About feasibility of SpaceX's human exploration Mars mission scenario with Starship

After decades where human spaceflight missions have been reserved to low Earth orbit, recent years have seen mission proposals and even implemented plans, e.g. with the mission Artemis I, for returning to the lunar surface. SpaceX has published over various media (e.g., its official website, conference presentations, user manual) conceptual information for its reusable Starship to enable human exploration missions to the Martian surface by the end of the decade. The technological and human challenges associated with these plans are daunting. Such a mission at that distance would require excellent system reliability and in-situ-resource utilization on a grand scale, e.g. to produce propellant. The plans contain little details however and have not yet been reviewed concerning their feasibility. In this paper we show significant technological gaps in these plans. Based on estimates and extrapolated data, a mass model as needed to fulfill SpaceX's plans could not be reproduced and the subsequent trajectory optimization showed that the current plans do not yield a return flight opportunity, due to a too large system mass. Furthermore, significant gaps exist in relevant technologies, e.g. power supply for the Martian surface. It is unlikely that these gaps can be closed until the end of the decade. We recommend several remedies, e.g. stronger international participation to distribute technology development and thus improve feasibility. Overall, with the limited information published by SpaceX about its system and mission scenario and extrapolation from us to fill information gaps, we were not able to find a feasible Mars mission scenario using Starship, even when assuming optimal conditions such as 100% recovery rate of crew consumables during flight.

[Palliative surgery for metastatic prostate cancer]

Androgen deprivation in combination with novel hormonal agents, docetaxel, or in combination with abiraterone/prednisone plus docetaxel or darolutamid plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favorable response rates, basically all patients will develop castration resistant prostate cancer (CRPC) within 2.5 to 4 years. In addition to systemic chemotherapy, second-line hormonal treatment of systemic application of radionuclides such as radium223 or 177Lu-PSMA represent salvage management options. However, nowadays about 50-65% of patients will develop symptoms due to local progression of prostate cancer which is the result of improved oncological outcomes with significantly prolonged survival times due to the new medical treatment options. Management of such symptomatic local progression will become more important in upcoming years so that all uro-oncologists need to be aware of the various surgical management options. Complications of the lower urogenital tract such as recurrent gross hematuria ± bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction and acute urinary retention, rectourethral or rectovesical fistulas might be managed by palliative surgery such as palliative transurethral resection of the prostate (TURP), radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract might be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of the Detour® system (Coloplast GmbH, Hamburg, Germany).

[Palliative urologic surgery for metastatic prostate cancer: what needs to be considered in the future?]

Androgen deprivation in combination with novel hormonal agents, docetaxel or the combination of abiraterone/prednisone plus docetaxel or darolutamide plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favourable response rates, basically all patients will develop castration-resistant prostate cancer (CRPC) within 2.5 to 4 years. Systemic chemotherapy, second-line hormonal treatment or systemic application of radionuclides such as Radium-223 or 177Lu-PSMA represent salvage management options. As the new medical treatment options have led to an improved oncological outcome with significantly prolonged survival times, about 50% to 65% of patients will develop symptoms due to local progression of prostate cancer. The management of such symptomatic local progression will become more important in upcoming years, which means that all uro-oncologists need to be aware of the various surgical management options. If complications of the lower urogenital tract occur, for example repetitive gross haematuria with or without bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction, acute urinary retention or rectourethral or rectovesical fistulas, these may be managed by palliative surgery such as palliative TURP, radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract can be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of a Detour system. However, an individualised and risk-adapted treatment strategy needs to be developed for each single patient to achieve an optimal therapeutic outcome with improvement of both symptoms and quality of life. In specific clinical situations, best supportive care may be an adequate option.

Implementing Standardized Patient Education in Radiation Oncology

PURPOSE/OBJECTIVE(S)

Patient education empowers patients, improving their health status during and after cancer treatment (Howell et al., 2017). We hypothesize that standardizing healthcare provider delivery of educational materials (HPE) using an electronic medical record (EMR) will increase delivery to patients (pts).

MATERIALS/METHODS

During the study period (9/2020 - 11/2022) 13,650 pts in a multi-centered single health system (HS) received HPE and were analyzed in a retrospective convenience sample frame. There were 16,769 education touchpoints from Radiation Oncology departments (RO) and 8,269 from Medical Oncology (MO) departments. Provision of HPE was standardized in RO during this era. Relationship of ethnicity, age, and sex/gender to receipt of HPE at single vs multiple time points across the HS was examined using association analysis.

RESULTS

Within the combined sample taken from RO and MO departments in the HS the mean pt age was 64y (7 - >90); 71% of pts identified as white, 95.7% non-Hispanic, and 55% female. Across ethnicity, age, and sex/gender, increased HPE was provided in RO vs MO departments (p < 0.001). Distribution of HPE in RO was equal between male and female pts (73%), while distribution to female pts was higher than male in MO. (60% vs 57%, p < 0.001). Receipt of HPE at more than one time point was increased in RO across cancer types (Table 1). In RO, 73% of patients received education at more than one time point, compared to 58.7% in other departments (p < 0.001). Receipt of HPE at more than one time point was increased in RO for patients identifying as American Indian or Alaska Native (84% vs 0, p = 0.001, n = 28), Asian (73.4% vs 56%, p < 0.001, n = 824), and Black (75% vs 60%, p < 0.001, n = 4005). HPE was received at more than one time point in RO in 75.7% of patients age 7-39, 76.4% 40-64, 71.2% 65-79, and 67.6% in those 80 and above, compared to 62.0%, 63.2%, 56.3%, and 49.2%, respectively in MO departments (p = <0.01).

CONCLUSION

Standardization of HPE within RO increased delivery to patients across gender, race/ethnicity, age, and cancer diagnosis, particularly regarding number of educational touchpoints for patients in underserved populations based on race and age. Our results suggest that widespread standardization of HPE is likely to improve distribution of education to all patient groups and should be systematically supported.

Study on CerAMfacturing of Novel Alumina Aerospike Nozzles by Lithography-Based Ceramic Vat Photopolymerization (CerAM VPP)

Advanced ceramics are recognized as key enabling materials possessing combinations of properties not achievable in other material classes. They provide very high thermal, chemical and mechanical resistance and typically exhibit lower densities than metals. These properties predestine ceramics for many different applications, especially those in space. Aerospike nozzles promise an increased performance compared to classic bell nozzles but are also inherently more complex to manufacture due to their shape. Additive manufacturing (AM) drastically simplifies or even enables the fabrication of very complex structures while minimizing the number of individual parts. The applicability of ceramic AM (“CerAMfacturing”) on rocket engines and especially nozzles is consequently investigated in the frame of the “MACARONIS” project, a cooperation of the Institute of Aerospace Engineering at Technische Universität Dresden and the Fraunhofer Institute for Ceramic Technologies and Systems (IKTS) in Dresden. The goal is to develop novel filigree aerospike nozzles with 2.5 N and 10 N thrust. For this purpose, CerAM VPP (ceramic AM via Vat Photopolymerization) using photoreactive and highly particle-filled suspensions was utilized. This contribution gives an overview of the component development starting from CAD modeling, suspension development based on alumina AES-11C, heat treatment and investigation of the microstructure of the sintered components. It could be shown that modifying the suspension composition significantly reduced the formation of cracks during processing, resulting in defect-free filigree aerospike nozzles for application in space.

Increased Levels of sCD30 Have No Impact on the Incidence of Early ABMR and Long-Term Outcome in Intermediate-Risk Renal Transplant Patients With Preformed DSA

Background: It is still incompletely understood why some patients with preformed donor-specific anti-HLA antibodies (DSA) have reduced kidney allograft survival secondary to antibody-mediated rejection (ABMR), whereas many DSA-positive patients have favorable long-term outcomes. Elevated levels of soluble CD30 (sCD30) have emerged as a promising biomarker indicating deleterious T-cell help in conjunction with DSA in immunologically high-risk patients. We hypothesized that this would also be true in intermediate-risk patients.

Methods: We retrospectively analyzed pre-transplant sera from 287 CDC-crossmatch negative patients treated with basiliximab induction and tacrolimus-based maintenance therapy for the presence of DSA and sCD30. The incidence of ABMR according to the Banff 2019 classification and death-censored allograft survival were determined.

Results: During a median follow-up of 7.4 years, allograft survival was significantly lower in DSA-positive as compared to DSA-negative patients (p < 0.001). In DSA-positive patients, most pronounced in those with strong DSA (MFI > 5,000), increased levels of sCD30 were associated with accelerated graft loss compared to patients with low sCD30 (3-year allograft survival 75 vs. 95%). Long-term survival, however, was comparable in DSA-positive patients irrespective of sCD30 status. Likewise, the incidence of early ABMR and lesion score characteristics were comparable between sCD30-positive and sCD30-negative patients with DSA. Finally, increased sCD30 levels were not predictive for early persistence of DSA.

Conclusion: Preformed DSA are associated with an increased risk for ABMR and long-term graft loss independent of sCD30 levels in intermediate-risk kidney transplant patients.

Lower urinary tract signs and symptoms in patients with COVID-19

Background

The type of pneumonia that is caused by the new coronavirus (SARS-CoV-2) has spread across the world in a pandemic. It is not clear if COVID-19 patients have any lower urinary tract signs or symptoms.

Methods

The effect of COVID-19 on lower urinary tract function was studied in a prospective multi-centre, observational study including 238 patients who were admitted with symptoms caused by COVID-19 to the university hospital of Aachen in Germany and Tabriz in Iran.

Results

None of the patients reported to have any lower urinary tract symptoms. SARS-CoV-2 was found in the urine of 19% of the tested patients.

The mortality rate in COVID-19 infected patients with microscopic haematuria together with white blood cells in their urine, was significantly increased from 48 to 61% in the Tabriz cohort (p-value = 0.03) and from 30 to 35% in the Aachen cohort (p-value =0.045). Furthermore, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 30 to 58%. (p-value =0.039).

Conclusion

Patients admitted with COVID-19 did not report to have any lower urinary tract symptoms, even those patient who had a positive Urine SARS-CoV-2 PCR.

In addition, hematuria, WBC in urine as well as SARS- CoV-2 presence in urine, were found to be strong negative prognostic factors in admitted COVID-19 patients.

β2-microglobulin triggers NLRP3 inflammasome activation in tumor-associated macrophages to promote multiple myeloma progression

As substantial constituents of the multiple myeloma (MM) microenvironment, pro-inflammatory macrophages have emerged as key promoters of disease progression, bone destruction, and immune impairment. We identify beta-2-microglobulin (β2m) as a driver in initiating inflammation in myeloma-associated macrophages (MAMs). Lysosomal accumulation of phagocytosed β2m promotes β2m amyloid aggregation in MAMs, resulting in lysosomal rupture and ultimately production of active interleukin-1β (IL-1β) and IL-18. This process depends on activation of the NLRP3 inflammasome after β2m accumulation, as macrophages from NLRP3-deficient mice lack efficient β2m-induced IL-1β production. Moreover, depletion or silencing of β2m in MM cells abrogates inflammasome activation in a murine MM model. Finally, we demonstrate that disruption of NLRP3 or IL-18 diminishes tumor growth and osteolytic bone destruction normally promoted by β2m-induced inflammasome signaling. Our results provide mechanistic evidence for β2m's role as an NLRP3 inflammasome activator during MM pathogenesis. Moreover, inhibition of NLRP3 represents a potential therapeutic approach in MM.

A noninvasive diagnostic approach to retrospective donor HLA typing in kidney transplant patients using urine

Antibody-mediated rejection (AMR) is a major obstacle to long-term kidney transplantation. AMR is mostly caused by donor specific HLA antibodies, which can arise before or any time after transplantation. Incomplete donor HLA typing and unavailability of donor DNA regularly preclude the assessment of donor-specificity of circulating anti-HLA antibodies. In our centre, this problem arises in approximately 20% of all post-transplant HLA-antibody assessments. We demonstrate that this diagnostic challenge can be resolved by establishing donor renal tubular cell cultures from recipient´s urine as a source of high-quality donor DNA. DNA was then verified for genetic origin and purity by fluorescence in situ hybridization and short tandem repeat analysis. Two representative cases highlight the diagnostic value of this approach which is corroborated by analysis of ten additional patients. The latter were randomly sampled from routine clinical care patients with available donor DNA as controls. In all 12 cases, we were able to perform full HLA typing of the respective donors confirmed by cross-comparison to results from the stored 10 donor DNAs. We propose that this noninvasive diagnostic approach for HLA typing in kidney transplant patients is valuable to determine donor specificity of HLA antibodies, which is important in clinical assessment of suspected AMR.

The Scientific Value of Abstracts on Prostate Cancer Presented at the European Association of Urology Congresses

Background: Scientific congresses are an important medium for presenting recent clinical findings. Publication of abstracts allows wider dissemination.

Objectives: To determine the publication rates of prostate cancer abstracts presented at the annual congress of the European Association of Urology (EAU).

Design, Setting, and Participants: All abstracts with the term prostate cancer or carcinoma presented at the congress of the European Association of Urology from 2015 to 2018 were analyzed. We captured their publication rate, journal impact factor and time to publication. Moreover, we formulated a scoring system to determine the grade of discrepancy between the conclusions mentioned in the congress abstract and published abstract.

Results: A total of 834 abstracts presented at EAU annual meeting included prostate cancer or carcinoma in their title. We recorded a publication rate of 56.8% with 474 of the 834 abstracts being published with a mean time of 12.5 months.

Conclusion: Approximately, 57% of the prostate cancer abstracts presented at the EAU congress are published in peer reviewed journals. This acceptance rate indicates the high distribution and dissemination of these abstracts.

Can the predictive value of multiparametric MRI for prostate cancer be improved by a liquid biopsy with SelectMDx?

BACKGROUND

SelectMDx is a urinary biomarker test for determining prostate cancer risk.

AIM

In a group of patients with a biopsy proven prostate cancer (PCa) who had undergone a multi parametric Magnetic Resonance Imaging (mpMRI) and urinary biomarker test with SelectMDx, we studied the additive value of SelectMDx to mpMRI and correlated that to the radical prostatectomy histology.

METHODS AND RESULTS

Thirty-nine consecutive patients with a positive prostate biopsy were included in the study. They all had mpMRI and SelectMDx and underwent a radical prostatectomy. Overall, the mpMRI showed a PIRADS ≤3 lesion in seven cases out of the 39 patients. Significant lesions (PIRADS ≥4) were found in 32 cases (82%), that is, in 17 cases a PIRADS 5 lesion and in 15 cases a PIRADS 4 lesion. The mpMRI missed significant PCa in seven cases (18%) who had a PIRADS ≤3 lesion but had a significant PCa on final histology after RP. In our study, the positive predictive values of mpMRI were 97% and that of the SelectMDx was 100%.

CONCLUSION

In this real-life selected group of consecutive patients with a confirmed positive PCa biopsy and available mpMRI, the liquid biopsy test with SelectMDx, did not provide an additional information about the PCa clinical significance. The addition of SelectMDx was only found valuable in those patients who had a very high-risk PCa (ie, GS ≥8) who had a positive SelectMDx test outcome despite of a negative mpMRI outcome.

Virus-specific memory T cell responses unmasked by immune checkpoint blockade cause hepatitis

Treatment of advanced melanoma with combined PD-1/CTLA-4 blockade commonly causes serious immune-mediated complications. Here, we identify a subset of patients predisposed to immune checkpoint blockade-related hepatitis who are distinguished by chronic expansion of effector memory CD4⁺ T cells (T_EM cells). Pre-therapy CD4⁺ T_EM cell expansion occurs primarily during autumn or winter in patients with metastatic disease and high cytomegalovirus (CMV)-specific serum antibody titres. These clinical features implicate metastasis-dependent, compartmentalised CMV reactivation as the cause of CD4⁺ T_EM expansion. Pre-therapy CD4⁺ T_EM expansion predicts hepatitis in CMV-seropositive patients, opening possibilities for avoidance or prevention. 3 of 4 patients with pre-treatment CD4⁺ T_EM expansion who received αPD-1 monotherapy instead of αPD-1/αCTLA-4 therapy remained hepatitis-free. 4 of 4 patients with baseline CD4⁺ T_EM expansion given prophylactic valganciclovir and αPD-1/αCTLA-4 therapy remained hepatitis-free. Our findings exemplify how pathogen exposure can shape clinical reactions after cancer therapy and how this insight leads to therapeutic innovations.

The IKZF1-IRF4/IRF5 Axis Controls Polarization of Myeloma-Associated Macrophages

The bone marrow niche has a pivotal role in progression, survival, and drug resistance of multiple myeloma cells. Therefore, it is important to develop means for targeting the multiple myeloma bone marrow microenvironment. Myeloma-associated macrophages (MAM) in the bone marrow niche are M2 like. They provide nurturing signals to multiple myeloma cells and promote immune escape. Reprogramming M2-like macrophages toward a tumoricidal M1 phenotype represents an intriguing therapeutic strategy. This is especially interesting in view of the successful use of mAbs against multiple myeloma cells, as these therapies hold the potential to trigger macrophage-mediated phagocytosis and cytotoxicity. In this study, we observed that MAMs derived from patients treated with the immunomodulatory drug (IMiD) lenalidomide skewed phenotypically and functionally toward an M1 phenotype. Lenalidomide is known to exert its beneficial effects by modulating the CRBN-CRL4 E3 ligase to ubiquitinate and degrade the transcription factor IKAROS family zinc finger 1 (IKZF1). In M2-like MAMs, we observed enhanced IKZF1 levels that vanished through treatment with lenalidomide, yielding MAMs with a bioenergetic profile, T-cell stimulatory properties, and loss of tumor-promoting capabilities that resemble M1 cells. We also provide evidence that IMiDs interfere epigenetically, via degradation of IKZF1, with IFN regulatory factors 4 and 5, which in turn alters the balance of M1/M2 polarization. We validated our observations in vivo using the Crbn^I391V mouse model that recapitulates the IMiD-triggered IKZF1 degradation. These data show a role for IKZF1 in macrophage polarization and can provide explanations for the clinical benefits observed when combining IMiDs with therapeutic antibodies.See related Spotlight on p. 254.

To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic

Introduction

After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries.

Material and methods

An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16^th-22^nd and April 20^th-26^th 2020. The results were evaluated using descriptive analyses.

Results

27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers–however, the number of COVID-19 patients and urologists did not reach double digits.

Conclusion

The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.

FRI0365 REAL-WORLD EFFECTIVENESS AND SAFETY OF APREMILAST IN A LARGE COHORT OF GERMAN PATIENTS WITH PSORIATIC ARTHRITIS: 1-YEAR ANALYSIS OF AN ONGOING MULTICENTER, PROSPECTIVE, NON-INTERVENTIONAL STUDY

Background:

Apremilast (APR) has been studied extensively in phase III randomized, controlled trials. However, real-world information is limited on the effectiveness and safety of APR in patients with psoriatic arthritis (PsA).

Objectives:

To assess the effectiveness and safety of APR in a large cohort of patients with active PsA from routine clinical practice settings in Germany.

Methods:

In this multicenter, prospective, non-interventional study, the primary endpoint was the proportion of patients reaching ≥1 point (≥20%) improvement from baseline (BL) in the Physician’s Global Assessment of Disease Activity (PhGA) score. Other endpoints included effects on swollen and tender joint counts (SJC/TJC), psoriasis-involved body surface area (BSA), enthesitis, dactylitis, Patient’s Global Assessment of Disease Activity score (PtGA), Psoriatic Arthritis Impact of Disease (PsAID) tool, pain, and pruritus. The current analysis is based on observed data through 1 year of study duration.

Results:

A total of 545 German patients were enrolled and followed up to 12 months of APR treatment; 488 patients were included in the safety analysis and 418 in the full analysis set. The mean age was 55 years, mean body mass index was 29.5 kg/m2, and 60% were female. The mean duration of psoriasis and PsA was 26 years and 18 years, respectively. At BL, 46.7% of patients had enthesitis based on the Leeds Enthesitis Index (LEI; mean [SD]: 2.9 [1.72]) and 23% had dactylitis (mean [SD]: 2.2±2.03); 74% of patients were biologic-naive. Effectiveness is shown after ~1 month (Visit 1 [V1]) and ~4 months (Visit 2 [V2]) and for up to 225 patients after 12 months (Visit 5 [V5]) of treatment (Table).

Improvements were also seen in PtGA, overall pain, and pruritus. A subanalysis suggests APR was associated with greater benefits in biologic-naive patients compared with patients who previously received biologic therapy. Observed safety and tolerability through V5 were consistent with the known overall safety profile of APR. Common adverse events in clinical trials were similar, with a lower incidence of diarrhea (11.1%), nausea (7.0%), headache (3.9%), and respiratory tract infection (0.8%).

Conclusion:

Data from this large, real-world cohort of patients with PsA show the effectiveness of APR. In patients with up to 12 months of follow-up, APR was associated with rapid and maintained improvements in physician-assessed and patient-reported outcomes. Safety and tolerability were consistent with the known profile of APR.

Table.

Disclosure of Interests:

Jürgen Wollenhaupt Grant/research support from: Abbott, BMS, MSD, Pfizer, UCB – grant/research support, Consultant of: Abbott, BMS, MSD, Pfizer, UCB – consultant, Harald Strothmeyer: None declared, Michael Fiene: None declared, Stephan Morys Employee of: Amgen Inc. – employment; Celgene GmbH – employment at the time of study conduct, Christian Bach Employee of: Amgen Inc. – employment; Celgene GmbH – employment at the time of study conduct, Josefine Roemmler-Zehrer Employee of: Amgen Inc. – employment; Celgene GmbH – employment at the time of study conduct

Positioning human body models for crashworthiness using model order reduction

A new technique to accelerate the positioning of human body models (HBMs) by means of a dimensionality reduction of a database of precomputed simulations is presented. First, a set of important subspace deformation modes which are used to approximate the model's movements observed in the training simulations are computed. In the second step, a convex optimization problem is solved in order to obtain an optimal position of the human body model as described by the user. We apply the proposed method to a new reclined seating position of the Total Human Model for Safety (THUMS, v5).

Results after two years of follow up after intravesical thermochemotherapy with heated mitomycin 40 in patients with high-risk superficial bladder cancer

512

Background: Standard management of high risk TCC is either BCG or radical cystectomy, alternative treatment options are limited. It is known that the anti-tumor effect of heated mitomycin is 10 fold higher than at room temperature, which is the standard of intravesical therapy. We herein report the first 2 year follow up (FU) after intravesical therapy with heated mitomycin in a cohort of patients with high risk superficial bladder cancer (TCC). Methods: Treatment was performed for 1 hour with machine bladder irrigation (COMBAT) which maintaines temperature of mitomycin (40 mg) exactly at 43 C. Patients underwent therapy with a 6 week course of weekly treatment and were than followed by cystoscopy every 3 month and if necessary biopsy. Results: We identified 62 patients out of a total group of 108 patients who met the inclusion criteria for high risk TCC according to the EAU Guidelines and who got the complete 6 courses of treatment. 2 were lost of follow up, 1 died due to cardiac problems and 1 from metastatic prostate carcinoma. The remaining 58 patients had a mean FU of 26 month (16-54 m) and included 20 non-responders to BCG. 48/58 patients had CIS or pT1 Tumors or both, 10 patients had pTa+CIS. There were 5 recurrences, all superficial stage pTa, one in the rigth ureter, all could be managed without cystectomy. 8 patients had progressive or recurrent CIS/pT1 or were progressive to pT2 after therapy and underwent cystectomy. Conclusions: In this high risk cohort of 58 patients with a high rate of BCG non-responders only 8 patients had to undergo cystectomy during a 2 year follow up. Intravesical therapy with heated mitomycin is safe and well tolerated and may be an additional alternative treatment before cystectomy is performed in high risk patients with high risk TCC or BCG non responders.

ITIH5 and ECRG4 DNA Methylation Biomarker Test (EI-BLA) for Urine-Based Non-Invasive Detection of Bladder Cancer

Bladder cancer is one of the more common malignancies in humans and the most expensive tumor for treating in the Unites States (US) and Europe due to the need for lifelong surveillance. Non-invasive tests approved by the FDA have not been widely adopted in routine diagnosis so far. Therefore, we aimed to characterize the two putative tumor suppressor genes ECRG4 and ITIH5 as novel urinary DNA methylation biomarkers that are suitable for non-invasive detection of bladder cancer. While assessing the analytical performance, a spiking experiment was performed by determining the limit of RT112 tumor cell detection (range: 100-10,000 cells) in the urine of healthy donors in dependency of the processing protocols of the RWTH cBMB. Clinically, urine sediments of 474 patients were analyzed by using quantitative methylation-specific PCR (qMSP) and Methylation Sensitive Restriction Enzyme (MSRE) qPCR techniques. Overall, ECRG4-ITIH5 showed a sensitivity of 64% to 70% with a specificity ranging between 80% and 92%, i.e., discriminating healthy, benign lesions, and/or inflammatory diseases from bladder tumors. When comparing single biomarkers, ECRG4 achieved a sensitivity of 73%, which was increased by combination with the known biomarker candidate NID2 up to 76% at a specificity of 97%. Hence, ITIH5 and, in particular, ECRG4 might be promising candidates for further optimizing current bladder cancer biomarker panels and platforms.

HLA Haplotypes In 250 Families: The Baylor Laboratory Results And A Perspective On A Core NGS Testing Model For The 17th International HLA And Immunogenetics Workshop

Since their inception, the International HLA & Immunogenetics Workshops (IHIW) served as a collaborative platform for exchange of specimens, reference materials, experiences and best practices. In this report we present a subset of the results of human leukocyte antigen (HLA) haplotypes in families tested by next generation sequencing (NGS) under the 17th IHIW. We characterized 961 haplotypes in 921 subjects belonging to 250 families from 8 countries (Argentina, Austria, Egypt, Jamaica, Germany, Greece, Kuwait, and Switzerland). These samples were tested in a single core laboratory in a high throughput fashion using 6 different reagents/software platforms. Families tested included patients evaluated clinically as transplant recipients (kidney and hematopoietic cell transplant) and their respective family members. We identified 486 HLA alleles at the following loci HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5, -DQA1, -DQB1, -DPA1, -DPB1 (77, 115, 68, 69, 10, 6, 4, 44, 31, 20 and 42 alleles, respectively). We also identified nine novel alleles with polymorphisms in coding regions. This approach of testing samples from multiple laboratories across the world in different stages of technology implementation in a single core laboratory may be useful for future international workshops. Although data presented may not be reflective of allele and haplotype frequencies in the countries to which the families belong, they represent an extensive collection of 3rd and 4th field resolution level 11-locus haplotype associations of 486 alleles identified in families from 8 countries.

Recent advances in urologic surgical techniques for pyeloplasty

Pyeloplasty is one of the most common urological reconstructive interventions. Since the presentation of the first open pyeloplasty by Anderson and Hynes in 1949, the management of ureteropelvic junction obstruction has dramatically developed. The most immense progress was made in the 1990s with the introduction of laparoscopy. A multitude of new minimal surgical techniques have been introduced since then. In the last few years, the innovations were based on refinement of already-existing techniques and technology. With this aim, single-port surgery, three-dimensional vision for laparoscopy, robotic technology, and alternative techniques for creating the anastomosis-like fibrin glue have been introduced. This unsystematic review is timely, and the scientific interest is to present and discuss some of the latest advances in surgical techniques and different approaches for the intra- and post-operative management in pyeloplasty. To the best of our knowledge, this is the only review looking at the recent advances in urological surgical techniques for pyeloplasty during the last few years with a focus on new technology and surgical techniques.

Generation of an Oncolytic Herpes Simplex Virus 1 Expressing Human MelanA

Robust anti-tumor immunity requires innate as well as adaptive immune responses. We have shown that plasmacytoid dendritic cells develop killer cell-like activity in melanoma cell cocultures after exposure to the infectious but replication-deficient herpes simplex virus 1 (HSV-1) d106S. To combine this innate effect with an enhanced adaptive immune response, the gene encoding human MelanA/MART-1 was inserted into HSV-1 d106S via homologous recombination to increase direct expression of this tumor antigen. Infection of Vero cells using this recombinant virus confirmed MelanA expression by Western blotting, flow cytometry, and immunofluorescence. HSV-1 d106S-MelanA induced expression of the transgene in fibroblast and melanoma cell lines not naturally expressing MelanA. Infection of a melanoma cell line with CRISPR-Cas9-mediated knockout of MelanA confirmed de novo expression of the transgene in the viral context. Dependent on MelanA expression, infected fibroblast and melanoma cell lines induced degranulation of HLA-matched MelanA-specific CD8+ T cells, followed by killing of infected cells. To study infection of immune cells, we exposed peripheral blood mononuclear cells and in vitro-differentiated macrophages to the parental HSV-1 d106S, resulting in expression of the transgene GFP in CD11c+ cells and macrophages. These data provide evidence that the application of MelanA-encoding HSV-1 d106S could enhance adaptive immune responses and re-direct MelanA-specific CD8+ T cells to tumor lesions, which have escaped adaptive immune responses via downregulation of their tumor antigen. Hence, HSV-1 d106S-MelanA harbors the potential to induce innate immune responses in conjunction with adaptive anti-tumor responses by CD8+ T cells, which should be evaluated in further studies.

Multi-disciplinary and shared decision-making approach in the management of organ-confined prostate cancer

Decision-making in the management of organ-confined prostate cancer is complex as it is based on multi-factorial considerations. It is complicated by a multitude of issues, which are related to the patient, treatment, disease, availability of equipment(s), expertise, and physicians. Combination of all these factors play a major role in the decision-making process and provide for an interactive decision-making preferably in the multi-disciplinary team (MDT) meeting. MDT decisions are comprehensive and are often based on all factors including patients' biological status, disease and its aggressiveness, and physician and centres' expertise. However, one important and often under rated factor is patient-related factors. There is considerable evidence that patients and physicians have different goals for treatment and physicians' understanding of their own patients' preferences is not accurate. Several patient-related key factors have been identified such as age, religious beliefs, sexual health, educational background, and cognitive impairment. We have focused on these areas and highlight some key factors that need to be taken considered whilst counselling a patient and understanding his choice of treatment, which might not always be match with the clinicians' recommendation.

Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group

OBJECTIVE

Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.

MATERIAL AND METHOD

A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.

RESULTS

Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P=0.04).

CONCLUSION

Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.

Immunglobulin-A-Isotyp bei Anti-HLA-Antikörpern und Organüberleben von Patienten nach Nierentransplantation

Anti-Human-Leukocyte-Antigen-Antikörper (HLA-Ak) des Isotyps Immunglobulin A (IgA) erkennen ihr Zielantigen mit einer sehr hohen Affinität und Avidität. Eine systematische Erforschung des Einflusses von Anti-HLA-IgA-Antikörpern auf die Organabstoßung und den Organfunktionsverlust nach Organtransplantation hat gerade erst begonnen. Anhand der hier vorgestellten Arbeit soll gezeigt werden, dass neben der bekannten Beteiligung von Anti-HLA-Immunglobulin G (IgG) auch Anti-HLA-IgA eine Rolle bei der Organabstoßung spielen könnte. Im Rahmen der Studie wurden Seren von 276 Patienten untersucht. Alle Patienten hatten bereits mindestens eine Nierentransplantation bekommen und wurden aufgrund eines Funktionsverlusts des transplantierten Organs wieder dialysepflichtig. Als Messparameter für das Organüberleben wurde die in Monaten gemessene Dauer zwischen erfolgter Nierentransplantation und erneuter Dialyse nach Transplantation („Time to Dialysis“, TtD, Median) herangezogen. Die Testung des Ak-Profils der Patientenseren für die Isotpyen IgG und IgA wurde mittels Luminex-basierter Methode durchgeführt. Von den 276 getesteten Seren waren 89 Ak-positiv für Anti-HLA-IgA und 243 positiv für Anti-HLA-IgG. Es wurde eine starke Korrelation der beiden untersuchten Isotypen beobachtet (p < 0,0001). 86 von 89 der Anti-HLA-IgA-positiven Seren waren ebenfalls IgG-positiv. Wie erwartet hatten Patienten ohne Anti-HLA-Ak das längste Organüberleben (TtD 127 Monate). Patienten mit ausschließlich Anti-HLA-IgG zeigten im Vergleich dazu ein verringertes mittleres Organüberleben (TtD 116 Monate). Interessanterweise wurde ein signifikant verringertes Organüberleben bei IgA- und IgG-Ak doppelt positiven Patienten (TtD 88 Monate, p < 0,001) beobachtet. Nur 3 Patienten zeigten ausschließlich IgA-Ak, eine statistische Auswertung der TtD-Zeit ist hier nicht möglich. In einer früheren Studie mit 694 Patienten konnte bereits gezeigt werden, dass bei Patienten mit Anti-HLA-IgA-Ak, die spezifisch gegen das Spenderorgan gerichtet waren, das Organüberleben deutlich auf 76 Monate verringert war – wogegen Patienten mit nicht spenderspezifischen Anti-HLA-IgA-Ak im Median erst nach 82 Monaten wieder dialysepflichtig wurden. Die gleichzeitige Anwesenheit von Anti-HLA-IgA- und Anti-HLA-IgG-Ak im Serum von Patienten nach Nierentransplantation stellt eine hohe Risikoprognose für ein mögliches Organversagen dar. Dies zeigte sich in einer signifikant kürzeren Organüberlebenszeit verglichen mit transplantierten Patienten, bei denen lediglich Anti-HLA-IgG-Ak nachgewiesen wurden. Diese Daten deuten darauf hin, dass die – momentan nicht routinemäßig durchgeführte – Testung von Anti-HLA-IgA als neuer Parameter für eine bessere Risikostratifizierung sowohl vor als auch nach Nierentransplantation dienen könnte.

Leiomyoma arising from the right seminal duct/seminal vesicle-Report of a rare case and review of the literature

We present a case of a patient with a large, symptomatic abdominal tumour, which finally could be classified as a leiomyoma arising from the right seminal duct/seminal vesicle. In computed tomography (CT) scan, it appeared as a 7.5 × 6.5 cm solid, supravesical mass. A cystoscopy as well as bilateral retrograde studies was normal, a transrectal ultrasound-guided biopsy and an ultrasound-guided transabdominal biopsy of the mass were inconclusive. Subsequently, we performed a tumour extirpation through a lower midline laparotomy. Histological examination showed a leiomyoma arising from the right seminal duct or seminal vesicle. In this article, we discuss clinical presentation, findings on imaging and management of this rare benign tumour and review the relevant literature where only 13 similar cases could be identified.

Experimental setup for evaluation of cavitation effects in ESWL

Cavitation is a major fracture mechanism in extracorporeal shock wave lithotripsy (ESWL). However, it can cause tissue trauma and its effects on kidney stones and surrounding tissue are not fully understood. Therefore experimental setups enabling systematic parameter studies are crucial. We developed and evaluated a testing rig comprising three measuring methods in order to examine this mechanism. Our initial evaluation of this setup based on standard components showed promising results. Primary cavitation was displayed by high-speed photography 195 μs after the shock front had passed the focal zone. The effect of different pulse repetition rates (30, 60, 90, 120 SW/min) on the extension of the cavitation area was determined. The lifetime of secondary cavitation was analysed by B-mode ultrasound imaging. In a post processing progress the images showing bubbles were compared to a reference picture for both types of cavitation and the number of pixels that changed colour was counted. Furthermore stone comminution at different pulse repetition rates (30, 60, 90, 120 SW/min) was investigated by fixed-dose fragmentation. We observed an inverse correlation of cavitation and fragmentation. As the pulse repetition rate increases, the area of primary cavitation grows whereas the fragmentation efficiency decreases. B-mode imaging showed that secondary cavitation bubbles persisted between the shocks and can serve as nuclei. The higher the pulse repetition rate is, the more of these nuclei remain and thus facilitate formation of primary cavitation. The experimental setup provides reproducible results regarding the development of primary and secondary cavitation on the one hand and the fragmentation of phantom stones on the other hand. Therefore it can be utilized to further investigate the effect of different boundary conditions and shock wave parameters on cavitation and stone comminution. The impact of different focal sound fields is subject of ongoing research.

Diagnostic and Prognostic Implications of FGFR3high/Ki67high Papillary Bladder Cancers

Prognostic/therapeutic stratification of papillary urothelial cancers is solely based upon histology, despite activated FGFR3-signaling was found to be associated with low grade tumors and favorable outcome. However, there are FGFR3-overexpressing tumors showing high proliferation-a paradox of coexisting favorable and adverse features. Therefore, our study aimed to decipher the relevance of FGFR3-overexpression/proliferation for histopathological grading and risk stratification. N = 142 (n = 82 pTa, n = 42 pT1, n = 18 pT2-4) morphologically G1⁻G3 tumors were analyzed for immunohistochemical expression of FGFR3 and Ki67. Mutation analysis of FGFR3 and TP53 and FISH for FGFR3 amplification and rearrangement was performed. SPSS 23.0 was used for statistical analysis. Overall FGFR3high/Ki67high status (n = 58) resulted in a reduced ∆mean progression-free survival (PFS) (p < 0.01) of 63.92 months, and shorter progression-free survival (p < 0.01; mean PFS: 55.89 months) in pTa tumors (n = 50). FGFR3mut/TP53mut double mutations led to a reduced ∆mean PFS (p < 0.01) of 80.30 months in all tumors, and FGFR3mut/TP53mut pTa tumors presented a dramatically reduced PFS (p < 0.001; mean PFS: 5.00 months). Our results identified FGFR3high/Ki67high papillary pTa tumors as a subgroup with poor prognosis and encourage histological grading as high grade tumors. Tumor grading should possibly be augmented by immunohistochemical stainings and suitable clinical surveillance by endoscopy should be performed.

Anti-HLA alloantibodies of the IgA isotype in re-transplant candidates part II: Correlation with graft survival

We reported previously on the widespread occurrence of anti-HLA alloantibodies of the IgA isotype (anti-HLA IgA) in the sera of solid-organ re-transplantation (re-tx) candidates (Arnold et al., ). Specifically focussing on kidney re-tx patients, we now extended our earlier findings by examining the impact of the presence and donor specificity of anti-HLA IgA on graft survival. We observed frequent concurrence of anti-HLA IgA and anti-HLA IgG in 27% of our multicenter collective of 694 kidney re-tx patients. This subgroup displayed significantly reduced graft survival as evidenced by the median time to first dialysis after transplantation (TTD 77 months) compared to patients carrying either anti-HLA IgG or IgA (TTD 102 and 94 months, respectively). In addition, donor specificity of anti-HLA IgA had a significant negative impact on graft survival (TTD 74 months) in our study. Taken together, our data strongly indicate that presence of anti-HLA IgA, in particular in conjunction with anti-HLA-IgG, in sera of kidney re-tx patients is associated with negative transplantation outcome.

Heat targeted drug delivery (COMBAT) in superficial TCC : First midterm results in a cohort of high-risk patients scheduled for cystectomy

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Background: Due to the suboptimal outcomes in recurrent superficial TCC over the last 30 years the search for new treatments continues. We report the first mid term results of a high risk cohort of heavily pretreated patients by a circulating device for intravesical thermochemotherapy.It is known that the effect of mitomycin increases at a temperature over 40 C. Methods: 58 patients with different failed methods of former intravesical therapy and recurrent TCC (21 intermediate risk and 37 high risk patients) were treated with the COMBAT device which facilitates irrigation of the bladder with mitomycin 40 mg at exactly 43 degree Celsius for 1 hour/6 courses weekly.Side effects were monitored prospectively and success of the treatment was controlled by ReTUR whenever possible and afterwards by 3 monthly cystoscopy and cytology. Results: 22 patients had dysuria during treatment and 9/58 suffered from hematuria but without intervention. In 6 cases urinary tract infection occured and 3 patients had allergic reaction. In one patient thermochemotherapy must be terminated due to pain and discomfort, no long term morbidity was recorded over the whole period. The FU was 14 month (3-29) for the entire cohort, 17 patients had a FU of over 2 years. One Patient had recurrent pTaGIII Tumor managed successfully by TUR. 2 patients underwent cystectomy because of invasive recurrence early after intravesical therapy, one patient developed bone metastasis 2 years after therapy without intravesical tumor. Conclusions: Thermochemotherapy with heated mitomycin is a well tolerated new option for patients with superficial TCC who are at high risk of recurrence or progression.The toxicity is acceptable and no long term morbidity was obeserved. The rate of cystectomies in this heavily pretreated group of patients including 18 BCG failures was very low with N= 2 respective 1,9%. Intravesical thermochemotherapy seems to be a new therapeutic bladder preserving option in high risk patients with superficial TCC. It is of note that thermochemotherapy has now been included in the European Guidelines.

Robotic stone surgery - Current state and future prospects: A systematic review

Objective

To provide a comprehensive review of robot-assisted surgery in urolithiasis and to consider the future prospects of robotic approaches in stone surgery.

Materials and methods

We performed a systematic PubMed© literature search using predefined Medical Subject Headings search terms to identify PubMed-listed clinical research studies on robotic stone surgery. All authors screened the results for eligibility and two independent reviewers performed the data extraction.

Results

The most common approach in robotic stone surgery is a robot-assisted pyelolithotomy using the da Vinci™ system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Several studies show this technique to be comparable to classic laparoscopic and open surgical interventions. One study that focused on ureteric stones showed a similar result. In recent years, promising data on robotic intrarenal surgery have been reported (Roboflex Avicenna™; Elmed Medical Systems, Ankara, Turkey). Initial studies have shown its feasibility and high stone-free rates and prove that this novel endoscopic approach is safe for the patient and comfortable for the surgeon.

Conclusions

The benefits of robotic devices in stone surgery in existing endourological, laparoscopic, and open treatment strategies still need elucidation. Although recent data are promising, more prospective randomised controlled studies are necessary to clarify the impact of this technique on patient safety and stone-free rates.

Encouraging treatment algorithm for computer-assisted navigated total knee arthroplasty (TKA): A retrospective cohort analysis

OBJECTIVE

Navigated computer-assisted total knee arthroplasty (TKA) shows inconclusive mid- to long-term outcome results and is limited by increased costs, surgery-time and an additional learning curve. We introduced a treatment algorithm preserving computer-assisted TKA for patients with adipositas-per-magna, posttraumatic leg-deformities, osteosynthetic material in-situ or reduced preoperative X-ray quality.

METHODS

237 primary unilateral TKA were allocated based on the treatment concept described above. A retrospective pre- and postoperative radiological analysis was performed.

RESULTS

222 TKA (93.7%) were within 3° varus/valgus of mechanical-lower-limb axis (mean absolute deviation: 1.8° ± 1.3°).

CONCLUSION

This algorithm showed an excellent postoperative implantation-accuracy based on an accurate preoperative surgery-planning.

Radical prostatectomy for locally advanced and metastatic prostate cancer

The management of advanced prostate cancer remains challenging. Traditionally, radical prostatectomy was discouraged in patients with locally advanced or node positive disease owing to the increased complication rate and treatment related morbidity. However, technical advances and refinements in surgical techniques have enabled the outcomes for patients with high risk prostate cancer to be improved. More recently, the concept of cytoreductive prostatectomy has been described where surgery (often Combined with an extended lymph node dissection) is performed in the setting of metastatic disease. Indirect evidence suggests an advantage using the cytoreductive approach. Hypothetical explanations for this observed benefit include decreased tumour burden, immune modulation, improved response to secondary treatment and avoidance of secondary complications attributable to local tumour growth. Nevertheless, prospective trials are required to investigate this further.

High-Risk Non-Muscle-Invasive Bladder Cancer-Therapy Options During Intravesical BCG Shortage

Bladder cancer is the second commonest urinary tract malignancy with 70–80 % being non-muscle invasive (NMIBC) at diagnosis. Patients with high-risk NMIBC (T1/Tis, with high grade/G3, or CIS) represent a challenging group as they are at greater risk of recurrence and progression. Intravesical Bacilli Calmette-Guerin (BCG) is commonly used as first line therapy in this patient group but there is a current worldwide shortage. BCG has been shown to reduce recurrence in high-risk NMIBC and is more effective that other intravesical agents including mitomycin C, epirubicin, interferon-alpha and gemcitabine. Primary cystectomy offers a high change of cure in this cohort (80–90 %) and is a more radical treatment option which patients need to be counselled carefully about. Bladder thermotherapy and electromotive drug administration with mitomycin C are alternative therapies with promising short-term results although long-term follow-up data are lacking.

[Predictive factors and prognostic consequences of perioperative complications of radical cystectomies for urothelial carcinoma in patients of 80 years or more]

OBJECTIVE

To define the predictive factors and the prognostic consequences of perioperative complications occurrence while radical cystectomies for urothelial carcinoma treatment in patients older than 80 years.

MATERIAL AND METHOD

Retrospective analysis of clinical and biological preoperative data and outcome of eighty patients of 80 years or more, treated with radical cystectomy between 1990 and 2010 in one centre. Perioperative complications were graded according to the classification from Clavien-Dindo.

RESULTS

Twenty-eight patients (35%) had a single perioperative complication and nineteen (24%) had multiple (≥2) perioperative complications. Overall survival of patients with multiple perioperative complications was significantly lower than that of patients who had no complications (Log-rank P=0.0004). The occurrence of multiple perioperative complications was associated with Charlson and ASA scores, with pelvic irradiation and induction chemotherapy histories. However, in multivariate analysis, only the existence of respiratory comorbidity was an independent risk factor for the occurrence of multiple perioperative complications.

CONCLUSIONS

The occurrence of multiple perioperative complications was associated with reduced overall survival in elderly patients after radical cystectomy. The existence of respiratory comorbidity was the only independent risk factor for the occurrence of multiple perioperative complications.

LEVEL OF EVIDENCE

5.

Soil Parameters Drive the Structure, Diversity and Metabolic Potentials of the Bacterial Communities Across Temperate Beech Forest Soil Sequences

Soil and climatic conditions as well as land cover and land management have been shown to strongly impact the structure and diversity of the soil bacterial communities. Here, we addressed under a same land cover the potential effect of the edaphic parameters on the soil bacterial communities, excluding potential confounding factors as climate. To do this, we characterized two natural soil sequences occurring in the Montiers experimental site. Spatially distant soil samples were collected below Fagus sylvatica tree stands to assess the effect of soil sequences on the edaphic parameters, as well as the structure and diversity of the bacterial communities. Soil analyses revealed that the two soil sequences were characterized by higher pH and calcium and magnesium contents in the lower plots. Metabolic assays based on Biolog Ecoplates highlighted higher intensity and richness in usable carbon substrates in the lower plots than in the middle and upper plots, although no significant differences occurred in the abundance of bacterial and fungal communities along the soil sequences as assessed using quantitative PCR. Pyrosequencing analysis of 16S ribosomal RNA (rRNA) gene amplicons revealed that Proteobacteria, Acidobacteria and Bacteroidetes were the most abundantly represented phyla. Acidobacteria, Proteobacteria and Chlamydiae were significantly enriched in the most acidic and nutrient-poor soils compared to the Bacteroidetes, which were significantly enriched in the soils presenting the higher pH and nutrient contents. Interestingly, aluminium, nitrogen, calcium, nutrient availability and pH appeared to be the best predictors of the bacterial community structures along the soil sequences.

Processing of membranes for oxygenation using the Bellhouse-effect

State-of-the-art lung support systems are limited to short time application because of a lack of long term hemocompatibility and protein absorption on the membrane surfaces. In a highly interdisciplinary project at RWTH Aachen University a biohybrid lung assist system with endothelialised gas exchange flat membranes is developed to improve long term compatibility of oxygenators. To increase the gas exchange performance of flat membranes hollows are imprinted in the membrane surfaces. This approach is based on the research of B. J. Bell-house et al. [1], who discovered this effect, now known as Bellhouse-effect, around 1960. In this paper a processes to manufacture membrane assemblies for oxygenation with imprinted hollows on the flat membrane surfaces is reviewed.

Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results

The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels. Postoperative pain and metal ions decreased significantly (P ≤ 0.016). Cobalt decreased faster than chrome. Patients with intraoperative pseudotumors, osteolysis or bilateral THA did not have higher pre- or postoperative ion values (P ≥ 0.053). Females showed higher postoperative chrome levels (P=0.031). One major post-revision complication (femoral nerve palsy) and one re-revision (late onset infection) occurred.