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Focal therapy (FT) ablates areas of prostate cancer rather than treating the whole gland. We compared oncological outcomes of FT to radical prostatectomy (RP). Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA

espanolAntecedentes. Existen pocas descripciones de la presentacion clinica y evolucion de infecciones consecutivas por SARS-CoV-2 con un seguimiento lo suficientemente largo. Metodos. Descripcion de los primeros 100 pacientes consecutivos con COVID-19 probada microbiologicamente en un gran hospital de Madrid, incluyendo un seguimiento minimo de dos meses. Resultados. La mediana de edad de los pacientes (52% hombres) fue de 61,5 anos (RIC=39,5-82,0) y la mediana de IMC fue de 28,8 kg/m2 (RIC=24,7-33,7). El 72% de los pacientes tuvieron una o mas comorbilidades con un indice de Charlson ajustado a la edad de 2 (RIC=0-5,7). Cinco pacientes (5%) estaban inmunodeprimidos. Los sintomas mas comunes al momento del diagnostico fueron fiebre (80,0%), tos (53,0%) y disnea (23,0%). La mediana de saturacion de O2 en el momento del primer examen fue del 94% (RIC=90-97). La radiografia de torax al ingreso fue compatible con neumonia en el 63% de los casos (bilateral en el 42% y unilateral en el 21%). El 30% fueron manejados en su domicilio y el 70% ingresados en el hospital. Trece pacientes ingresaron en la UCI con una mediana de 11 dias de estancia en la Unidad (RIC=6,0-28,0). El score CALL de nuestra poblacion vario de 4 a 13. En general, el 60,0% de los pacientes recibio tratamiento antibiotico y el 66,0%, tratamiento antiviral empirico, principalmente con lopinavir/ritonavir (65%) o hidroxicloroquina (42%). La mortalidad, con un minimo de 60 dias de seguimiento, fue del 23%. La mediana de edad de los pacientes fallecidos fue de 85 anos (RIC=79-93). Conclusiones. Encontramos una alta mortalidad en los primeros 100 pacientes diagnosticados con COVID-19 en nuestra institucion, asociada con edad avanzada y presencia de enfermedades subyacentes graves. EnglishBackground. There are few descriptions of the clinical presentation and evolution of consecutive SARS-CoV-2 infections with a long-enough follow up. Methods. Description of the first consecutive 100 patients with microbiologically-proven COVID-19 in a large hospital in Madrid, Spain including a minimum of two-month follow up. Results. The median age of the patients (52% males) was 61.5 years (IQR=39.5-82.0) and the median BMI was 28.8 kg/m2 (IQR=24.7-33.7). Overall 72% of the patients had one or more co-morbid conditions with a median age-adjusted Charlson index of 2 (IQR=0-5.7). Five patients (5%) were immunosuppressed. The most common symptoms at the time of diagnosis were fever (80.0%), cough (53.0%) and dyspnea (23.0%). The median O2 saturation at the time of first examination was 94% (IQR=90-97). Chest X-ray on admission was compatible with pneumonia in 63% of the cases (bilateral in 42% and unilateral in 21%). Overall, 30% were managed at home and 70% were admitted to the hospital. Thirteen patients were admitted to the ICU with a median of 11 days of stay in the Unit (IQR=6.0-28.0). CALL score of our population ranged from 4 to 13. Overall, 60.0% of patients received antibiotic treatment and 66.0%, empirical antiviral treatment, mainly with lopinavir/ritonavir (65%) or hydroxychloroquine (42%). Mortality, with a minimum of 60 days of follow up, was 23%. The median age of the deceased patients was 85 years (IQR=79-93). Conclusions. We found a high mortality in the first 100 patients diagnosed with COVID-19 at our institution, associated with advanced age and the presence of serious underlying diseases.

Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS.Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS≥3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern≥4 at histology.In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35).Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy.

Background Despite the key importance of magnetic resonance imaging (MRI) parameters, risk classification systems for biochemical recurrence (BCR) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) are still based on clinical variables alone. Objective We aimed at developing and validating a novel classification integrating clinical and radiological parameters. Design, setting, and participants A retrospective multicenter cohort study was conducted between 2014 and 2020 across seven academic international referral centers. A total of 2565 patients treated with RP for PCa were identified. Outcome measurements and statistical analysis Early BCR was defined as two prostate-specific antigen (PSA) values of ≥0.2 ng/ml within 3 yr after RP. Kaplan-Meier and Cox regressions tested time and predictors of BCR. Development and validation cohorts were generated from the overall patient sample. A model predicting early BCR based on Cox-derived coefficients represented the basis for a nomogram that was validated externally. Predictors consisted of PSA, biopsy grade group, MRI stage, and the maximum diameter of lesion at MRI. Novel risk categories were then identified. The Harrel’s concordance index (c-index) compared the accuracy of our risk stratification with the European Association of Urology (EAU), Cancer of the Prostate Risk Assessment (CAPRA), and International Staging Collaboration for Cancer of the Prostate (STAR-CAP) risk groups in predicting early BCR. Results and limitations Overall, 200 (8%), 1834 (71%), and 531 (21%) had low-, intermediate-, and high-risk disease according to the EAU risk groups. The 3-yr overall BCR-free survival rate was 84%. No differences were observed in the 3-yr BCR-free survival between EAU low- and intermediate-risk groups (88% vs 87%; p = 0.1). The novel nomogram depicted optimal discrimination at external validation (c-index 78%). Four new risk categories were identified based on the predictors included in the Cox-based nomogram. This new risk classification had higher accuracy in predicting early BCR (c-index 70%) than the EAU, CAPRA, and STAR-CAP risk classifications (c-index 64%, 63%, and 67%, respectively). Conclusions We developed and externally validated four novel categories based on clinical and radiological parameters to predict early BCR. This novel classification exhibited higher accuracy than the available tools. Patient summary Our novel and straightforward risk classification outperformed currently available preoperative risk tools and should, therefore, assist physicians in preoperative counseling of men candidate to radical treatment for prostate cancer.

This paper investigates the evolution of human capital in China for 31 provinces over the period of 1985–2016 from a club convergence perspective. Per capita human capital stocks, estimated using the Jorgenson–Fraumeni lifetime income approach, are for the first time examined within a non-linear latent factor framework that allows to model a wide range of transition dynamics for each province along the path to convergence. The study finds no overall convergence between provinces in China, however, the results strongly support the existence of multiple convergence clubs. While a small group of provinces are converging toward the highest levels of human capital, most of the other provinces are failing to catch up and form separate clusters that converge to lower equilibria. These regional patterns provide new evidence on the increasing human capital gap between Chinese provinces, posing a significant challenge to a more inclusive and harmonious human and economic development.

Current guidelines do not provide strong recommendations on preservation of the neurovascular bundles during radical prostatectomy in case of high-risk (HR) prostate cancer and/or suspicious extraprostatic extension (EPE). We aimed to evaluate when, in case of unilateral HR disease, contralateral nerve sparing (NS) should be considered or not.Within a multi-institutional data set we selected patients with unilateral HR prostate cancer, defined as unilateral EPE and/or seminal vesicle invasion (SVI) on multiparametric (mp) magnetic resonance imaging (MRI), or unilateral International Society of Urologic Pathologists (ISUP) 4-5 or prostate specific antigen ≥20 ng/ml. To evaluate when to perform NS based on the risk of contralateral EPE, we relied on chi-square automated interaction detection, a recursive machine-learning partitioning algorithm developed to identify risk groups, which was fit to predict the presence of EPE on final pathology, contralaterally to the prostate lobe with HR disease.A total of 705 patients were identified. Contralateral EPE was documented in 87 patients (12%). Chi-square automated interaction detection identified 3 groups, consisting of 1) absence of SVI on mpMRI and index lesion diameter ≤15 mm, 2) index lesion diameter ≤15 mm and contralateral ISUP 2-3 or index lesion diameter15 mm and negative contralateral biopsy or ISUP 1, and 3) SVI on mpMRI or index lesion diameter15 mm and contralateral biopsy ISUP 2-3. We named those groups as low, intermediate and high-risk, respectively, for contralateral EPE. The rate of EPE and positive surgical margins across the groups were 4.8%, 14% and 26%, and 5.6%, 13% and 18%, respectively.Our study challenges current guidelines by proving that wide bilateral excision in men with unilateral HR disease is not justified. Pending external validation, we propose performing NS and incremental NS in case of contralateral low and intermediate EPE risk, respectively.

Small-molecule modulators of cystic fibrosis transmembrane conductance regulator (CFTR) biology show promise in the treatment of cystic fibrosis (CF). A Cftr knockout (Cftr KO) mouse expressing mutants of human CFTR would advance in vivo testing of new modulators. A bacterial artificial chromosome (BAC) carrying the complete hCFTR gene including regulatory elements within 40.1 kb of DNA 5′ and 25 kb of DNA 3′ to the gene was used to generate founder mice expressing hCFTR. Whole genome sequencing indicated a single integration site on mouse chromosome 8 (8qB2) with ~6 gene copies. hCFTR+ offspring were bred to murine Cftr KO mice, producing hCFTR+/mCftr− (H+/m−) mice, which had normal survival, growth and goblet cell function as compared to wild-type (WT) mice. Expression studies showed hCFTR protein and transcripts in tissues typically expressing mCftr. Functionally, nasal potential difference and large intestinal short-circuit (Isc) responses to cAMP stimulation were similar in magnitude to WT mice, whereas small intestinal cAMP ΔIsc responses were reduced. A BAC transgenic mouse with functional hCFTR under control of its regulatory elements has been developed to enable the generation of mouse models of hCFTR mutations by gene editing for in vivo testing of new CF therapies.

Discrete fracture network (DFN) analysis methods can assist in our understanding of bench-scale slope performance in open pit mines and provide results that are more representative of structural conditions compared to conventional kinematic methods. Conventional kinematic analysis may not adequately capture the complexity of the fracture network and its impact on bench-scale stability because this method is typically limited to analysis of simple rock blocks or wedges formed by one or two fracture sets only. This simplification of block geometries, combined with the limitation of not adequately representing variations in the location and spacing of discontinuities forming blocks, can result in significant differences between theoretical and observed bench performance. DFN methods provide an alternative approach to conventional kinematic methods to model the structural fabric. The fracture networks developed through DFN modelling incorporate variations in the location, spacing, and persistence of discontinuities. DFN-based approaches allow more detailed analysis of the probability of occurrence, probability of failure, and expected back-break when compared to conventional kinematic methods as wedge geometries are more explicitly defined from observed features. This paper provides a comparison between conventional kinematic analysis and a DFN-based approach to bench design, with a focus on back-break metrics for two case studies: one slope governed by potential planar instability and a second where potential wedge failure is the controlling mechanism. The impact of mining processes and time-dependent rock mass degradation on observed back-break is discussed. Comparison between the results of both conventional kinematic and DFN methods to actual bench performance observed at the Bingham Canyon Mine indicates that the DFN approach can deliver results that are more structurally representative of field conditions.

Background An increase in nosocomial and health care-related infective endocarditis (IE) has been described. Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare characteristics of patients with IE and SOT against those without SOT. Methods We used data from the Spanish Collaboration on Endocarditis obtained during the period 2008–2018. Results We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients had other types of transplantation (bone marrow, hematopoietic precursors, and cornea) and were excluded from the analysis. Compared with patients without SOT, patients with SOT had a higher median age (69 vs. 61 years, p Conclusion IE in SOT patients has specific characteristics. Most of the cases are nosocomial and over 70% are hospital-or health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus infections. Figure 1. Kaplan Meier survival curves for patients with and without solid organ transplantation (SOT). SOT: 56 kidney, 18 liver (2 combined with kidney), 8 heart, 3 lung. Funding Acknowledgement Type of funding source: None

Se presenta el diseño, implementación y operación de un módulo didáctico desarrollado con la finalidad de obtener una adecuada capacitación en el manejo de los Sistemas Fototérmicos y Fotovoltaicos. Al verificar el desempeño del equipo, se observaron sus capacidades tales como: Sistema de captación fototérmica con circulación natural y forzada, almacenamiento de líquido, suministro y distribución de tubería. Se incluye el Sistema de captación fotovoltaica trabajando paralelamente con la distribución de energía requerida para un sistema de bombeo y contribuir en el funcionamiento del sistema utilizando lámparas de halógeno para prácticas dentro del laboratorio. Al poner el sistema a disposición de la comunidad académica de la institución, se mejoró el proceso de enseñanza aprendizaje, facilitando la labor del docente e incrementando la motivación del estudiante a adquirir conocimientos en este tema. Basándose en la idea de trabajar con un sistema fototérmico de aplicaciones prácticas con el suministro de energía fotovoltaica, con los sistemas de simulación a uno real.

The People's Republic of China (PRC) has achieved significant improvements in educational attainment levels since the market-oriented reforms began almost four decades ago. However, there are still educational gaps among different groups and education inequality remains an issue. Addressing urban disparities remains a pertinent matter in optimizing China's transition towards a knowledge-driven economy. This paper investigates education inequality in urban China, using subgroup and regression-based decompositions of inequality of educational attainment, to evaluate whether the determinants to urban education inequality are similar within and across regions. Using the urban datasets from the China Household Income Project surveys for 2013, education inequality was measured for up to 100 cities from 14 provinces. The results reveal heterogeneity in educational attainment, education inequality, and the determinants of education inequality in urban China. Regression-based decompositions of education inequality revealed that the determinants of education inequality are not homogeneous between and within regions and provinces. While the type of middle school and National Higher Education Entrance Examination scores are predominantly among the largest contributors, the size and order of their contributions vary among different regions, provinces and age cohorts. Other major contributing factors varied from parents' occupation to parent's education and parental employment type. The results imply that since cities aren't homogeneous, therefore, they have different contributing factors towards education inequality. The results suggest that location-specific policy targets and priorities may produce more favorable outcomes in reducing education inequality.

Objectives The role of biofilm production in the outcome of candidaemia remains under discussion. Current evidence relies on variable biofilm detection methods while evaluating distinct clinical end points. We aimed to determine the impact of biofilm production measured by metabolic activity (MA) and biomass (BM) on the prognosis of adults with candidaemia. Methods Retrospective cohort including 280 adults with candidaemia admitted from 2010 to 2016. BM was assessed using crystal violet binding stain and the XTT reduction assay was used to detect MA. Strains were classified as high and moderate-low biofilm producers according to published cut-offs. The primary outcome was overall mortality within 7 and 30 days. The secondary outcome was unfavourable prognosis defined as metastatic infection, admission to an intensive care unit due to the severity of candidaemia, or death within 30 days. Results High BM and high MA were detected in 90 (32.1%) and 114 (40.7%) of the 280 isolates, respectively. Comparison of high and moderate-low biofilm forming isolates revealed no correlation between biofilm production and 7-day mortality (BM high 15/90 (16.7%) versus moderate-low 24/190 (12.6%); MA high 12/114 (10.5%) versus moderate-low 27/166 (16.3%)), 30-day mortality (BM high 34/90 (37.8%) versus moderate-low 61/190 (32.1%); MA high 33/114 (28.9%) versus moderate-low 62/166 (37.3%)), or unfavourable prognosis (BM high 45/90 (50.0%) versus moderate-low 73/190 (38.4%); MA high 41/114 (36.0%) versus moderate-low 77/166 (46.4%)). Conclusions Biofilm production was not a predictor of mortality or of unfavourable prognosis in adults with candidaemia.

AIMS: Macrophage phagocytosis of dead cells is a prerequisite for inflammation resolution. Because CXCL4 induces macrophage phagocytosis in vitro, we examined the impact of exogenous CXCL4 infusion on cardiac wound healing and macrophage phagocytosis following myocardial infarction (MI). METHODS AND RESULTS: CXCL4 expression significantly increased in the infarct region beginning at Day 3 post-MI, and macrophages were the predominant source. Adult male C57BL/6J mice were subjected to coronary artery occlusion, and MI mice were randomly infused with recombinant mouse CXCL4 or saline beginning at 24 h post-MI by mini-pump infusion. Compared with saline controls, CXCL4 infusion dramatically reduced 7 day post-MI survival [10% (3/30) for CXCL4 vs. 47% (7/15) for saline, P

Candins are commonly used as initial therapy in patients with candidemia and are known to diffuse poorly into ocular tissue. The aim of our multicenter study was to assess whether eye involvement was more common in patients initially treated with echinocandins. We performed a post hoc analysis of a prospective, multicenter, population-based candidemic surveillance program implemented in Spain during 2010-2011 (CANDIPOP project). Eye involvement was detected in 13 of 168 patients with candidemia (7.7%) who underwent ophthalmoscopy. Two patients had endophthalmitis, while the remaining patients had chorioretinitis. The frequency of ocular candidiasis was similar in patients receiving initial therapy with candins (3/56; 5.4%) or with other regimens (10/112; 8.9%). At multivariate analysis, risk conditions for eye involvement were dialysis after candidemia (OR, 19.4; 95% CI, 1.7-218.4) and involvement of organs other than the eye (OR, 5.4; 95% CI, 1.1-25.7). In conclusion, eye involvement was not found to be more frequent in patients receiving initial therapy with echinocandins than in patients receiving other drugs.

An outbreak of Clostridium difficile infection (CDI) caused by ribotype 027 (B1/NAP1) began in our hospital in November 2014, and produced 141 episodes in the following months. The aim of this study is to describe this outbreak, assess risk factors for recurrence of CDI-027 and to analyze the implementation of a novel treatment strategy. This is a prospective study of all patients with CDI-027, from November 2014 to November 2015. The epidemiological data were collected daily for each patient. We compared clinical characteristics and treatment between patients with and without recurrence of CDI-027. Interestingly, liver cirrhosis was present in 22% of the patients, and most of them received prophylaxis for hepatic encephalopathy with rifaximin. Patients were also taking antimicrobial drugs (93.6%) and proton pump inhibitors (80.1%). Overall, 27 (23.5%) patients had a first recurrence of CDI-027. Liver cirrhosis increased the risk of recurrence (44.4% vs 14.8%). Patients treated with a prolonged oral vancomycin regimen vs the conventional regimen (oral metronidazole or 10 days of vancomycin) had fewer recurrences (8.6 versus 44.7% [p ≤ 0.01]; OR, 0.91; 95% CI, 0.028-0.294) and less attributable mortality (0% versus 7.1%; p = 0.058). We report an outbreak of CDI-027, mainly in patients with liver cirrhosis. Recurrence of CDI-027 was more common in those patients. A novel approach involving high-dose prolonged vancomycin taper as a first-line treatment, together with a bundle of outbreak measures, seemed to reduce the number of cases of CDI-027, recurrences, and attributable mortality. Nevertheless, this approach warrants further investigation.

Die transrektale Sonografie mit systematischer Biopsie gilt derzeit als Standard fur die Diagnose eines Prostatakarzinoms. Allerdings ist das Verfahren nicht immer prazise – hochgradige Erkrankungen konnen ubersehen und niedrig maligne Veranderungen ubertherapiert werden. Die Fusionsbiopsie konnte eine Alternative darstellen, aber dazu muss sie zuverlassig reproduzierbar sein. Das haben Mediziner aus den USA gepruft.