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Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p =

Transperineal biopsy (TPB) of the prostate has been increasingly utilized as it has reduced infection risks. Traditionally however, it is performed under general anaesthesia, thus it carries a differing set of risks. Recently, new studies have performed TPB under local anaesthesia with success. In the present study, we explored our experience of performing TPB under local anaesthesia in an Australian cohort.In this prospective study based at a metropolitan outpatient clinic, patients were provided with TPB under local anaesthesia. We assessed prostate cancer detection rates, complication rates and patient tolerability. Pain tolerability was assess using patient reported pain score on the visual analogue scale. Follow up data was collected at days 7 and 30 post-biopsy via telephone interview.A total of 48 patients were enrolled in this study between June 2020 and March 2021. Median age was 65.5 years and median PSA was 6.95 ng/mL. Clinically significant prostate cancer was detected in 58% of patients. During the procedure, pain scores were rated the highest during infiltration of local anaesthetic agent with a median score of 5. By the conclusion of the procedure, median pain score was 1. Vast majority of patients (85.4%) would opt for a repeat TPB under local anaesthesia should the need for prostate biopsy arise again. Two of our patients experienced infectious complications, and one experienced urinary retention.Our data is in line with currently available data and confirms that TPB under local anaesthesia can be achieved in a safe and tolerable manner.

OBJECTIVES: To assess whether metformin reduces radio-resistance and increases survival in men undergoing external beam radiation therapy (EBRT) for prostate cancer (PCa), and to determine its effect on hypoxia inducible factor 1-α (HIF1α). PATIENTS AND METHODS: All patients treated with curative intent with EBRT for PCa at a major cancer centre between 2000 and 2007 were included in this study. The outcome measures of time to biochemical failure (BF), metastasis, PCa-specific mortality and overall survival (OS) were analysed in those taking metformin vs those not, using competing risk and Cox regression models. To determine metformin's effect on HIF1α expression and survival in vitro, PC3 cells with high basal HIF1α levels were subjected to increasing doses of metformin after H2 O2 -induced oxidative stress. RESULTS: A total of 2055 eligible cases, including 113 who were on metformin, were identified, with a median follow-up of 95.7 months. There were no differences in age, initial prostate-specific antigen level, Gleason score, T-stage, D'Amico risk class or duration of androgen deprivation therapy (ADT) between patients who were or were not on metformin. Treatment with metformin did not result in any apparent improvement in time to BF, time to metastasis detection or OS, but there was a 1.5-fold increase in PCa-specific deaths (P = 0.045) in patients on metformin and ADT when adjusted for cancer risk and comorbidities. When comparing patients on high-dose metformin (>1 g/d) with those on low-dose metformin (≤1 g), there was no difference in either time to metastases or time to BF. In vitro metformin at a high concentration of 100 μM did not reduce HIF1α expression, nor did metformin affect the PC3 cell survival when exposed to oxidative stress (H2 O2 ). CONCLUSIONS: No association was found between the use of metformin and time to metastasis detection, time to BF or OS in patients undergoing radiation therapy with or without ADT for PCa. In vitro, low therapeutic concentrations of metformin had no effect on HIF1α, and this observation could explain the conflicting evidence for the effectiveness of metformin in men undergoing EBRT for PCa. Higher, more toxic doses of metformin may be required to inhibit the mammalian target of rapamycin-HIF1α pathway in this patient group.

True metastatic ureteric lesions are exceptionally rare when sourced from any primary tumour. Primary prostatic cancer metastasis to the ureter is understandably even more atypical with very few cases reported in current literature. True intramural ureteric metastatic disease deposited from prostate cancer is an even rarer occurrence. We present a case of a man in his mid-60s with left-sided hydronephrosis in the setting of biochemical recurrence of Gleason 9 prostate cancer. Initially misdiagnosed as obstruction secondary to mass effect from a large trigonal lesion, subsequent investigation revealed solid intramural metastatic deposit of prostate primary tumour in the distal ureter. We detail current hypotheses regarding the subsequent pathophysiology of the disease and its common clinical presentations. Our case highlights that prostatic metastasis should be considered as a differential in coexisting prostate cancer and ureteric obstruction despite its low incidence.

Zinc ions (Zn2+) are known to influence cell survival and proliferation. However the homeostatic regulation of Zn2+ and their role in prostate cancer (PC) progression is poorly understood. Therefore the subcellular distribution and uptake of Zn2+ in PC cells were investigated. Inductively coupled plasma mass spectroscopy and fluorescent microscopy with the Zn2+-specific fluorescent probe FluoZin-3 were used to quantify total and free Zn2+, respectively, in the normal prostate epithelial cell line (PNT1A) and three human PC cell lines (PC3, DU145 and LNCaP). The effects of Zn2+ treatment on proliferation and survival were measured in vitro using MTT assays and in vivo using mouse xenografts. The ability of Zn2+ to protect against oxidative stress via a HIF1α-dependent mechanism was investigated using a HIF1α knock-down PC3 model. Our results demonstrate that the total Zn2+ concentration in normal PNT1A and PC cells is similar, but PC3 cells contain significantly higher free Zn2+ than PNT1A cells (p < 0.01). PNT1A cells can survive better in the presence of high concentrations of Zn2+ than PC3 cells. Exposure to 10 µM Zn2+ over 72 hours significantly reduces PC3 cell proliferation in vitro but not in vivo. Zn2+ increases PC3 cell survival up to 2.3-fold under oxidative stress, and this protective effect is not seen in PNT1A cells or in a HIF1α-KD PC3 cell model. A state of Zn2+ dyshomeostasis exists in PC. HIF1α is an integral component of a Zn2+-dependent protective mechanism present in PC3 cells. This pathway may be clinically significant through its contribution to castrate-resistant PC survival.

BackgroundHealth care websites provide a valuable resource of health information to online consumers, especially patients. Official surgical and medical society websites should be a reliable first point of contact. ObjectiveThe primary aim of this study was to quantitatively assess medical and surgical society websites for content and highlight the essential features required for a high-quality, user-friendly society website. MethodsTwenty specialty association websites from each of the regions, Australia, UK, Canada, Europe, and the USA were selected for a total of 100 websites. Medical and surgical specialities were consistent across each region. Each website was systematically and critically analysed for content and usability. ResultsThe average points scored per website was 3.2 out of 10. Of the total (N=100) websites, 12 scored at least 7 out of 10 points and 2 scored 9 out of 10. As well, 35% (35.0/100) of the websites had an information tab for patients on their respective homepages while 38% (38.0/100) had download access to patient information. A minority of the websites included different forms of multimedia such as pictures and diagrams (24.0/100, 24%) and videos (18.0/100, 18%). ConclusionsWe found that most society websites did not meet an adequate standard for delivery of information. Half of the websites were not patient accessible, with the primary focus being for health professionals. As well, most required logins for information access. Specialty health care societies should create patient-friendly websites that would be beneficial to all online consumers.

The exploitation of Islander pearl divers in Torres Strait and the Queensland Government's control of divers' wages was the major cause of a strike by 400 divers in 1936. The strike was also fuelled by overall discontent with the Queensland Government's rule and a desire to be free of the Queensland Protectors. An address in 1935 by Stephen Davies, Bishop of Carpentaria, urging the Commonwealth of Australia to strip Queensland and other states of management of Island and Aboriginal affairs provided the catalyst. Davies's Torres Strait Island clergy played a pivotal role in the resistance to state control. One lasting effect of the strike lay in the introduction of elected Islander councils in 1937, but what happened subsequently allowed the perpetuation of Queensland control through the new Department of Native Affairs. The results of the strike fell short of the complete transfer to the Commonwealth that the Torres Strait pearl divers and clergy had envisaged.

Testicular teratoma is a sub-type of Non-Seminomatous Germ Cell Tumour (NSGCT) and often occurs in two distinct age groups. Adult testicular teratomas are often mixed and are malignant. Teratoma can be divided histologically into mature and immature. Pure mature teratoma of the testis is rare. Intratubular Germ Cell Neoplasia (ITGCN) is a common feature associated with teratoma. Teratoma is frequently chemoresistant and clinical management of these tumours includes radical inguinal orchidectomy followed by Retroperitoneal Lymph Node (RPLND) dissection if indicated. Long-term oncological outcomes for mature and immature testicular teratoma are equivocal.

Recent movements within world Anglicanism towards a more democratic representation of the church are in contrast to Torres Strait Islanders' assertion of their own male-led conservative and hierarchical body. These characteristics have marked Torres Strait Island Anglicanism for many years. On the surface, the various strands leading to a conflict over a choice of leader in 1997 focused upon discordant relationships and faulty decision-making procedures, especially the surrender of the diocese of Carpentaria to the adjacent diocese of North Queensland and a subsequent choice of a bishop where Torres Strait clergy claimed that the terms of the surrender had been dishonoured. Yet below the surface, the cleavage between Island and European leadership was also a sign of the ideological shift which was occurring in the Anglican Church of Australia. Supported by European elements within that church opposed to the ordination of women, Islander clergy charged that the mainland body was deserting the faith and ord...

(1998). First contact mission narratives from eastern Papua New Guinea. The Journal of Pacific History: Vol. 33, No. 1, pp. 111-116.

Spermatocytic seminoma (SCS) with sarcoma is an extremely rare testicular tumor with only 11 cases previously described in the literature. We present the 12th case of SCS with sarcoma in a 29-year-old male. SCS itself is an uncommon germ cell tumor with a relatively indolent clinical course that mostly affects males around the fifth decade of life. Sarcomatous differentiation of SCS occurs in 5% to 6% of cases and correlates with a higher possibility of metastatic disease and a poor prognosis. Clinically, this tumor manifests as a slow-growing testicular mass often with an accelerated period of secondary growth. After a concise review of the literature, we conclude that SCS with sarcoma should be treated by radical inguinal orchidectomy with strong consideration given to adjuvant chemotherapy.

(1982). The fortunes of Charles W. Abel of Kwato 1891–1930. The Journal of Pacific History: Vol. 17, No. 4, pp. 195-217.

WHEN THE PRIME MINISTER OF FIJI, RATU SIR KAMISESE MARA, VISITED PAPUA New Guinea in 1974 he laid a wreath at the Fijian martyrs' memorial near Rabaul. The ceremony at the memorial, built to commemorate the deaths of four pioneer Fijian teachers in 1878, attracted widespread notice.1 From a historian's point of view, the graves of teachers scattered along the Papua New Guinea coast?Loyalty Islanders, Niueans, Rarotongans, Samoans, Tongans, Fijians and others?are a reminder that the introduction of 'new ways' in Papua New Guinea was the work, not of white men alone, but of hundreds of Pacific Islands teachers. Many of these teachers were Fijians. Between 1875 and 1935, the teachers' lists from Fiji contained 40 names of those who went to New Britain, 97 who worked in Papua, and 14 who volunteered for the Solomon Islands.2

southern part of mainland New Guinea as employees of the London Mis sionary Society. Apart from two parties of Loyalty Islanders, the teachers were from the Polynesian islands of Niue, Rarotonga and Samoa, with a small number of Tahitians.1 From the 1820s, when Tahitian teachers had begun to spread the faith of Evangelical Christianity to the Cook Islands and Tonga, the use of Islands agents had become a standard part of Protestant missionary practice. The Methodists had raised an auxiliary group of local preachers and class-leaders in the islands where they went. The Samoan pastors, or faifeau Samoa, whose first party arrived at Port Moresby in 1883, 12 years after the founding of the New Guinea Mission, were the last 'national' group among the L.M.S. Islands teachers in New Guinea. But on the frontiers of the western Pacific they were no less pioneers than other Islands teachers. Missionary ex pansion in New Guinea, as in other parts of Oceania, would have been difficult without the Samoan pastors. As a significant strand in the Evangelical missionary movement, the work of the Islands teachers invites attention. The 1,100 Polynesian and Melanesian teachers and their wives who travelled to other Pacific islands have so far received little scrutiny by historians, and the records of the L.M.S. and Methodist missions in New Guinea contain valuable documentation of the

professed a reverence for the secure and respectable, and was easily convinced of the superiority of his own mode of thought. But Abel was also more intelligent than most of his colleagues and was a more violent partisan. In him ordinary qualities were magnified to an extraordinary degree. A self-educated emigrant who had worked at the age of 18 as a labourer among Maoris in New Zealand, Abel returned to England in 1884 to acquire an elementary knowledge of ethnology at Cheshunt College.1 Arriving in British New Guinea in 1890, Abel wrote a monograph on the Logea Islanders of eastern Papua into which he threw his characteristic passion for thoroughness. No one ever saw the habits of Logea man with a more dispassionate eye, nor recorded them with a more objective pen, than the Rev. Charles Abel. What were his legends? How did he collect food? * Part of the research upon which this article is based was derived from the Kwato Archives held by the University of Papua and New Guinea, which at the time of writing had not been catalogued. l R. W. Abel, Charles W. Abel of Kwato (New York 1934), 24. Founded in 1768, Cheshunt College was primarily a theological school which broadened its curriculum in the mid-19th century to include a missionary course. This emphasized theology and the art of preaching, and included elementary ethnology.