Molecular Urothelial Tumor Cell Subtypes Remain Stable During Metastatic Evolution

Urothelial cancer (UC) care is moving toward precision oncology. For tumor biology-driven treatment of metastatic UC (mUC), molecular subtypes play a crucial role. However, it is not known whether subtypes change during metastatic evolution. To address this, we analyzed a UC progression cohort (N = 154 patients) with 138 matched primary tumors (PRIM) and synchronous or metachronous distant metastasis (MET) by immunohistochemistry, and mRNA sequencing in a subgroup of 20 matched pairs. Protein-based tumor cell subtypes and histomorphology remained stable during metastatic progression (concordance: 94%, 95% confidence interval [CI] 88-97%). In comparison, transcriptome-based molecular consensus subtypes exhibited higher heterogeneity between PRIM and MET (concordance: 45%, 95% CI 23-69%), with switches particularly occurring between luminal and stroma-rich tumors. Of note, all tumors classified as stroma rich showed luminal tumor cell differentiation. By an in-depth analysis, we found a negative correlation of luminal gene and protein expression with increasing desmoplastic stroma content, suggesting that luminal tumor cell differentiation of "stroma-rich tumors" is superimposed by gene expression signals stemming from the stromal compartment. Immunohistochemistry allows tumor cell subtyping into luminal, basal, or neuroendocrine classes that remain stable during metastatic progression. These findings expand our biological understanding of UC MET and have implications for future subtype-stratified clinical trials in patients with mUC. PATIENT SUMMARY: Urothelial carcinomas (UCs) occur in different appearances, the so-called molecular subtypes. These molecular subtypes will gain importance for the therapy of metastatic UCs in the future. We could demonstrate that the subtype remains stable during metastasis, which is highly relevant for future studies.

[Prevention of recurrence of urolithiasis]

Urolithiasis is one of the most frequent urological diseases. Identifying the causes of stone formation forms the basis for successful prevention of recurrence. Metabolic diagnostics and measures for prevention of recurrence are based on the assignment of the patient to a low-risk or high-risk group. Analysis of the urinary calculi is an essential prerequisite for identifying patients at risk. The general recommendations on diet and lifestyle are considered to be the basis of treatment. Depending on the type of stone and the individual biochemical risk profile of a patient, these general measures should be supplemented by targeted medical nutrition therapy and pharmacological treatment. Mixed stones can pose a challenge for the treatment and prevention of recurrence. A personalized treatment decision that takes the various components of mixed stones into account could further improve the prevention of recurrence of urolithiasis.

Elucidating the need for prostate cancer risk calculators in conjunction with mpMRI in initial risk assessment before prostate biopsy at a tertiary prostate cancer center

OBJECTIVE

Utilizing personalized risk assessment for clinically significant prostate cancer (csPCa) incorporating multiparametric magnetic resonance imaging (mpMRI) reduces biopsies and overdiagnosis. We validated both multi- and univariate risk models in biopsy-naïve men, with and without the inclusion of mpMRI data for csPCa detection.

METHODS

N = 565 men underwent mpMRI-targeted prostate biopsy, and the diagnostic performance of risk calculators (RCs), mpMRI alone, and clinical measures were compared using receiver operating characteristic curve (ROC) analysis and decision curve analysis (DCA). Subgroups were stratified based on mpMRI findings and quality.

RESULTS

csPCa was detected in 56.3%. PI-RADS score achieved the highest area under the curve (AUC) when comparing univariate risk models (AUC 0.82, p < 0.001). Multivariate RCs showed only marginal improvement in csPCa detection compared to PI-RADS score alone, with just one of four RCs showing significant superiority. In mpMRI-negative cases, the non-MRI-based RC performed best (AUC 0.80, p = 0.016), with the potential to spare biopsies for 23%. PSA-density and multivariate RCs demonstrated comparable performance for PI-RADS 3 constellation (AUC 0.65 vs. 0.60-0.65, p > 0.5; saved biopsies 16%). In men with suspicious mpMRI, both mpMRI-based RCs and the PI-RADS score predicted csPCa excellently (AUC 0.82-0.79 vs. 0.80, p > 0.05), highlighting superior performance compared to non-MRI-based models (all p < 0.002). Quality-assured imaging consistently improved csPCa risk stratification across all subgroups.

CONCLUSION

In tertiary centers serving a high-risk population, high-quality mpMRI provides a simple yet effective way to assess the risk of csPCa. Using multivariate RCs reduces multiple biopsies, especially in mpMRI-negative and PI-RADS 3 constellation.

Delayed symptomatic renal arteriovenous fistula in a 24 years old male following renal biopsy

We report a case of a 24-year-old male with a history of kidney biopsy at young age due to chronic renal dysfunction and challenging hypertension, who presented with flank pain and hematuria. Initial imaging suggested renal pelvis enlargement, but MRI revealed a massive renal arteriovenous malformation (AVM). Angiographic embolization was abandoned due to extensive effluent flow, followed by successful surgical resection preserving healthy kidney tissue. This case underscores the importance of considering renal AVMs in the differential diagnosis of young patients with gross hematuria or refractory hypertension to prevent complications and improve patient outcomes.

Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options

AIM

Less than a dozen cases of psoas abscesses in pregnancy have been described in the literature. We reviewed the literature when treating a patient with a psoas abscess after ipsilateral double J-ureteral stent placement (in the following: "double J-stent") due to infected hydronephrosis.

METHODS

In January 2022, this review was searched using the Pubmed/MEDLINE database and the mesh terms "Psoas Abscess" AND "Pregnancy". Studies were included in any language and of all years, describing a psoas abscess during pregnancy. When patients did not have a psoas abscess, the abscess occurred after pregnancy, or when there was no full text available, the article was excluded.

MAIN RESULTS

Ten case reports about patients with psoas abscesses during pregnancy were included. The classical symptomatic triad of psoas muscle abscess included lower back pain, limping and persistent fever with daily spikes. However, in most cases, not all three symptoms can be found. Especially, fever is absent in more than half of the patients. Psoas abscesses are described between 13 and 39 weeks of gestation. Primary psoas abscesses with haematogenous spread are more common during pregnancy than secondary with spread per continuitatem. In the literature, the main reasons for psoas abscess are spinal tuberculosis, drug abuse or underlying diseases such as Crohn's disease. It is not uncommon for the definite cause to be unclear. Regarding the patient's symptoms, pyelonephritis is often considered a possible aetiology. In general, the main treatment options include antibiotic treatment and abscess drainage. There is no higher caesarean section rate, and no negative outcome for the foetus has been described.

CASE PRESENTATION

In our patient, a 38-year-old obese Caucasian woman, who had received a left double J-stent for infected hydronephrosis at 15 weeks of gestation, we successfully treated a psoas abscess of 20 × 10 cm with a sonographically assisted abscess drainage and antibiotics. The further course of pregnancy and the elective repeat caesarean section at 38 + 0 weeks of gestation were without any problems. Double J-stent placement and laser stone lithotripsy during puerperium were performed because of recurrent urolithiasis.

CONCLUSIONS

Although rare, psoas abscesses can occur during pregnancy, and it has often been treated surgically in the past. A psoas abscess as a complication after infected hydronephrosis and intervention during pregnancy has never been reported in the literature. Even for obese patients, minimally invasive therapy may be a treatment option that has rarely been reported in the literature.

Cryosectioning-enabled super-resolution microscopy for studying nuclear architecture at the single protein level

DNA-PAINT combined with total Internal Reflection Fluorescence (TIRF) microscopy enables the highest localization precisions, down to single nanometers in thin biological samples, due to TIRF's unique method for optical sectioning and attaining high contrast. However, most cellular targets elude the accessible TIRF range close to the cover glass and thus require alternative imaging conditions, affecting resolution and image quality. Here, we address this limitation by applying ultrathin physical cryosectioning in combination with DNA-PAINT. With "tomographic & kinetically-enhanced" DNA-PAINT (tokPAINT), we demonstrate the imaging of nuclear proteins with sub-3 nanometer localization precision, advancing the quantitative study of nuclear organization within fixed cells and mouse tissues at the level of single antibodies. We believe that ultrathin sectioning combined with the versatility and multiplexing capabilities of DNA-PAINT will be a powerful addition to the toolbox of quantitative DNA-based super-resolution microscopy in intracellular structural analyses of proteins, RNA and DNA in situ.

Expression of the microtubule-associated protein 2 (MAP2) as a potential independent prognostic marker in prostate cancer

PURPOSE

Investigation of Microtubuli-associated Protein 2 (MAP2) expression and its clinical relevance in prostate cancer.

MATERIAL AND METHODS

MAP2 expression was immunohistochemically analysed on radical prostatectomy specimens using whole block sections (n = 107) and tissue microarrays (TMA; n = 310). The staining intensity was evaluated for carcinoma, benign tissue and prostatic intraepithelial neoplasia. Expression data were correlated with clinicopathological parameters and biochemical recurrence-free survival. Additionally, MAP2 protein expression was quantitatively analysed in the serum of histologically confirmed prostate carcinoma patients and the control group using a commercial enzyme-linked immunosorbent assay.

RESULTS

MAP2 staining was significantly stronger in neoplastic tissue than in non-neoplastic prostatic glands, both in whole block sections (p < 0.01) and in TMA sections (p < 0.05). TMA data revealed significantly stronger MAP2 staining in high-grade tumors. Survival analysis showed a significant correlation between strong MAP2 staining in carcinoma and shortened biochemical recurrence-free survival after prostatectomy (p < 0.001). Multivariate Cox regression analysis confirmed MAP2 as an independent predictor for an unfavourable course. Mean MAP2 serum levels for non-PCA vs. PCA patients differed significantly (non-PCA = 164.7 pg/ml vs. PCA = 242.5 pg/ml, p < 0.001).

CONCLUSION

The present data support MAP2 as a novel biomarker in PCA specimens. MAP2 is correlated with tumor grade and MAP2 high-expressing PCA is associated with an increased risk of biochemical recurrence after radical prostatectomy. Future studies are necessary to evaluate MAP2 as a valuable immunohistochemical biomarker in preoperative PCA diagnostic procedures, in particular with regard to treatment modalities.

Ring Finger Protein 34 (RNF34) as a Prognostic Biomarker for Clear Cell Renal Cell Carcinoma

INTRODUCTION

Ring finger proteins play pivotal roles in diverse cellular processes and are implicated in contribution to cancer. Ring finger protein 34 (RNF34) has antiapoptotic and oncogenic properties. RNF34 is upregulated during carcinogenesis and tumor progression in the colorectal adenoma-carcinoma sequence and was already described to mediate chemoresistance. In clear cell renal cell carcinoma (ccRCC), however, the role and expression patterns of RNF34 are unknown.

METHODS

First, we investigated the association of RNF34 mRNA expression with clinicopathological parameters and survival using data obtained from The Cancer Genome Atlas (TCGA) ccRCC cohort (N = 533). To assess RNA34 protein expression, we performed immunohistochemical (IHC) staining of an established ccRCC cohort (University of Bonn) in a tissue microarray (TMA) format. This validation cohort contains 109 primary ccRCC samples. IHC data were associated with clinicopathological parameters and overall survival (Kaplan-Meier analysis). Adjustment for covariables was done using the Cox regression model.

RESULTS

RNF34 expression is correlated with adverse clinicopathological parameters. Survival analysis revealed an association between RNF34 expression and shortened survival. Cox regression analysis confirmed RNF34 expression as an independent prognostic parameter.

CONCLUSION

Our study provides evidence for RNF34 as a prognostic biomarker in ccRCC and points toward a major role of this protein in renal cell carcinoma carcinogenesis.

[Polypharmacy and medication review in the context of prehabilitation]

Against the background of typical geriatric multimorbidity and with the particular vulnerability of geriatric patients, polypharmacy deserves special attention. In accordance with the guidelines, medication should not only be reviewed regularly, but also on an ad hoc basis and with each hospital stay-and also in the context of prehabilitation. Thus, not only substances that interfere with the currently planned intervention, anesthesia, or risk of bleeding should be considered, but any medication that increases common risks for geriatric patients. These include drugs that cause or increase a tendency to fall, induce delirium, or alter the comedication through potential drug-drug interactions. Measures to minimize the risk include the following: exact documentation of medications, structured and complete transfer of information, patient and family training about any side effects that may occur, a recall system for possible laboratory checks, and compliance with the instructions for taking the medication.

Dual-color DNA-PAINT single-particle tracking enables extended studies of membrane protein interactions

DNA-PAINT based single-particle tracking (DNA-PAINT-SPT) has recently significantly enhanced observation times in in vitro SPT experiments by overcoming the constraints of fluorophore photobleaching. However, with the reported implementation, only a single target can be imaged and the technique cannot be applied straight to live cell imaging. Here we report on leveraging this technique from a proof-of-principle implementation to a useful tool for the SPT community by introducing simultaneous live cell dual-color DNA-PAINT-SPT for quantifying protein dimerization and tracking proteins in living cell membranes, demonstrating its improved performance over single-dye SPT.

Identification of F-Box/SPRY Domain-Containing Protein 1 (FBXO45) as a Prognostic Biomarker for TMPRSS2-ERG-Positive Primary Prostate Cancers

BACKGROUND

F-box/SPRY domain-containing protein 1 (FBXO45) plays a crucial role in the regulation of apoptosis via the ubiquitylation and degradation of specific targets. Recent studies indicate the prognostic potential of FBXO45 in several cancers. However, its specific role in prostate carcinoma remains unclear.

METHODS

A systematic analysis of FBXO45 mRNA expression in PCA was performed using The Cancer Genome Atlas database and a publicly available Gene Expression Omnibus progression PCA cohort. Subsequently, FBXO45 protein expression was assessed via immunohistochemical analysis of a comprehensive tissue microarray cohort. The expression data were correlated with the clinicopathological parameters and biochemical-free survival. The immunohistochemical analyses were stratified according to the TMPRSS2-ERG rearrangement status. To assess the impact of FBXO45 knockdown on the tumour proliferation capacity of cells and metastatic potential, transfection with antisense-oligonucleotides was conducted within a cell culture model.

RESULTS

FBXO45 mRNA expression was associated with adverse clinicopathological parameters in the TCGA cohort and was enhanced throughout progression to distant metastasis. FBXO45 was associated with shortened biochemical-free survival, which was pronounced for the TMPRSS2-ERG-positive tumours. In vitro, FBXO45 knockdown led to a significant reduction in migration capacity in the PC3, DU145 and LNCaP cell cultures.

CONCLUSIONS

Comprehensive expression analysis and functional data suggest FBXO45 as a prognostic biomarker in PCA.

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

PURPOSE

Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution.

METHODS

Two hundred and fifty-nine men with PI-RADS 3-5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2.

RESULTS

CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4-5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors.

CONCLUSION

SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.

Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis

Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.

Mental Health in Individuals with a History of Mental Disorder during COVID-19-Pandemic - Preliminary Results of the National Cohort Study in Germany

Introduction

Research of COVID-19-Pandemic mental health impact focus on three groups: the general population, (2) so called vulnerable groups (e.g. individuals with mental disorders) and (3) individuals suffering COVID-19 including Long-COVID syndromes.

Objectives

We investigate whether individuals with a history of depression in the past, react to the COVID-19 pandemic with increased depressive symptoms.

Methods

Longitudinal Data stem from the NAKO-Baseline-Assessment (2014-2019, 18 study centers in Germany, representative sampled individuals from 20 to 74 years) and the subsequent NAKO-COVID-Assessment (5-11/2020). The sample for analysis comprises 115.519 individuals. History of psychiatric disorder was operationalized as lifetime self-report for physician-diagnosed depression. Depressive symptoms were measured with the PHQ 9.

Results

Mean age of the sample at baseline was 49.95 (SD 12.53). It comprised 51.70 women; 14 % of the individuals had a history of physician-diagnosed depression. Considering a PHQ-Score with cut-off 10 as a clinical relevant depression, 3.65 % of the individuals without history of depression and 24.19 % of those with a history of depression were depressed at baseline. The NAKO-COVID-Assessment revealed 6.53 % depressed individuals without any history of depression and a similar rate of 23.29 % in those with history of depression.

Conclusions

In contrast to that what we expected, individuals with a history of a physician-diagnosed depression, did not react with increasing depressiveness during the first phase of the pandemic in Germany. Several reasons could be discussed. Whether there medium and long-term impact remains open.

Disclosure

No significant relationships.

The value of diastolic speckle-tracking parameters in predicting outcome after surgical ventricular restoration

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): DZHK (German Centre for Cardiovascular Research) BMBF (German Ministry of Education and Research)

Background. Parameters of speckle-tracking echocardiography (STE) are incorporated into the integrative assessment of left ventricular (LV) diastolic function 1. In this study we aimed to evaluate both established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm planned for surgical ventricular restoration (SVR).

Methods. We retrospectively examined data of 137 patients (60 ± 11 years, 25% women) with anteroapical LV aneurysm who underwent SVR and for whom preoperative echocardiography was available and feasible for STE and for conventional assessment of LV diastolic function by transmitral flow. STE parameters evaluated were: left atrial reservoir strain (LAS), early and late global diastolic strain rate (GLSRe and GLSRa), ratio of early-to-late diastolic strain rate (GLSRe/GLSRa), and ratio of early diastolic transmitral flow velocity (E) to GLSRe and to GLSRa. In 24 patients we evaluated an association of diastolic echocardiographic parameters with mean pulmonary artery pressure (PAPm) and mean pulmonary capillary wedge pressure (PCWPm) obtained invasively within 6 days of echocardiography. Preoperative echocardiographic parameters were assessed in whole cohort of patients for the association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation.

Results. During a median follow-up of 4.7 years (IQR: 1.4-8.1 years) events occurred in 59 patients. GLSRa, E/GLSRa and LAS demonstrated significant correlation with PAPm and PCWPm (Table 1). GLSRa with optimal cut-off value of ≤ 0.41 s-1 was able to detect PAPm &gt;30 mmHg with sensitivity of 0.8 and specificity of 0.8 (AUC 0.85; 95% CI 0.68-1.0; p = 0.008). E/GLSRa ≥1.24 m was able to detect PAPm &gt;30 mmHg with sensitivity of 1.0 and specificity of 0.8 (AUC 0.87; 95%CI 0.7-1.0; p = 0.005). There was significant difference in event-free survival between groups stratified by cut-offs for GLSRa (Fig. 1A) and E/GLSRa (Fig. 1B). After adjustment for important clinical (age, sex, plasma creatinine, atrial fibrillation) and echocardiographic parameters (fractional shortening and LV end-systolic volume index) GLSRa and E/GLSRa remained an independent predictors of events (HR 0.16; 95% CI: 0.03-0.86; p = 0.032 and HR 1.22; 95% CI: 1.03-1.43; p = 0.018) and demonstrated higher prognostic value compared to LAS, other STE parameters and conventional parameters of LV diastolic function.

Conclusion. Late diastolic longitudinal strain rate and ratio of early diastolic transmitral flow velocity to late diastolic longitudinal strain rate demonstrated association with hemodynamic parameters in patients with LV anteropaical aneurysm and might be used for the evaluation of LV diastolic function. These parameters showed prognostic value for patients underwent SVR and could be implemented for preoperative evaluation of these patients. Abstract Table 1. Correlation data  Abstract Figure 1. Survival curves

[Comparison of catheter-associated quality of life in external urinary diversion: nephrostomy vs. suprapubic catheter]

Einleitung

Die katheterbezogene Lebensqualität (LQ) bei Nephrostomieträgern wurde bisher noch nie systematisch untersucht. Dies sollte nun erstmalig vergleichend mit einer ebenfalls externen Urinableitung, dem suprapubischen Katheter, geschehen.

Methodik

Das die katheterbezogene LQ untersuchende Assessment nach Mary Wilde wurde bei Patienten mit perkutaner Nephrostomie (PCN) in lebenslanger Intention und minimaler Liegedauer von 3 Monaten vorgelegt.

Ergebnisse

Es zeigte sich insgesamt bei 66 Patienten (davon 42 mit unilateraler PCN) mit einem Punktwert von median 4,0 auf einer Skala von 0–5 eine nur moderat eingeschränkte katheterbezogene LQ. Diese wurde insgesamt und in allen Domänen schlechter als bei Patienten mit suprapubischem Katheter (SPK) bewertet, bei denen sich ein Score von 4,3 im Median fand. Signifikant waren die Unterschiede in den Einzelitems „Gefühl der Erniedrigung“, „Konflikte mit ärztlichem oder pflegerischem Personal“, „Angst vor schmerzhaften Katheterwechseln“, „Gefühl als kranke Person“, „Behinderungen in Aktivitäten des täglichen Lebens“ und „Besorgnis, nicht alles tun zu können, was ich mag“. Ebenso ergaben sich bei PCN-Trägern signifikant häufiger Angst vor Katheterlecks und Uringeruch. Die Anzahl der einliegenden PCN und die Grunderkrankung spielten für die Beurteilung der LQ keine Rolle.

Schlussfolgerung

Erstmals wurde die katheterassoziierte LQ, die sich bei PCN-Trägern nur moderat eingeschränkt fand, mit einem validierten Assessment quantitativ eingeordnet. Die Angabe der Betroffenen, sich als „krank“ und in der Ausübung von Aktivitäten des täglichen Lebens „behindert“ zu fühlen und die Angst vor Urinleckagen und schmerzhaften Wechseln sollten Ansporn für eine sorgfältige Indikationsstellung und technisch korrekte Katheterwechsel sein.

[Guidelines for consultations regarding incontinence care products]

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

Design Features to Accelerate the Higher-Order Assembly of DNA Origami on Membranes

Nanotechnology often exploits DNA origami nanostructures assembled into even larger superstructures up to micrometer sizes with nanometer shape precision. However, large-scale assembly of such structures is very time-consuming. Here, we investigated the efficiency of superstructure assembly on surfaces using indirect cross-linking through low-complexity connector strands binding staple strand extensions, instead of connector strands binding to scaffold loops. Using single-molecule imaging techniques, including fluorescence microscopy and atomic force microscopy, we show that low sequence complexity connector strands allow formation of DNA origami superstructures on lipid membranes, with an order-of-magnitude enhancement in the assembly speed of superstructures. A number of effects, including suppression of DNA hairpin formation, high local effective binding site concentration, and multivalency are proposed to contribute to the acceleration. Thus, the use of low-complexity sequences for DNA origami higher-order assembly offers a very simple but efficient way of improving throughput in DNA origami design.

Calibration-free counting of low molecular copy numbers in single DNA-PAINT localization clusters

Single-molecule localization microscopy (SMLM) has revolutionized light microscopy by enabling optical resolution down to a few nanometer. Yet, localization precision commonly does not suffice to visually resolve single subunits in molecular assemblies or multimeric complexes. Because each targeted molecule contributes localizations during image acquisition, molecular counting approaches to reveal the target copy numbers within localization clusters have been persistently proposed since the early days of SMLM, most of which rely on preliminary knowledge of the dye photophysics or on a calibration to a reference. Previously, we developed localization-based fluorescence correlation spectroscopy (lbFCS) as an absolute ensemble counting approach for the SMLM-variant DNA-PAINT (points accumulation for imaging in nanoscale topography), for the first time, to our knowledge, circumventing the necessity for reference calibrations. Here, we present an extended concept termed lbFCS+, which allows absolute counting of copy numbers for individual localization clusters in a single DNA-PAINT image. In lbFCS+, absolute counting of fluorescent loci contained in individual nanoscopic volumes is achieved via precise measurement of the local hybridization rates of the fluorescently labeled oligonucleotides ("imagers") employed in DNA-PAINT imaging. In proof-of-principle experiments on DNA origami nanostructures, we demonstrate the ability of lbFCS+ to truthfully determine molecular copy numbers and imager association and dissociation rates in well-separated localization clusters containing up to 10 docking strands. For N ≤ 4 target molecules, lbFCS+ is even able to resolve integers, providing the potential to study the composition of up to tetrameric molecular complexes. Furthermore, we show that lbFCS+ allows resolving heterogeneous binding dynamics, enabling the distinction of stochastically generated and a priori indistinguishable DNA assemblies. Beyond advancing quantitative DNA-PAINT imaging, we believe that lbFCS+ could find promising applications ranging from biosensing to DNA computing.

[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]

Hintergrund

Die Anlage eines transurethralen Dauerkatheters (DK) oder suprapubischen Harnblasenkatheters (SPK) in lebenslanger Indikation stellt einen Eingriff mit relevanten Komplikationen, Komorbiditäten und möglichen Auswirkungen auf die katheterassoziierte Lebensqualität des Betroffenen dar. Letztere wurde aber bisher noch nicht untersucht.

Methodik

Zur Anwendung kam ein validiertes Assessment zur katheterbezogenen Lebensqualität mit 25 Items in 5 Domänen. Befragt wurden im Rahmen eines Katheterwechsels Patienten mit einem DK oder SPK in lebenslanger Intention, die diesen mindestens 3 Monate trugen.

Ergebnisse

Fragebögen von 357 Patienten, davon 260 Männer und 97 Frauen, 193 mit SPK und 162 mit DK (2 ohne Angabe) lagen vor. Patienten mit DK waren mit 78,9 ± 11,1 Jahren signifikant älter als solche mit SPK mit 74,4 ± 12,6 Jahren (p < 0,001). Der mittlere Gesamtlebensqualitätsscore lag bei 4,1 ± 0,9 Punkten auf einer Skala von 1 (maximal beeinträchtigte Lebensqualität) bis 5 (keine Beeinträchtigung der Lebensqualität). Es zeigten sich u. a. mit niedrigeren Scores eine vermehrte Angst vor Katheterlecks, Angst vor Uringeruch und Harnwegsinfektionen und vor schmerzhaften Katheterwechseln. Diese Sorgen waren v. a. bei Frauen, solchen mit Harninkontinenz, Trägern eines Katheters ≥ 18 Ch und bei Patienten < 70 Jahren vorhanden. Frauen mit einem SPK wiesen eine schlechtere Bewertung ihrer Lebensqualität als Männer mit SPK auf.

Schlussfolgerung

Die gefundenen Ergebnisse sollten in die Aufklärung zu einer lebenslangen Katheterableitung einfließen bzw. im Kontext möglicher Alternativen wie z. B. einer operativen Desobstruktion oder einer Hilfsmittelversorgung mit dem Patienten bzw. Betreuungspersonen besprochen werden.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00120-021-01642-1) enthält weitere Tabellen mit detaillierten Ergebnissen der Fragen der 5 abgefragten Domänen.

Evolution of AquablationVR-From innovation to establishment

Technological progress is continuously improving medical care. The urological profession is well-known for further development of technical innovations and quick transfer into daily practice. Robot-assisted surgery, for example, has been part of the clinical routine in modern urological clinics for many years. In the endourological field, the implementation and further evolution of laser-based procedures have dominated research in the last decade. Recently, in 2015, the presentation of a new robot-assisted technique of waterjet-based ablation of prostate tissue raised attention in the society-the AquablationVR therapy. Aquablation therapy has been investigated within several randomized and controlled clinical trials, and-with growing experience- the technique has been modified over recent years to improve the safety of the procedure. Due to the clinical outcome, the number of hospitals performing Aquablation therapy is increasing continuously. This article provides an overview of the technique, its modifications, and the current status of evidence.

Combined Arrhenius-Merz Law Describing Domain Relaxation in Type-II Multiferroics

Electric fields were applied to multiferroic TbMnO_{3} single crystals to control the chiral domains, and the domain relaxation was studied over 8 decades in time by means of polarized neutron scattering. A surprisingly simple combination of an activation law and the Merz law describes the relaxation times in a wide range of electric field and temperature with just two parameters, an activation-field constant and a characteristic time representing the fastest possible inversion. Over the large part of field and temperature values corresponding to almost 6 orders of magnitude in time, multiferroic domain inversion is thus dominated by a single process, the domain wall motion. Only when approaching the multiferroic transition other mechanisms yield an accelerated inversion.

P–485 A systematic analysis of acupuncture for IVF treatment: how should the HFEA traffic light scale for add-ons rate it?

Study question

How should acupuncture be rated on the Human Fertilisation and Embryology Authority traffic light scheme for IVF add-ons?

Summary answer

Randomised controlled trials examining the possible effects of acupuncture on IVF success rates are conflicting, and acupuncture should be rated amber.

What is known already

The use of complementary therapies in assisted reproduction and IVF has become increasingly more commonplace in recent years. Patients seeking to maximise their chances of conception are often interested in purchasing additional treatments (termed ‘add-ons’) to augment their treatment cycle, often at a high price even in the absence of robust underlying evidence. The use of acupuncture is popular due to putative holistic benefits including stress reduction, and the perceived lack of side-effects and minimal invasiveness. The HFEA traffic light system has not yet rated any complementary therapies, even though these are promoted by fertility clinics.

Study design, size, duration

A systematic review of randomised controlled trials (RCTs) of acupuncture during IVF treatment was conducted. A literature search for acupuncture studies was conducted on the PubMed database and the University College London (UCL) library database. Search terms used were “acupuncture” paired with “IVF”, “in vitro fertilisation”, “assisted reproduction” and “RCT”. Study quality and variance in treatment protocols were assessed, to understand both any evidence and its quality. Statistical analysis was performed using STATA.

Participants/materials, setting, methods

The UCL library database yielded 403 individual search results and PubMed database yielded 47. Papers were screened and sorted according to the inclusion and exclusion criteria. Inclusion: publication in English, in an English-language journal; RCT; intervention administered during IVF; either pregnancy rate (PR), ongoing/clinical PR or live birth rate (LBR) reported. Exclusion: reviews; not in English; not RCT; above outcomes not reported.

Main results and the role of chance

After final screening, a total of 34 acupuncture RCTs were included in the review and meta-analysis. The sample sizes of the studies analysed ranged from 44 to 809 (median 162). Only a minority of studies (18%, 6/34) involved blinding of both assessor and participant, while foregoing incorporation of blinding into study design was most common (44%, 15/34 studies). There was little consistency regarding the timing of acupuncture treatment during the IVF protocol across RCTs. A total of 21/34 studies (62%) had a protocol involving acupuncture administration before and after the embryo transfer procedure on the day of transfer. The number of needle insertions during the treatment protocols ranged from 5–13 (mean 8.7). Manual acupuncture only was performed in 8/34 (24%) of studies and 26/34 (76%) utilised electrical stimulation of at least some of the acupuncture needles. Out of 34 RCTs, only 10/34 studies (29%) reported LBR. The meta-analysis included all identified RCTs. The most clinically relevant outcome measure reported in each study found a slight benefit of acupuncture for overall IVF success (OR 1.37, 95% CI 1.13–1.65) however the effect was diluted when only comparing studies reporting LBR (OR 1.14 ,95% CI 0.81–1.61).

Limitations, reasons for caution

Methodological heterogeneity of acupuncture RCTs in IVF (needling location, stimulation, retention time, repetition and timing) complicates data pooling. Underlying neurophysiological mechanisms of action are still being clarified and may help delineate optimal regimens, potentially tailored to individual causes of infertility. Treatment safety and potential for worse outcomes must be considered.

Wider implications of the findings: Complementary therapies are a popular add-on for IVF treatment but assessing them from a robust biomedical perspective is challenging due to issues with study design (including controls), study quality and general attitudes. For acupuncture, future research should arguably focus on biomedical perspectives and shift away from Traditional Chinese Medicine philosophies.

Trial registration number

Not applicable

Impact of Multiparametric Stone Measurement in Noncontrast Computer Tomography on Ureterorenoscopic Stone Removal

PURPOSE

Low-dose computer tomography (NCCT) is the standard imaging modality for patients with acute flank pain with a suspicion of urolithiasis. The stone size is usually measured 2D by a radiologist. We compared 3D stone measurement using different windows to the 2D measurement and evaluated the clinical impact on ureterorenoscopic stone removal (URS).

METHODS

One hundred sixty-four patients (201 stones) with a preoperative NCCT, following a URS within 4 weeks, were included in this study. Stone location, number and size of stones, operating time, and laser lithotripsy were documented. Stones were measured in 3D using bone and soft tissue window. The maximum diameter was compared to the radiological report. The U test, Kruskal-Wallis, and regression were used for statistical analyses.

RESULTS

Almost two-thirds (64.68%; 130 stones) of stone measurements in 3D with the bone window were lower than the radiologist reports in 2D. One-third (34.83%; 70 stones) of stone measurements were higher and 0.5% (1 stone) reported the same size. Using the 3D soft tissue window, 81.09% (163 stones), 17.91% (37 stones), and 1% (2 stones) of stones were measured bigger, smaller, or had the same measurement results, respectively. In the clinical setting, we could calculate a cutoff for laser lithotripsy at a maximum stone diameter of 5.70 mm (p < 0.01) with the 3D and 6.01 mm with the 2D measurements, respectively, and found a significant correlation between maximum stone diameter and operating time (p < 0.01) and number of stones and operating time (p < 0.01 with and p = 0.02 without laser).

CONCLUSION

3D stone measurement with bone window seems to be more accurate than 2D measurement, but 2D is sufficient for planning stone treatment.

Association between neuropathy and B-vitamins: A systematic review and meta-analysis

BACKGROUND

Peripheral neuropathy (PN) is common in patients with diseases that are in turn associated with deficiency of the B-vitamins, and vitamin treatment has shown mixed results.

METHODS

This systematic review and meta-analysis studied the association between PN/pain and B-vitamin biomarkers and investigated whether vitamin treatment can ameliorate the symptoms. PubMed and Web of Science were searched according to the study protocol.

RESULTS

A total of 46 observational and seven interventional studies were identified and included in the data synthesis. The presence of PN was associated with lowered B12 levels (pooled estimate [95% CIs] = 1.51 [1.23-1.84], n = 34, Cochran Q Test I²  = 43.3%, p = 0.003) and elevated methylmalonic acid (2.53 [1.39-4.60], n = 9, I²  = 63.8%, p = 0.005) and homocysteine (3.48 [2.01-6.04], n = 15, I²  = 70.6%, p < 0.001). B12 treatment (vs. the comparators) showed a non-significant association with symptom improvement (1.36 (0.66-2.79), n = 4, I²  = 28.9%). Treatment with B1 was associated with a significant improvement in symptoms (5.34 [1.87-15.19], n = 3, I²  = 64.6%, p = 0.059). Analysis of seven trials combined showed a non-significant higher odds ratio for improvement under treatment with the B-vitamins (2.58 [0.98-6.79], I²  = 80.0%, p < 0.001).

CONCLUSIONS

PN is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine. Overall, interventional studies have suggested that B-vitamins could improve symptoms of PN. Available trials have limitations and generally did not investigate vitamin status prior to treatment. Well-designed studies, especially in non-diabetes PN, are needed. This meta-analysis is registered at PROSPERO (ID: CRD42020144917).

Grief and loss in old age: Exploration of the association between grief and depression

BACKGROUND

The proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association.

METHODS

The cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed.

RESULTS

With increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support.

LIMITATIONS

Assessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded.

CONCLUSION

The study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

Otoferlin is a prognostic biomarker in patients with clear cell renal cell carcinoma: A systematic expression analysis

OBJECTIVES

To comprehensively investigate the role of otoferlin as a prognostic and diagnostic biomarker in clear cell renal cell carcinoma.

METHODS

Three independent cohorts were used to study otoferlin in clear cell renal cell carcinoma: The Cancer Genome Atlas cohort (messenger ribonucleic acid expression; clear cell renal cell carcinoma n = 514, normal renal tissue n = 81); study validation cohort (messenger ribonucleic acid expression; clear cell renal cell carcinoma n = 79, normal renal tissue n = 44); and immunohistochemistry cohort (protein expression; clear cell renal cell carcinoma n = 142, normal renal tissue n = 30). Otoferlin gene expressions were extracted from The Cancer Genome Atlas database or determined using quantitative real-time polymerase chain reaction, respectively. Protein expression was assessed using immunohistochemistry staining against otoferlin on tissue microarrays. Correlations between otoferlin messenger ribonucleic acid/protein expression and clinicopathological data/patient survival were statistically tested.

RESULTS

Otoferlin messenger ribonucleic acid expression was significantly upregulated in clear cell renal cell carcinoma compared with normal renal tissue. High expression levels correlated with advanced stage, higher grade and metastatic tumors, accompanied by independent prognostic significance for overall and cancer-specific survival. In contrast, otoferlin protein expression was downregulated in tumor tissue. Although, high otoferlin expression in clear cell renal cell carcinoma was positively correlated with histological grading and independently predictive of a shortened progression-free survival.

CONCLUSION

Our data suggest otoferlin as an indicator of tumor aggressiveness and as a prognostic biomarker for patients with clear cell renal cell carcinoma, leading to the conclusion that otoferlin could promote the malignancy of clear cell renal cell carcinoma.

Exposure to bisphenol A differentially impacts neurodevelopment and behavior in Drosophila melanogaster from distinct genetic backgrounds

Bisphenol A (BPA) is a ubiquitous environmental chemical that has been linked to behavioral differences in children and shown to impact critical neurodevelopmental processes in animal models. Though data is emerging, we still have an incomplete picture of how BPA disrupts neurodevelopment; in particular, how its impacts may vary across different genetic backgrounds. Given the genetic tractability of Drosophila melanogaster, they present a valuable model to address this question. Fruit flies are increasingly being used for assessment of neurotoxicants because of their relatively simple brain structure and variety of measurable behaviors. Here we investigated the neurodevelopmental impacts of BPA across two genetic strains of Drosophila-w¹¹¹⁸ (control) and the Fragile X Syndrome (FXS) model-by examining both behavioral and neuronal phenotypes. We show that BPA induces hyperactivity in larvae, increases repetitive grooming behavior in adults, reduces courtship behavior, impairs axon guidance in the mushroom body, and disrupts neural stem cell development in the w¹¹¹⁸ genetic strain. Remarkably, for every behavioral and neuronal phenotype examined, the impact of BPA in FXS flies was either insignificant or contrasted with the phenotypes observed in the w¹¹¹⁸ strain. This data indicates that the neurodevelopmental impacts of BPA can vary widely depending on genetic background and suggests BPA may elicit a gene-environment interaction with Drosophila fragile X mental retardation 1 (dFmr1)-the ortholog of human FMR1, which causes Fragile X Syndrome and is associated with autism spectrum disorder.

Downstream Neighbor of SON (DONSON) Expression Is Enhanced in Phenotypically Aggressive Prostate Cancers

Simple Summary

Downstream neighbor of SON (DONSON) plays a crucial role in cell cycle progression and in maintaining genomic stability. We identified DONSON to be associated with an aggressive histopathological phenotype and unfavorable survival in prostate cancer (PCa) in different transcriptomic cohorts and on the protein level in our tissue microarray cohort. DONSON expression in the primary tumor was particularly strong in locally advanced, metastasized, and dedifferentiated carcinomas (TNM Stage, Gleason). Highly proliferating tumors exhibited a significant correlation to DONSON expression, and DONSON expression was notably upregulated in distant metastases and androgen-deprivation resistant metastases. In vitro, specific DONSON-knockdown significantly reduced the migration capacity in PC-3 and LNCaP, which further suggests a tumor-promoting role of DONSON in PCa. The results of our comprehensive expression analyses, as well as the functional data obtained after DONSON-depletion, lead us to the conclusion that DONSON is a promising prognostic biomarker with oncogenic properties in PCa.

Abstract

Downstream neighbor of Son (DONSON) plays a crucial role in cell cycle progression and in maintaining genomic stability, but its role in prostate cancer (PCa) development and progression is still underinvestigated. Methods: DONSON mRNA expression was analyzed with regard to clinical-pathological parameters and progression using The Cancer Genome Atlas (TCGA) and two publicly available Gene Expression Omnibus (GEO) datasets of PCa. Afterwards, DONSON protein expression was assessed via immunohistochemistry on a comprehensive tissue microarray (TMA). Subsequently, the influence of a DONSON-knockdown induced by the transfection of antisense-oligonucleotides on proliferative capacity and metastatic potential was investigated. DONSON was associated with an aggressive phenotype in the PCa TCGA cohort, two GEO PCa cohorts, and our PCa TMA cohort as DONSON expression was particularly strong in locally advanced, metastasized, and dedifferentiated carcinomas. Thus, DONSON expression was notably upregulated in distant and androgen-deprivation resistant metastases. In vitro, specific DONSON-knockdown significantly reduced the migration capacity in the PCa cell lines PC-3 and LNCaP, which further suggests a tumor-promoting role of DONSON in PCa. In conclusion, the results of our comprehensive expression analyses, as well as the functional data obtained after DONSON-depletion, lead us to the conclusion that DONSON is a promising prognostic biomarker with oncogenic properties in PCa.

Prognostic role of left ventricular diastolic function assessed by speckle tracking echocardiography in patients after surgical ventricular repair

Background

Assessment of left ventricular (LV) diastolic function brings important prognostic information for patients with heart failure and could be evaluated by speckle tracking echocardiography (STE). Less known about its role in patients planned for surgical ventricular repair due to LV aneurysm.

Purpose

The aim of this study was to evaluate the prognostic role of STE parameters of LV diastolic function for prediction of all-cause mortality in patients after surgical ventricular repair.

Methods

We retrospectively evaluated data of 163 consecutive pts (mean age 62.3±11.5 years, 74.8% males) with anteroapical LV aneurysm who underwent surgical ventricular repair combined with coronary artery bypass surgery (71.8%) Prognostic role for prediction of all-cause mortality was assessed for various STE parameters, including left atrial strain (LAS) measured as peak reservoir strain and for the ratio of early to late global longitudinal strain rate (GLSRe/GLSRa).

Results

During a median follow-up of 4.7 years (IQR: 1.6–8.9 years) there were 65 deaths, 5 year survival rate was 73.8 (95% CI 67–79%). Baseline ejection fraction, end-diastolic and end-systolic volumes of LV did not differ between pts who died and survived at 5 year after the surgery, whereas LAS was significantly higher and GLSRe/GLSRa was significantly lower in survivors. Cox proportional hazard model adjusted to demographic and clinical variables demonstrated that LAS and GLSRe/GLSRa were independent predictors of all-cause death, with HR of 0.79 (95% CI 0.66–0.95, p=0.012) for each 5% increase of LAS and HR of 1.24 (95% CI 1.1–1.4, p=0.001) for each 0.5 increase of GLSRe/GLSRa. Moreover, GLSRe/GLSRa remained an independent predictor after additional adjustment for LV end-systolic volume, sphericity index and presence of mitral insufficiency of grade 2 and higher. A significant difference in median survival time was demonstrated according to the following cut-offs: LAS ≥16.7% (12.1 vs. 6.4 years, p=0.01), GLSRe/GLSRa ratio ≥2.3 (3.3 years vs. 10.2 years, p=0.0005) (Figure). The classification and regression tree analysis with the application of all two-dimensional, Doppler and various speckle-tracking echocardiographic parameters revealed that GLSRe/GLSRa and LAS were the most important echocardiographic variables for risk stratification for 5-year mortality.

Conclusion

This study demonstrates that STE parameters of LV diastolic function are important predictors of all-cause mortality after surgical ventricular repair due to anteroapical aneurysm of LV and could be used in the preoperative decision-making process.

Funding Acknowledgement

Type of funding source: None