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Prostate cancer antigen 3 (PCA3) is a urinary biomarker for prostate cancer and has demonstrated a good specificity and sensitivity representing a minimally invasive test.PCA3 assay could be useful in combination with PSA to suggest an eventual rebiopsy in men who have had one or more previous negative prostate biopsies.Combination of multiple tumor biomarkers will be the trend in the near future to achieve the goal of evaluate the aggressiveness of cancer and at the same time reducing the number of unnecessary biopsies.

Prostate cancer antigen 3 (PCA3) is a urinary biomarker for prostate cancer and has demonstrated a good specificity and sensitivity representing a minimally invasive test.PCA3 assay could be useful in combination with PSA to suggest an eventual rebiopsy in men who have had one or more previous negative prostate biopsies.Combination of multiple tumor biomarkers will be the trend in the near future to achieve the goal of evaluate the aggressiveness of cancer and at the same time reducing the number of unnecessary biopsies.

ObjectivesAlthough a set of computer-aided risk scoring systems (CARSS), that use the National Early Warning Score and routine blood tests results, have been validated for predicting in-hospital mortality and sepsis in unplanned admission to hospital, little is known about their performance for COVID-19 patients. We compare the performance of CARSS in unplanned admissions with COVID-19 during the first phase of the pandemic.Designa retrospective cross-sectional studySettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (>=18 years) non-elective admissions discharged between 11-March-2020 to 13-June-2020 with an index NEWS electronically recorded within ±24 hours. We assessed the performance of all four risk score (for sepsis: CARS_N, CARS_NB; for mortality: CARM_N, CARM_NB) according to discrimination (c-statistic) and calibration (graphically) in predicting the risk of COVID-19 and in-hospital mortality.ResultsThe risk of in-hospital mortality following emergency medical admission was 8.4% (500/6444) and 9.6% (620/6444) had a diagnosis of COVID-19. For predicting COVID-19 admissions, the CARS_N model had the highest discrimination 0.73 (0.71 to 0.75) and calibration slope 0.81 (0.72 to 0.89). For predicting in-hospital mortality, the CARM_NB model had the highest discrimination 0.84 (0.82 to 0.75) and calibration slope 0.89 (0.81 to 0.98).ConclusionsTwo of the computer-aided risk scores (CARS_N and CARM_NB) are reasonably accurate for predicting the risk of COVID-19 and in-hospital mortality, respectively. They may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions because they are automated and require no additional data collection.Article SummaryIn this study, we found that two of the automated computer-aided risk scores are reasonably accurate for predicting the risk of COVID-19 and in-hospital mortality, respectively.They may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions because they are automated and require no additional data collection.Although we focused on in-hospital mortality (because we aimed to aid clinical decision making in the hospital), the impact of this selection bias needs to be assessed by capturing out-of-hospital mortality by linking death certification data and hospital data.We identified COVID-19 based on ICD-10 code ‘U071’ which was determined by COVID-19 swab test results (hospital or community) and clinical judgment and so our findings are constrained by the accuracy of these methods

ObjectivesTo consider the potential of the National Early Warning Score (NEWS2) for COVID-19 risk prediction on unplanned admission to hospital.DesignLogistic regression model development and validation study using a cohort of unplanned emergency medical admission to hospital.SettingYork Hospital (YH) as model development dataset and Scarborough Hospital (SH) as model validation dataset.ParticipantsUnplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020) from two hospitals (YH for model development; SH for external model validation) based on admission NEWS2 electronically recorded within ±24 hours of admission. We used logistic regression modelling to predict the risk of COVID-19 using NEWS2 (Model M0’) versus enhanced cNEWS models which included age + sex (model M1’) + subcomponents (including diastolic blood pressure + oxygen flow rate + oxygen scale) of NEWS2 (model M2’). The ICD-10 code ‘U071’ was used to identify COVID-19 admissions. Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥5.ResultsThe prevalence of COVID-19 was higher in SH (11.0%=277/2520) than YH (8.7%=343/3924) with higher index NEWS2 (3.2 vs 2.8) but similar in-hospital mortality (8.4% vs 8.2%). The c-statistics for predicting COVID-19 for cNEWS models (M1’,M2’) was substantially better than NEWS2 alone (M0’) in development (M2’: 0.78 (95%CI 0.75-0.80) vs M0’ 0.71 (95%CI 0.68-0.74)) and validation datasets (M2’: 0.72 (95%CI 0.69-0.75) vs M0’ 0.65 (95%CI 0.61-0.68)). Model M2’ had better calibration than Model M0’ with improved sensitivity (M2’: 57% (95%CI 51%-63%) vs M0’ 44% (95%CI 38%-50%)) and similar specificity (M2’: 76% (95%CI 74%-78%) vs M0’ 75% (95%CI 73%-77%)) for validation dataset at NEWS2≥5.ConclusionsModel M2’ is reasonably accurate for predicting the on-admission risk of COVID-19. It may be clinically useful for an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions.

ObjectivesThere are no established mortality risk equations specifically for unplanned emergency medical admissions which include patients with the novel coronavirus SARS-19 (COVID-19). We aim to develop and validate a computer-aided risk score (CARMc19) for predicting mortality risk by combining COVID-19 status, the first electronically recorded blood test results and latest version of the National Early Warning Score (NEWS2).DesignLogistic regression model development and validation study using a cohort of unplanned emergency medical admissions to hospital.SettingYork Hospital (YH) as model development dataset and Scarborough Hospital (SH) as model validation dataset.ParticipantsUnplanned adult medical admissions discharged over three months (11 March 2020 to 13 June 2020) from two hospitals (YH for model development; SH for external model validation) based on admission NEWS2 electronically recorded within ±24 hours and/or blood test results within ±96 hours of admission. We used logistic regression modelling to predict the risk of in-hospital mortality using two models: 1) CARMc19_N: age + sex + NEWS2 including subcomponents + COVID19; 2) CARMc19_NB: CARMc19_N in conjunction with seven blood test results and acute kidney injury score. Model performance was evaluated according to discrimination (c-statistic), calibration (graphically), and clinical usefulness at NEWS2 thresholds of 4+, 5+, 6+.ResultsThe risk of in-hospital mortality following emergency medical admission was similar in development and validation datasets (8.4% vs 8.2%). The c-statistics for predicting mortality for Model CARMc19_NB is better than CARMc19_N in the validation dataset (CARMc19_NB = 0.88 (95%CI 0.86 to 0.90) vs CARMc19_N = 0.86 (95%CI 0.83 to 0.88)). Both models had good internal and external calibration (CARMc19_NB: 1.01 (95%CI 0.88 vs 1.14) & CARMc19_N: 0.95 (95%CI 0.83 to 1.06)). At all NEWS2 thresholds (4+, 5+, 6+) model CARMc19_NB had better sensitivity and similar specificity.ConclusionsWe have developed a validated CARMc19 score with good performance characteristics for predicting the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded vital signs and blood tests results. Since the CARMc19 scores place no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Objectives Although the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring for deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic. Design a retrospective cross-sectional study Setting Two acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively. Participants Adult (>=18 years) non-elective admissions discharged between 11-March-2020 to 13-June-2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission are used to predict mortality at four-time points (in-hospital, 24hours, 48hours, and 72hours) in COVID-19 versus non-COVID-19 admissions. Results Out of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7yrs), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (e.g., NEWS2=5: 36% vs 9%). Conclusions The index or on-admission NEWS and NEWS2 offer lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 is not better than the index NEWS. For each value of the index NEWS or index NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19. Article Summary This study data is from a single NHS Trust and used the index NEWS/NEWS2 scores. The extent to which these findings are generalisable, especially to minority ethnic groups with higher mortality, needs further study. Although we found no evidence of NEWS2 as having a superior performance to NEWS, this does suggest that the additional enhancements in NEWS2 are having a limited impact and the underlying reasons need further study. NEWS and NEWS2 are repeatedly updated for each patient according to local hospital protocols, and the extent to which changes in NEWS or NEWS2 over time reflect changes in mortality risk needs further study.

Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826). Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.

Today, distribution systems are subject to an increasing penetration of dispersed generation. This is an important step toward a new green, sustainable, paradigm of energy. However, injections from renewables on distribution networks can cause technical issues in power systems, which require to put in operation new monitoring and control procedures and apparatuses. The paper details the Smart Grid experiment developed by A.S.SE.M. (a DSO of Central Italy) on its distribution grid. The project, incentivized by the Italian Energy Authority in the framework of Resolution ARG/elt 39/10, involves the installation of protection and automation devices in the HV/MV substation and over the distribution grid, 10 MV users and one LV user. The following innovative features are provided: increase in the reliability of Loss of Mains protections by transfer trip messages; logic selectivity between protections; centralized voltage control; real-time monitoring and control of generation. This project, together with the other pilot applications supported by Res. ARG/elt 39/10, will provide important information to the Italian Energy Authority, useful to define an output-based regulation for Smart Grids.

Alterations in the expression of signal activation molecules, such as the T-cell receptor (TCR) zeta and epsilon chains and p56lck tyrosine kinase, are described in tumor-infiltrating lymphocytes (TIL). The aim of this study was to ascertain if such molecules were present in near-tumor-tissue lymphocytes (NTTL) and peripheral blood lymphocytes (PBL), as well as TIL, of renal cell carcinoma patients, to verify whether this tumor induces immunosuppression only locally or affects distant lymphocytes as well. Tissue from the tumor and from healthy nearby sites, as well as blood samples, were obtained from 27 consecutive patients who had undergone radical nephrectomy for renal cell carcinoma. Phenotype analysis and immunohistochemical staining of the TCR zeta and epsilon chains and p56lck were performed with standard techniques on TIL, NTTL, and PBL, and values were compared for each patient. Low expression of the TCR zeta chain and an almost complete absence of TCR epsilon chain and p56lck expression was observed in TIL (median values: 10% for zeta chain and 0% for epsilon and p56lck). In NTTL, these signal transduction molecules were expressed by a higher percentage of cells (60%, 50%, and 60%, respectively; p=0.000 vs. TIL), whereas PBL showed an almost normal expression of zeta and epsilon chains (80% and 90%, respectively; p=0.000 vs. TIL). Conversely, p56lck was detected in a greater proportion of NTTL than PBL (50% vs. 10%; p=0.001). The absence or the very low expression of signaling activation molecules in TIL compared with NTTL and PBL in renal cancer patients suggest that tumor-induced immunosuppression generally occurs or starts locally.

INTRODUCTION AND OBJECTIVES: The frequency-volume chart or micturition diary records a patientias voiding pattern during normal daily activities. The aim of this study was to formulate a comprehensive pelvic diary testing it on a selected population of healthy young female athletes in order to discover possible hidden pelvic dysfunctions. METHODS: The pelvic diary was designed after a structured literature review carried out from 1966 to December 2010 using MEDLINE via PubMed. In order to test this 7-day pelvic diary in a healthy control group a pilot observational prospective cohort study was planned, involving healthy young female athletes. Moreover all participants had to fill out the following validated symptom and healthrelated quality of life (HR-QoL) questionnaires: ICI-Q SF, OAB-q Short Form, P-QOL, Wexner score. RESULTS: From January 2012 to March 2012 a 7-day pelvic diary and the validated questionnaires were mailed to 422 female athletes by post. Replies were received from 284 of them. The mean age was 24.9 years with a mean body mass index of 20.9. Most of them were either volleyball (60.4%) or basketball (26.4%) players. Mean urinary frequency was 5.4 1.7. Mean compiled days were 6.4 1.5 days. Mean daily urine volume was 1119 600.9. Overall 46 subjects reported urinary incontinence episodes and 66 urgency. Moreover 12 athletes reported voiding problems. Concerning bowel symptom, 18 had faecal incontinence (77.8% gas incontinence) and 6 complained of pain during defecation. Regarding sexual and genital problems, 6 complained of dyspareunia and 10 had a feeling of heaviness in the vaginal area. The mean Wexner score was 6.01; the mean OAB-q SF score was 6.2. Concerning P-OQL domains we recorded the following mean score values: general health 30.1 10.18; prolapse impact 15.8 12.4; role limitation 15.2 13.0; physical limitation 14.9 12.8; personal relationships 6.5 11.2; emotions 15.4 14.3; sleep/energy 14.5 12.6; severity measures 15.6 14. CONCLUSIONS: Our comprehensive pelvic diary allowed us to detect hidden pelvic dysfunctions in young healthy women like validated symptom questionnaries. Because a validated urinary diary does not currently exist, in order to corroborate our preliminary results future steps will be to compare our pelvic questionnaire against an adequate gold standard such as the above mentioned validated symptom questionnaires.

Post-radical prostatectomy incontinence is mainly attributable to iatrogenic verify the importance of preoperative biofeedback (BFB) in an attempt to identify a strategy to improve postoperative urinary incontinence.Ninety candidates (median age 68 years: range 49-75) for radical retropubic prostatectomy were evaluated. Forty-five patients underwent preoperative pelvic floor training (PFT) and BFB, whereas the remaining 45 (control group) had preoperative PFT only. Patients started PFT exercises two weeks before surgery and continued during the immediate postoperative period, after catheter removal (6-7 days after surgery), and thereafter at home. No adjuvant therapy was administered and all 90 patients were assessed at follow up visits timed 1, 3 and 6 months post surgery.Patients who were completely dry and without use of pads were defined as continent. At the 1-month follow-up, 6.6% (3/45) of both the PFT+BFB group and the PFT only arm were continent. After 3 months, the continence rate had increased to 33.3% (15/45) and 26.6% (12/45), respectively, and at 6-month follow-up, this percentage had further risen to 71.1% (32/45) in the former group and 66.6% (30/45) in the latter group. No significant differences were observed between the two arms during follow-up, but there was a statistically significant correlation between follow-up time and continence improvement in each group.Preoperative BFB associated with PFT does not significantly influence urinary continence recovery after radical prostatectomy.

The nature of catalytic asymmetric dihydroxylation (AD), in particular the problem of ligand leaching from insoluble polymer-bound (IPB) Cinchona alkaloid derivatives, has been investigated. An upper limit to the amount of dissolved ligand, and methods for its evaluation, which assure a basically heterogeneous character of the observed AD reaction, are presented. A new copolymer architecture, which meets the established stability requirements and allows the highly enantioselective (87-99 % ee) IPB-AD of representative alkene substrates, is also described.

Transrectal prostatic ultrasonography is an inexpensive, non-invasive procedure which permits an accurate evaluation of the dimensions and echostructure of the prostate and seminal vesicles. Prostatic tumors may present as hypoechogenic (60-80%) or isoechogenic nodules (30%), the latter requiring the use of specific techniques, which increase the sensitivity and specificity of the procedure (contrast-enhanced color-power Doppler), to identify and characterize focal lesions. The color Doppler increases the predictive value of TRUS (62-75%) but has a low sensitivity, while the power Doppler enables us to study vessels with slow blood flow. The recent introduction of contrast medium could lead to an enhancement of the Doppler signal, thus increasing sensitivity of the exam; it is also, however, an expensive, invasive and time-consuming method. Improved test sensitivity has also increased the problems relating to the identification of very small prostatic lesions which are probably of low clinical significance.

Transrectal prostatic ultrasonography with biopsy is a fundamental step in the diagnosis of prostate cancer. The number of bioptic samples taken has a direct influence on the sensitivity of the diagnostic procedure. We compared the degree of acceptance of the biopsy, using visual analogue scale, with the appearance of complications in two groups of 250 patients: group A (sextant biopsy) and group B (traditional transrectal prostatic biopsy + 2 additional lateral samples from each lobe). 21% of group A patients reported slight pain, 63% tolerable pain and 16% severe pain, while pain intensity of group B patients was 18%, 65% e 17%, respectively. The appearance and degree of painful symptomatology, and the frequency of serious complications were not significantly different in either group. The extensive prostatic biopsy is well tolerated by patients and is associated with modest local complications.

Traditional 2-D ultrasound is a fast, inexpensive, non-invasive procedure and may be used routinely for the pre and post-operative evaluation of patients with various grade of cystocele, but a new tool in ultrasound investigation is recently available: the 3D scan. Our aim is to assess the real usefulness of 3D scan in the evaluation of cystocele grade. 15 women with clinical and urodynamic findings of genuine stress incontinence and grade 2-3 cystocele (in accord to Baden-Walker grading) underwent both ultrasonographic 3D imaging and traditional 2D trans labial scan with Convex probe (3.5 Mh). Correct evaluation of the relationships between the bladder, urethrovesical junction, urethra and pubic bones at rest and when straining was correctly evaluated by 2D scan in all the women underwent the examination, whereas 3D scan did not let us exactly quantify the same anatomical defect. 3D ultrasound did not prove to be as useful as traditional trans-labial 2D ultrasound procedure to provide an objective demonstration of the mobility of the urethrovesical junction. A possible explanation is that the lack of reliability of 3D investigation is due to the impossibility of real-time scanning that make approximate the choice of the image to evaluate. In conclusion traditional ultrasound is up to now an important complementary evaluation for the study of female urinary incontinence which allows not only morphological documentation but can also improve our knowledge of function and anatomy of lower urinary tract. Finally it is basic to stress that a worldwide standardisation will be the starting point for the real success of this technique and, especially for the new 3D scan, it will be important to achieve this goal together a large amount of data to compare for defining the real importance of this investigation.