS, with a relatively low nephroureterectomy rate, and therefore provides oncological control and renal preservation in patients more likely to die eventually from other causes. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Endoscopic management of upper tract urothelial carcinoma (UTUC) using either ureteroscopy and laser ablation, or percutaneous resection, is a management option for treating selected low-grade tumours with favourable characteristics. However, the evidence base for such practice is relatively weak, as the reported experience is mainly limited to small case series (level of evidence 4), or non-randomised comparative studies that are unmatched for tumour stage (level of evidence 3b), with variability of follow-up duration and reported outcome measures. The present systematic review comprehensively reviews the outcomes of all studies of endoscopic management of UTUC, including the role of topical adjuvant therapy. It establishes for the first time a structured reference for endoscopic management of UTUC, and is a foundation for further clinical studies. OBJECTIVE To systematically review the oncological outcomes of upper tract urothelial carcinoma (UTUC) treated with ureteroscopic and percutaneous management., The standard treatment of UTUC is radical nephroureterectomy (RNU). However, over the last two decades several institutions have treated UTUC endoscopically, either via ureteroscopic ablation or percutaneous nephroscopic resection of tumour (PNRT), for both imperative and elective indications., METHODS For evidence acquisition the Pubmed database was searched for English language publications in December 2011 using the following terms: upper tract (UT) transitional cell carcinoma (TCC), upper tract TCC, UTTCC, upper tract urothelial cell carcinoma, upper tract urothelial carcinoma, UTUC, endoscopic management, ureteroscopic management, laser ablation, percutaneous management, PNRT, conservative management, ureteroscopic biopsy, biopsy, BCG, mitomycin C, topical therapy., RESULTS There are no randomised trials comparing endoscopic management with RNU. Most published studies were retrospective case series (and database reviews), or unmatched comparative studies., There was strong selection bias for favourable tumour characteristics in many endoscopically treated groups., There was variation in medical comorbidity and indication for treatment across different study groups., The biopsy verification of underlying UTUC pathology was inconsistent., The follow-up in most studies was limited, typically to a mean 3 years., CONCLUSIONS There is a high rate of UT recurrence with endoscopically managed UTUC, and a grade-related risk of tumour progression and disease-specific mortality., Overall, renal preservation may be high with ≈20% of patients proceeding eventually to RNU. For highly selected Grade 1 (or low-grade) disease managed in experienced centres, 5-year disease-specific survival (DSS) may be equivalent to RNU, although the small study groups and short follow-ups preclude comments on less favourable Grade 1 (or low-grade) tumour characteristics, or DSS, in the longer-term., For Grade 3 (or high-grade) disease, DSS outcomes are poor and endoscopic management should only be considered for compelling imperative indications in the context of the patient's overall life expectancy and competing comorbidity. [ABSTRACT FROM AUTHOR]

ABSTRACT Insufficient priority is being given to meet the physical health-care needs of people with mental illness. Mental health nurses, as the largest professional group working in mental health care, have a pivotal role in improving the physical health and well-being of people with mental illness. Through health-promotion strategies, alongside recovery-focused support aimed at avoiding deteriorating physical health, mental health nurses can significantly contribute to improving the current rate of premature death experienced by people with enduring mental illness. Drawing from contemporary policy, alongside practical examples taken from the published literature, this paper considers what constitutes recommended best practice in dealing with the physical health-care needs of people with mental illness. The role that UK-based health-care policy plays in shaping care delivery that meets the needs of people with mental illness is explored and placed within the context of global health concerns. Recommendations are made on how mental health nursing can work to provide evidence for a reassertion that nurses are well placed to work across organizational and professional boundaries to deliver person-centred care and a holistic approach to population health and well-being. [ABSTRACT FROM AUTHOR]

The Longmen Shan is the steepest topographic front at the India-Asia collision zone and the site of the Mw 7.9 Wenchuan earthquake. Here to explain the interseismic GPS velocities across the greater Longmen Shan region, we develop a boundary element model including earthquake cycle effects, topography, the westward dipping Beichuan Fault and a ∼20 km deep, shallowly dipping, detachment, inferred from observed afterslip and from structural considerations. Previous analyses which neglected the detachment and earthquake cycle effects have found shortening rates near zero. In contrast, we find that interseismic GPS data are consistent with a shortening rate of 5.7±1.5mm/yr and maximum surface slip-deficit rate of 9.5±2.5mm/yr. This model unifies the interpretation of geodetic deformation throughout the earthquake cycle and suggests that the Longmen Shan is an active fold-and-thrust belt with of Wenchuan-like recurrence intervals as short as 600 years., Earth and Planetary Sciences

A letter to the editor is presented in response to the article on deliberate hydroxycarbamide overdose in an adult with essential thrombocythaemia.

The article presents a case study of a 25-year-old male with back pain on a four-week history of lethargy, nausea and weight loss among other conditions. The patient is stated to have undergone biochemical analysis, computed tomography scan and skin nodule biopsy which revealed nephromegaly, a condition with enlarged kidneys, and possible lymphoma. Bone marrow examination and immunophenotyping are said to have been performed which confirmed acute lymphoblastic leukaemia (ALL).