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Patients with asthma may feel limited in physical activity (PA). Reduced PA has been demonstrated in asthmatics versus healthy controls, and increasing PA associated with improved asthma outcomes. Obesity is commonly found with difficult-to-control asthma and worsens outcomes. We compared PA levels in participants with difficult-to-control asthma and elevated body mass index (BMI) (DOW group) and two mild-moderate asthma groups: one with BMI25 kg/mThis cross-sectional study used 7-day recordings from wrist-worn accelerometers to compare PA between groups. Inactive time, light (LPA), moderate-vigorous PA (MVPA) were measured, along with two novel metrics: intensity gradient (IG) reflecting PA intensity, and average acceleration (AA) reflecting PA volume. PA parameters were compared using ANOVA or Kruskall-Wallis testing. Correlation and linear regression analyses explored associations between PA parameters and asthma outcomes. As AA was the PA parameter correlated most closely with asthma-related outcomes, an exploratory analysis compared outcomes in highest and lowest AA quartiles.75 participants were recruited; 57 accelerometer readings were valid and included in analysis. Inactive time was significantly higher (Overweight/obese participants with difficult-to-control asthma performed less PA, and activity of reduced intensity and volume. Increased AA is associated with improvement in several asthma-related outcomes. Increased PA should be recommended to relevant patients.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background An algorithm that identifies individuals with a digital electronic health record (EHR) signature homologous to patients with atrial fibrillation (AF) could delineate a subpopulation that may benefit from early interventions to reduce future adverse events. Purpose We aimed to train and test a scalable algorithm to identify individuals at higher risk of incident AF in the short-term, and quantify associations with AF and a range of other conditions. Methods We used UK primary care EHR data from individuals aged ≥30 years without known AF in the CPRD-GOLD dataset (Jan 2, 1998, Nov 30, 2018), randomly divided into training (80%) and testing (20%) datasets. We trained a random forest classifier using age, sex, ethnicity and comorbidities (FIND-AF). Performance was evaluated in the testing dataset with internal bootstrap validation with 200 samples, and compared against the CHA2DS2-VASc and C2HEST scores. We calculated the cumulative incidence rate for AF, heart failure, valvular heart disease (and specifically aortic stenosis), MI, stroke or TIA, peripheral vascular disease, CKD, diabetes and COPD. Incident diagnoses were the first record of that condition in primary or secondary care records from any diagnostic position. We excluded individuals for the analysis of each condition who had a preceding diagnosis of that condition. Fine and Gray’s models with competing risk of death were fit for each condition between higher and lower predicted AF risk. Results FIND-AF could be applied to 100% of records for 2 081 139 individuals in the cohort. In the testing dataset (n = 416 228), individuals at higher predicted AF risk had similar baseline characteristics to individuals who developed incident AF (Table 1). Prediction performance for AF was strongest for FIND-AF (AUROC 0·824, 95% CI 0·813-0·829; Brier score 0.069) compared with CHA2DS2-VASc (0·784, 0·773-0·794; 0.093) and C2HEST (0·757, 0·744-0·770; 0.102). FIND-AF demonstrated favourable reclassification and superior net benefit on decision curve analysis, with robust performance in both sexes and across ethnic groups. The higher predicted risk cohort, compared to lower predicted risk, had a 20-fold higher 6-month incidence rate for AF and higher long-term risk of AF (HR 8·75, 95% CI 8·44-9·06), but also incident heart failure (HR 12.54, 95% CI 12.08-13.01) aortic stenosis (9.98, 9.16-10.87), stroke/TIA (8.07, 7.80-8.34), CKD (6.85, 6.70-7.00), peripheral vascular disease (6.62, 6.28-6.98), valvular heart disease (6.49, 6.14-6.85), MI (5.02, 4.82-5.22), diabetes (2.05, 2.00-2.10) and COPD (2.02, 2.00-2.05) (Figure 1). This cohort were also at higher risk of death (10.45, 10.23-10.68), accounting for 71% of cardiovascular deaths. Conclusions FIND-AF is applicable to national electronic health records data, identifies people at higher risk of incident AF within the next 6 months with good performance, and predicts risk of a range of other conditions and death.

We consider the following Gelfand problem ( P ) λ { − Δ u = λ a ( x ) f ( u ) a m p ; in Ω , u > 0 a m p ; in Ω , u = 0 a m p ; on ∂ Ω , \begin{equation*} (P)_\lambda \qquad \left \{\begin {array}{ll} -\Delta u = \lambda a(x) f(u) & \text { in } \Omega , \\ u>0 & \text { in } \Omega , \\ u= 0 & \text { on } \partial \Omega , \end{array}\right . \end{equation*} where λ > 0 \lambda >0 is a parameter and f ( u ) = e u f(u)=e^u or f ( u ) = ( u + 1 ) p f(u)=(u+1)^p where p > 1 p>1 and a ( x ) a(x) is a nonnegative function with certain monotonicity (we allow a ( x ) = 1 a(x)=1 ). Here Ω \Omega is an annular domain which is also a double domain of revolution. Our interest will be in the question of the regularity of the extremal solution. We obtain improved compactness because of the annular nature of the domain and we obtain further compactness under some monotonicity assumptions on the domain.

A prospective study was designed to (a) investigate the rate of daily weight gain among kittens less than 9 weeks old presented to an animal shelter, (b) identify factors (e.g., sex, clinical signs of disease, diet, and medical treatment) that affect daily weight gain, and (c) investigate the mortality of study kittens. The study of 203 kittens was conducted at a managed admission, no-kill animal shelter in upstate New York, USA, from April 2014 through October 2014. Body weight was measured daily from day of intake to adoption or 12 weeks of age. Fecal score, clinical signs of disease, food type, and medical treatments were recorded daily. Lethargy and being female were significantly associated with lower daily weight gain. Despite the challenges of shelter and foster care, the average daily weight gain for study kitten was higher than that reported in other settings such as catteries and laboratories. Five study kittens (2.5%) died or were euthanized. Daily monitoring systems provide opportunities for interventions, increased live outcomes, and improved welfare for kittens in shelter and foster care.

Contains fulltext : 248305.pdf (Publisher’s version ) (Closed access) CONTEXT: Treatment of metastatic urothelial carcinoma is currently undergoing a rapid evolution. OBJECTIVE: This overview presents the updated European Association of Urology (EAU) guidelines for metastatic urothelial carcinoma. EVIDENCE ACQUISITION: A comprehensive scoping exercise covering the topic of metastatic urothelial carcinoma is performed annually by the Guidelines Panel. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries, resulting in yearly guideline updates. EVIDENCE SYNTHESIS: Platinum-based chemotherapy is the recommended first-line standard therapy for all patients fit to receive either cisplatin or carboplatin. Patients positive for programmed death ligand 1 (PD-L1) and ineligible for cisplatin may receive immunotherapy (atezolizumab or pembrolizumab). In case of nonprogressive disease on platinum-based chemotherapy, subsequent maintenance immunotherapy (avelumab) is recommended. For patients without maintenance therapy, the recommended second-line regimen is immunotherapy (pembrolizumab). Later-line treatment has undergone recent advances: the antibody-drug conjugate enfortumab vedotin demonstrated improved overall survival and the fibroblast growth factor receptor (FGFR) inhibitor erdafitinib appears active in case of FGFR3 alterations. CONCLUSIONS: This 2021 update of the EAU guideline provides detailed and contemporary information on the treatment of metastatic urothelial carcinoma for incorporation into clinical practice. PATIENT SUMMARY: In recent years, several new treatment options have been introduced for patients with metastatic urothelial cancer (including bladder cancer and cancer of the upper urinary tract and urethra). These include immunotherapy and targeted treatments. This updated guideline informs clinicians and patients about optimal tailoring of treatment of affected patients.

Background: Asthma treatment guidelines recommend increasing corticosteroid dose to control symptoms and reduce exacerbations. This approach is potentially flawed because symptomatic asthma can occur without corticosteroid responsive type-2 (T2)-driven eosinophilic inflammation, and inappropriately high-dose corticosteroid treatment might have little therapeutic benefit with increased risk of side-effects. We compared a biomarker strategy to adjust corticosteroid dose using a composite score of T2 biomarkers (fractional exhaled nitric oxide [FENO], blood eosinophils, and serum periostin) with a standardised symptom–risk-based algorithm (control). Methods: We did a single-blind, parallel group, randomised controlled trial in adults (18–80 years of age) with severe asthma (at treatment steps 4 and 5 of the Global Initiative for Asthma) and FENO of less than 45 parts per billion at12 specialist severe asthma centres across England, Scotland, and Northern Ireland. Patients were randomly assigned (4:1) to either the biomarker strategy group or the control group by an online electronic case-report form, in blocks of ten, stratified by asthma control and use of rescue systemic steroids in the previous year. Patients were masked to study group allocation throughout the entirety of the study. Patients attended clinic every 8 weeks, with treatment adjustment following automated treatment-group-specific algorithms: those in the biomarker strategy group received a default advisory to maintain treatment and those in the control group had their treatment adjusted according to the steps indicated by the trial algorithm. The primary outcome was the proportion of patients with corticosteroid dose reduction at week 48, in the intention-to-treat (ITT) population. Secondary outcomes were inhaled corticosteroid (ICS) dose at the end of the study; cumulative dose of ICS during the study; proportion of patients on maintenance oral corticosteroids (OCS) at study end; rate of protocol-defined severe exacerbations per patient year; time to first severe exacerbation; number of hospital admissions for asthma; changes in lung function, Asthma Control Questionnaire-7 score, Asthma Quality of Life Questionnaire score, and T2 biomarkers from baseline to week 48; and whether patients declined to progress to OCS. A secondary aim of our study was to establish the proportion of patients with severe asthma in whom T2 biomarkers remained low when corticosteroid therapy was decreased to a minimum ICS dose. This study is registered with ClinicalTrials.gov, NCT02717689 and has been completed. Findings: Patients were recruited from Jan 8, 2016, to July 12, 2018. Of 549 patients assessed, 301 patients were included in the ITT population and were randomly assigned to the biomarker strategy group (n=240) or to the control group(n=61). 28·4% of patients in the biomarker strategy group were on a lower corticosteroid dose at week 48 compared with 18·5% of patients in the control group (adjusted odds ratio [aOR] 1·71 [95% CI 0·80–3·63]; p=0·17). In the per-protocol (PP) population (n=121), a significantly greater proportion of patients were on a lower corticosteroid dose at week 48 in the biomarker strategy group (30·7% of patients) compared with the control group (5·0% of patients; aOR 11·48 [95% CI 1·35–97·83]; p=0·026). Patient choice to not follow treatment advice was the principle reason for loss to PP analysis. There was no difference in secondary outcomes between study groups and no loss of asthma control among patients in the biomarker strategy group who reduced their corticosteroid dose. Interpretation: Biomarker-based corticosteroid adjustment did not result in a greater proportion of patients reducing corticosteroid dose versus control. Understanding the reasons for patients not following treatment advice in both treatment strategies is an important area for future research. The prevalence of T2 biomarker-low severe asthma was low.

Objective: Type 2 (T2) inflammation offers a therapeutic target for biologics. Previous trials suggest obesity influences T2-biomarker levels in asthma, though have not accounted for key variables, e.g., inhaled (ICS)/oral corticosteroid (OCS) use. We hypothesized that body mass index (BMI) would affect T2-biomarker levels, after adjusting for covariates.\ud \ud Methods: A retrospective analysis of data from two recent local trials of 153 participants with asthma (102 difficult-to-treat, 51 mild). Measurements included BMI, fractional exhaled nitric oxide (FeNO) and eosinophils. Correlation and regression analysis were performed for each biomarker to describe their relationship with BMI. Data was analysed overall, and by asthma severity, T2-status and BMI tertile.\ud \ud Results: Increasing BMI was associated with reduction in FeNO when stratified by BMI tertile (25ppb lowest tertile, 18ppb highest tertile; p = 0.014). Spearmans rank showed a negative correlation between BMI and FeNO in difficult-to-treat asthma (ρ= -0.309, p = 0.002). Linear regression adjusting for sex, age, smoking, atopy, allergic/perennial rhinitis, ICS and OCS confirmed BMI as a predictor of FeNO overall (β= -2.848, p = 0.019). Eosinophils were reduced in the highest BMI tertile versus lowest in difficult-to-treat asthma (0.2x109/L, 0.3x109/L respectively; p = 0.02).\ud \ud Conclusions: Increasing BMI is associated with lower FeNO in asthma when adjusted for relevant covariates, including steroid use. There also appears to be an effect on eosinophil levels. Obesity, therefore, affects T2 biomarker levels with implications for disease endotyping and determination of eligibility for biologic therapy. Whether this is due to masking of underlying T2-high status or development of a truly T2-low endotype requires further research.

The need for entirely online instruction as a result of the COVID-19 pandemic has raised many questions about university faculty readiness for online instruction and how to effectively support university faculty in integrating mobile technology into their practice. Previous research suggests subtypes of university faculty technology integration and in turn, a need for diversified approaches to professional development. However, such research is both limited and contested, and thus further research is needed. This multistudy examined whether there are qualitatively distinct faculty subtypes for mobile technology integration (Study 1: N = 83, Study 2: N = 45) based on their knowledge, self-efficacy, and attitudes towards mobile technology, and whether such subtypes, if indeed were present, were meaningfully associated with an adoption of mobile technology in the following semester. Findings from the latent profile analysis suggest five university faculty subtypes: Technology Enthusiasts, Knowledgeable Adopters, Prospective Adopters, Knowledgeable Skeptics, and Non-Adopters. Study 2 validates Study 1 findings. Findings illustrate that technology professional development opportunities only have value for certain university faculty groups and that resources would be better targeted elsewhere for faculty groups such as non-adopters. We discuss the implications of these findings for future efforts to support university faculty mobile technology integration.

Background: Diabetes mellitus is one of the fastest growing health crises of our time. One of the major complications is diabetic foot ulcers, many of which fail to heal. Tenotomy – transection of tendon fibres – may help to redistribute pressure in the foot and therefore help ulcer healing and prevent recurrence. The aim of this survey was to explore the availability of pressure relieving adjuncts, including tenotomy, in diabetic foot services and interest in collaborating in further research studies. Methods: An online survey was performed of healthcare professionals involved in the management of diabetic foot ulcers to explore the multidisciplinary composition of diabetic foot services, offloading therapies available and interest in collaborating in further research. Results: The survey gained 168 responses from 10 countries. Most responders were orthopaedic surgeons (61.3%, 103/168). Of those who responded, 70.8% (119/168) had a dedicated diabetic foot clinic and 99 (58.9%) reported having an active tenotomy service. 73.8% (124/168) of responders wished to further collaborate and 82.1% (138/168) were willing to help involve their patients in a future trial. Conclusions: The results of this survey showed the variation in tenotomy practice and an appetite for collaborative research in this area. The Vascular Society of Great Britain and Ireland Diabetic Foot Specialist Interest Group will address these uncertainties through targeted collaborative research to investigate tenotomy as a potential clinical and cost-effective treatment in diabetic foot care.

Background: understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.Methods: we reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.Results: of 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.Conclusions: belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.

Importance: This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. Objective: To examine existing studies on the effects of dry needling on spasticity and ROM. Data Sources: Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. Findings: Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. Conclusions and Relevance: This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. What This Article Adds: This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.

Transactions of the London and Middlesex Archaeological Society, 2.43, 3-191

International audience; Context: This overview presents the updated European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). Objective: To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. Evidence acquisition: A broad and comprehensive scoping exercise covering all areas of the MMIBC guideline has been performed annually since its 2017 publication (based on the 2016 guideline). Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries, resulting in yearly guideline updates. A level of evidence and a grade of recommendation were assigned. Additionally, the results of a collaborative multistakeholder consensus project on advanced bladder cancer (BC) have been incorporated in the 2020 guidelines, addressing those areas where it is unlikely that prospective comparative studies will be conducted. Evidence synthesis: Variant histologies are increasingly reported in invasive BC and are relevant for treatment and prognosis. Staging is preferably done with (enhanced) computerised tomography scanning. Treatment decisions are still largely based on clinical factors. Radical cystectomy (RC) with lymph node dissection remains the recommended treatment in highest-risk non–muscle-invasive and muscle-invasive nonmetastatic BC, preceded by cisplatin-based neoadjuvant chemotherapy (NAC) for invasive tumours in “fit” patients. Selected men and women benefit from sexuality sparing RC, although this is not recommended as standard therapy. Open and robotic RC show comparable outcomes, provided the procedure is performed in experienced centres. For open RC 10, the minimum selected case load is 10 procedures per year. If bladder preservation is considered, chemoradiation is an alternative in well-selected patients without carcinoma in situ and after maximal resection. Adjuvant chemotherapy should be considered if no NAC was given. Perioperative immunotherapy can be offered in clinical trial setting. For fit metastatic patients, cisplatin-based chemotherapy remains the first choice. In cisplatin-ineligible patients, immunotherapy in Programmed Death Ligand 1 (PD-L1)-positive patients or carboplatin in PD-L1–negative patients is recommended. For second-line treatment in metastatic disease, pembrolizumab is recommended. Postchemotherapy surgery may prolong survival in responders. Quality of life should be monitored in all phases of treatment and follow-up. The extended version of the guidelines is available at the EAU website: https://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/. Conclusions: This summary of the 2020 EAU MMIBC guideline provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. Patient summary: The European Association of Urology Muscle-invasive and Metastatic Bladder Cancer (MMIBC) Panel has released an updated version of their guideline, which contains information on histology, staging, prognostic factors, and treatment of MMIBC. The recommendations are based on the current literature (until the end of 2019), with emphasis on high-level data from randomised clinical trials and meta-analyses and on the findings of an international consensus meeting. Surgical removal of the bladder and bladder preservation are discussed, as well as the use of chemotherapy and immunotherapy in localised and metastatic disease. Radical cystectomy with urinary diversion remains the mainstay of managing muscle-invasive bladder cancer (MIBC). The use of neoadjuvant chemotherapy (NAC) has improved overall survival rates, but selection of patients who will benefit most from NAC remains challenging. In case bladder-preserving strategies are considered, patient stratification according to their risk profile is imperative and management should be discussed in a multidisciplinary team. As yet, there are no validated prognostic molecular markers to guide the clinical management of MIBC. In a metastatic setting, cisplatin-based chemotherapy remains the first choice in fit patients. In unfit patients, based on interim results from two on-going clinical trials, first-line treatment with pembrolizumab or atezolizumab for urothelial cancer is restricted to Programmed Death Ligand 1-positive patients only.

Regional comprehensive universities with access-oriented missions provide critical pathways for increasing the number and diversity of STEM graduates. The BOND program at California State University, Fresno supports the transition to college for first-time, full-time freshmen in selected STEM majors. BOND incorporates a learning community, active learning, and early course-based research experiences. Compared to comparison groups, students that participate in BOND are 1.93 times more likely to persist in STEM into their fourth year despite similar academic achievement in introductory STEM courses. A higher proportion of BOND students also engage with campus resources that support their first and second year on campus, which suggests that appropriate support builds persistence through the challenges of a STEM degree. This study highlights the importance of providing support strategies and resources in the first year for STEM retention, counter to the traditional narrative of “weeding out” students in their first year on campus.

Coronavirus Disease 19 (COVID-19) can present as an Adult Respiratory Distress Syndrome (ARDS)-like pneumonia Continuous Positive Airway Pressure (CPAP) for ARDS is usually delivered in Intensive Care Units (ICU) Pressure for ICU beds led to Glasgow Royal Infirmary developing a COVID-19 High Dependency Unit (C-HDU) where domiciliary non-invasive ventilators (NIV) (Lumis 150, Resmed) with supplementary oxygen delivered CPAP for respiratory failure due to COVID-19 pneumonia We review the feasibility and efficacy of delivering CPAP outside the ICU setting Method: Retrospective analysis of data from patients receiving CPAP in C-HDU (25th March to 8th May 2020) Results: 58 patients received CPAP in total 46/58 received CPAP only 18/46 improved and were discharged by day 30 12/46 died by day 30 12/46 required mechanical ventilation - of these 6/12 successfully extubated and well at day 30, 3/12 remain in ICU and 3/12 died 4/46 failed CPAP but survived with simple oxygen therapy 12/58 did not tolerate CPAP and were switched to nasal high flow oxygen - of these 8/12 are well at day 30 Conclusions: It is feasible to deliver CPAP using domiciliary NIV machines with supplementary oxygen for COVID-19 pneumonia outwith ICU CPAP has potential to improve patient outcomes, prevent ICU admissions and deliver tangible service efficiencies C-HDU established a multi-disciplinary approach to patient care, incorporating acute medical and respiratory physicians with respiratory physiology support and developed protocols using an iterative learning approach Trials for CPAP in COVID-19 pneumonia are ongoing, but our experience supports its role and the practicality of delivering CPAP using domiciliary NIV equipment

Introduction: Increasing corticosteroids (CS) to control asthma symptoms and exacerbations has potential for inappropriately high and difficult to down-titrate CS doses. Aims and Objectives: We tested whether a T2 biomarker-based strategy (BS) to guide CS reduction (factoring fractional exhaled nitric oxide (FeNO), blood eosinophils, serum periostin) vs. a symptom-based control would see fewer exacerbations and better asthma control and lung function. Methods: In this randomised (4:1/BS:control), single-blind parallel group trial, patients (pts) with severe asthma and FeNO Results: In the intention-to-treat population (240 BS vs. 61 control pts), the proportion of BS pts on lower CS dose at Wk48 was 28.4% vs. 18.5% in the controls (adjusted OR: 1.71; 95%CI 0.80, 3.63; p=0.165). In the per protocol (PP) population (n=121), significantly more pts had lower CS doses at Wk48 in the BS vs. the control group (30.7% vs. 5.0% (OR: 11.48; 95%CI 1.35, 97.83; p=0.026). Failure to follow treatment advice was the main reason for ITT and PP population differences. There was no difference in secondary outcomes between study arms. Conclusion: Biomarker based CS adjustment did not result in a greater proportion of pts reducing CS vs. control, probably because many pts did not follow treatment advice. The biomarker strategy seemed beneficial in pts where symptoms and T2 biomarker profile were discordant.

International audience; CONTEXT: In bladder cancer patients treated with radical cystectomy (RC), controversy exists regarding the impact of the annual hospital volume (HV) and/or surgeon volume (SV) on oncological outcomes and quality of care. OBJECTIVE: A systematic review was performed to evaluate the impact of HV and SV on clinical outcomes. Primary outcomes included in-hospital, 30-d, and 90-d mortality. Secondary outcomes included complications, long-term survival, positive surgical margin rate, lymphadenectomy performance, length of hospital stay, neobladder performance, and blood loss/transfusion rate. EVIDENCE ACQUISITION: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched. Comparative studies published after the year of 2000 including patients who underwent RC for bladder cancer were eligible for inclusion. Partial cystectomy was an exclusion criterion. Risk of bias (RoB) assessment was performed according to the ROBINS-1 tool. EVIDENCE SYNTHESIS: After screening of 1190 abstracts, 39 studies recruiting 549 542 patients were included. All studies were retrospective observation cohort studies (level of evidence 3). Twenty-two studies reported on HV only, six studies on SV only, and 12 on both. Higher HV, specifically an HV of >10, was associated with improved primary and secondary outcomes in most studies. In addition, there is some evidence that an HV of >20 improves outcomes. For SV, limited and conflicting data are reported. Most studies had moderate to high RoB. The results were synthesized narratively. CONCLUSIONS: Acknowledging the lower level of evidence, HV is likely associated with in-hospital, 30- and 90-d mortality, as well as the secondary outcomes assessed. Based on this study, the European Association of Urology Muscle-invasive and Metastatic Bladder Cancer Guideline Panel recommends hospitals to perform at least 10, and preferably >20, RCs annually or refer the patient to a center that reaches this number. For SV, limited and conflicting data are available. The available evidence suggests HV rather than SV to be the main driver of perioperative outcomes. PATIENT SUMMARY: Current literature suggests that the number of bladder removal operations per hospital per year is associated with postoperative survival as well as the quality of care provided. Copyright

CONTEXT Primary urethral carcinoma (PUC) is a rare cancer accounting for

Metal-on-metal (MoM) total hip arthroplasty (THA) can be associated with adverse metal reactions, including pseudotumors. This case report describes a 58-year-old female with an MoM THA-related pseudotumor that caused unilateral leg edema from compression of her external iliac vein. After thorough preoperative workup to rule out infection and deep vein thrombosis and consultation with a vascular surgeon, the patient underwent revision THA and excision of her pseudotumor. She had complete resolution of her swelling at 4 years after surgery. Review of all available case reports for this rare complication revealed that almost all patients were female. All patients underwent revision THA, with resolution of their symptoms. Literature review demonstrates that women are disproportionally affected by complications associated with MoM THA. We recommend close monitoring of patients with MoM THA, particularly women, for development of adverse metal reactions.

The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice.To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; ureteroscopy; nephroureterectomy; adjuvant treatment; instillation; recurrence; risk factors; and survival. References were weighted by a panel of experts.Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing number of retrospective articles in UTUC. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification, as well as for radical and conservative treatment; prognostic factors are also discussed. A single postoperative dose of intravesical mitomycin after radical nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumours and two functional kidneys.These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours.Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis; appropriate diagnosis and management is most important. We present recommendations based on current evidence for optimal management.

To effectively characterize the impact of viscous remanent magnetization (VRM) on the transient electromagnetic response, we present a set of analytical expressions for the vertical and radial VRM responses generated by a large circular loop over a magnetically viscous half-space. For a step-off excitation, Neel relaxation theory is used to express the VRM within the half-space as the product of a static on-time magnetization and a time-dependent aftereffect function. Through heuristic and empirical approximations to the elliptic integral of the second kind, we are able to convert Hankel integral-based expressions for static fields into simplified analytical expressions. These were validated with a numerical 1-D forward modeling code. Analytical expressions show that VRM responses are largest near the transmitter wire, and that at the center of a large loop, the strength of the VRM response is inversely proportional to the loop’s radius. We also present an estimate of the crossover time from which the VRM signal starts to dominate the transient response. We found that later crossover times were observed near the centers of large loops and that crossover times were much earlier near the transmitter wire. Also, the magnetic flux density has an earlier crossover time compared with its time derivative. To lower or remove the VRM response in an anticipated survey, our analytical expressions can be used straightforwardly to choose an appropriate loop size, identify the VRM response time window, and select an optimal set of time channels.

Item does not contain fulltext CONTEXT: Invasive bladder cancer is a frequently occurring disease with a high mortality rate despite optimal treatment. The European Association of Urology (EAU) Muscle-invasive and Metastatic Bladder Cancer (MIBC) Guidelines are updated yearly and provides information to optimise diagnosis, treatment, and follow-up of this patient population. OBJECTIVE: To provide a summary of the EAU guidelines for physicians and patients confronted with muscle-invasive and metastatic bladder cancer. EVIDENCE ACQUISITION: An international multidisciplinary panel of bladder cancer experts reviewed and discussed the results of a comprehensive literature search of several databases covering all sections of the guidelines. The panel defined levels of evidence and grades of recommendation according to an established classification system. EVIDENCE SYNTHESIS: Epidemiology and aetiology of bladder cancer are discussed. The proper diagnostic pathway, including demands for pathology and imaging, is outlined. Several treatment options, including bladder-sparing treatments and combinations of treatment modalities (different forms of surgery, radiation therapy, and chemotherapy) are described. Sequencing of these modalities is discussed. Potential indications and contraindications, such as comorbidity, are related to treatment choice. There is a new paragraph on organ-sparing approaches, both in men and in women, and on minimal invasive surgery. Recommendations for chemotherapy in fit and unfit patients are provided including second-line options. Finally, a follow-up schedule is provided. CONCLUSIONS: The current summary of the EAU Muscle-invasive and Metastatic Bladder Cancer Guidelines provides an up-to-date overview of the available literature and evidence dealing with diagnosis, treatment, and follow-up of patients with metastatic and muscle-invasive bladder cancer. PATIENT SUMMARY: Bladder cancer is an important disease with a high mortality rate. These updated guidelines help clinicians refine the diagnosis and select the appropriate therapy and follow-up for patients with metastatic and muscle-invasive bladder cancer.