Is it safe to defer prostate cancer treatment? Assessing the impact of surgical delay on the risk of pathological upstaging after robot-assisted radical prostatectomy

INTRODUCTION

We sought to investigate whether surgical delay may be associated with pathological upstaging in patients treated with robot assisted radical prostatectomy (RARP) for localized and locally advanced prostate cancer (PCa).

MATERIALS AND METHODS

Consecutive firstly-diagnosed PCa patients starting from March 2020 have been enrolled. All the patients were categorized according to EAU risk categories for PCa risk. Uni- and multivariate analysis were fitted to explore clinical and surgical predictors of pathological upstaging to locally advanced disease (pT3/pT4 - pN1 disease).

RESULTS

Overall 2017 patients entered the study. Median age at surgery was 68 (IQR 63-73) years. Overall low risk, intermediate risk, localized high risk and locally advanced disease were recorded in 368 (18.2 %), 1071 (53.1 %), 388 (19.2 %) and 190 (9.4 %), respectively. Median time from to diagnosis to treatment was 51 (IQR 29-70) days. Time to surgery was 56 (IQR 32-75), 52 (IQR 30-70), 45 (IQR 24-60) and 41 (IQR 22-57) days for localized low, intermediate and high risk and locally advanced disease, respectively. Considering 1827 patients with localized PCa, at multivariate analysis ISUP grade group ≥4 on prostate biopsy (HR: 1.30; 95 % CI 1.07-1.86; p = 0.02) and surgical delay only in localized high-risk disease (HR: 1.02; 95 % CI 1.01-1.54; p = 0.02) were confirmed as independent predictors of pathological upstaging to pT3-T4/pN1 disease at final histopathological examination.

CONCLUSIONS

In localized high-risk disease surgical delay could be associated with a higher risk of adverse pathologic findings.

Development and application of a second-generation multilingual tool for invasion risk screening of non-native terrestrial plants

Under the increasing threat to native ecosystems posed by non-native species invasions, there is an urgent need for decision support tools that can more effectively identify non-native species likely to become invasive. As part of the screening (first step) component in non-native species risk analysis, decision support tools have been developed for aquatic and terrestrial organisms. Amongst these tools is the Weed Risk Assessment (WRA) for screening non-native plants. The WRA has provided the foundations for developing the first-generation WRA-type Invasiveness Screening Kit (ISK) tools applicable to a range of aquatic species, and more recently for the second-generation ISK tools applicable to all aquatic organisms (including plants) and terrestrial animals. Given the most extensive usage of the latter toolkits, this study describes the development and application of the Terrestrial Plant Species Invasiveness Screening Kit (TPS-ISK). As a second-generation ISK tool, the TPS-ISK is a multilingual turnkey application that provides several advantages relative to the WRA: (i) compliance with the minimum standards against which a protocol should be evaluated for invasion process and management approaches; (ii) enhanced questionnaire comprehensiveness including a climate change component; (iii) provision of a level of confidence; (iv) error-free computation of risk scores; (v) multilingual support; (vi) possibility for across-study comparisons of screening outcomes; (vii) a powerful graphical user interface; (viii) seamless software deployment and accessibility with improved data exchange. The TPS-ISK successfully risk-ranked five representative sample species for the main taxonomic groups supported by the tool and ten angiosperms previously screened with the WRA for Turkey. The almost 20-year continuous development and evolution of the ISK tools, as opposed to the WRA, closely meet the increasing demand by scientists and decision-makers for a reliable, comprehensive, updatable and easily deployable decision support tool. For terrestrial plant screening, these requirements are therefore met by the newly developed TPS-ISK.

Impacts, Potential Benefits and Eradication Feasibility of Aquatic Alien Species in an Integral Natural State Reserve

Riverine wetlands are stepping-stone environments for the protection of local biodiversity, but they are particularly vulnerable to biological invasions. In order to take action against biological invasions, it is crucial to assess the impacts of alien species. However, it is also important to assess the potential benefits on ecosystem services that alien species could have. Once it has been verified that negative impacts are higher than potential benefits, it is important to propose feasible actions to contrast them. In this study, we assessed eight freshwater alien species recorded in an integral protected wetland using the Invasive Species Effects Assessment Tool (INSEAT) to quantify their negative impacts and potential benefits on ecosystem services. Moreover, for each species, we evaluated the feasibility of the main eradication techniques currently proposed in the literature using the Non-Native Risk Management scheme (NNRM), with the final aim of suggesting effective actions for their management. The INSEAT results indicated that all the assessed species had more impacts than benefits while NNRM provided useful indications on the best practical conservation actions to use for reducing the density, and therefore, the negative impacts on ecosystem services and the local biodiversity of the assessed alien species.

Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center

Background

The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked.

Objective

To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS).

Design setting and participants

We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score.

Surgical procedure

Redo PN was performed by using the Si Da Vinci robotic platform.

Measurements

Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated.

Results and limitations

Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2-4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7-9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148-200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5-22) min. Pure enucleation (SIB score 0-1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0-1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16-45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively.

Conclusions

Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney.

Patient summary

Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy.

Predictors of early catheter replacement after HoLEP. Results from a high-volume laser center

INTRODUCTION

The aim of the study was to investigate clinical and surgical factors associated with early catheter replacement in patients treated with Holmium Laser Enucleation of the Prostate (HoLEP).

MATERIALS AND METHODS

Data of patients treated with HoLEP at our Institution by a single surgeon from March 2017 to January 2021 were collected. Preoperative variables, including non-invasive uroflowmetry and abdominal ultrasonography (US), were recorded. Bladder wall modifications (BWM) at preoperative US were defined as the presence of single or multiple bladder diverticula or bladder wall thickening 5 mm. Clinical symptoms were assessed using validated questionnaires. Only events occurred within the first week after catheter removal were considered.

RESULTS

Overall, 305 patients were included, of which 46 (15.1%) experienced early catheter replacement. Maintenance of anticoagulants/antiplatelets (AC/AP) therapy at surgery (p=0.001), indwelling urinary catheter (p=0.02) and the presence of BWM (p=0.001) were more frequently reported in patients needing postoperative re-catheterization. Intraoperative complications (p=0.02) and median lasing time (p=0.02) were significantly higher in this group. At univariate analysis, indwelling urinary catheter (p=0.02), BWM (p=0.01), ongoing AC/AP therapy (p=0.01) and intraoperative complications (p=0.01) were significantly associated with early catheter replacement. At multivariate analysis, indwelling urinary catheter (OR: 1.28; p=0.02), BWM (OR: 2.87; p=0.001), and AC/AP therapy (OR: 2.21; p=0.01) were confirmed as independent predictors of catheter replacement.

CONCLUSIONS

In our experience the presence of indwelling urinary catheter before surgery, BWM and the maintenance of AC/AP therapy were shown to be independent predictors of early catheter replacement after HoLEP.

Development and application of a multilingual electronic decision-support tool for risk screening non-native terrestrial animals under current and future climate conditions

Electronic decision-support tools are becoming an essential component of government strategies to tackle non-native species invasions. This study describes the development and application of a multilingual electronic decision-support tool for screening terrestrial animals under current and future climate conditions: the Terrestrial Animal Species Invasiveness Screening Kit (TAS-ISK). As an adaptation of the widely employed Aquatic Species Invasiveness Screening Kit (AS-ISK), the TAS-ISK question template inherits from the original Weed Risk Assessment (WRA) and related WRA-type toolkits and complies with the ‘minimum requirements’ for use with the recent European Regulation on invasive alien species of concern. The TAS-ISK consists of 49 basic questions on the species’ biogeographical/historical traits and its biological/ecological interactions, and of 6 additional questions to predict how climate change is likely to influence the risks of introduction, establishment, dispersal and impact of the screened species. Following a description of the main features of this decision-support tool as a turnkey software application and of its graphical user interface with support for 32 languages, sample screenings are provided in different risk assessment areas for one representative species of each of the main taxonomic groups of terrestrial animals supported by the toolkit: mammals, birds, reptiles, amphibians, annelids, insects, molluscs, nematodes, and platyhelminths. The highest-scoring species were the red earthworm Lumbricus rubellus for the Aegean region of Turkey and the New Zealand flatworm Arthurdendyus triangulatus for Croatia. It is anticipated that adoption of this toolkit will mirror that of the worldwide employed AS-ISK, hence allowing to share information and inform decisions for the prevention of entry and/or dispersal of (high-risk) non-native terrestrial animal species – a crucial step to implement early-stage control and eradication measures as part of rapid-response strategies to counteract biological invasions.

A global-scale screening of non-native aquatic organisms to identify potentially invasive species under current and future climate conditions

The threat posed by invasive non-native species worldwide requires a global approach to identify which introduced species are likely to pose an elevated risk of impact to native species and ecosystems. To inform policy, stakeholders and management decisions on global threats to aquatic ecosystems, 195 assessors representing 120 risk assessment areas across all six inhabited continents screened 819 non-native species from 15 groups of aquatic organisms (freshwater, brackish, marine plants and animals) using the Aquatic Species Invasiveness Screening Kit. This multi-lingual decision-support tool for the risk screening of aquatic organisms provides assessors with risk scores for a species under current and future climate change conditions that, following a statistically based calibration, permits the accurate classification of species into high-, medium- and low-risk categories under current and predicted climate conditions. The 1730 screenings undertaken encompassed wide geographical areas (regions, political entities, parts thereof, water bodies, river basins, lake drainage basins, and marine regions), which permitted thresholds to be identified for almost all aquatic organismal groups screened as well as for tropical, temperate and continental climate classes, and for tropical and temperate marine ecoregions. In total, 33 species were identified as posing a 'very high risk' of being or becoming invasive, and the scores of several of these species under current climate increased under future climate conditions, primarily due to their wide thermal tolerances. The risk thresholds determined for taxonomic groups and climate zones provide a basis against which area-specific or climate-based calibrated thresholds may be interpreted. In turn, the risk rankings help decision-makers identify which species require an immediate 'rapid' management action (e.g. eradication, control) to avoid or mitigate adverse impacts, which require a full risk assessment, and which are to be restricted or banned with regard to importation and/or sale as ornamental or aquarium/fishery enhancement.

Beach nourishment using sediments from relict sand deposit: Effects on subtidal macrobenthic communities in the Central Adriatic Sea (Eastern Mediterranean Sea-Italy)

Nowadays nourishment is the most popular shore reconstruction strategy to counteract erosion of coastal areas. Sediments used for nourishment can have terrestrial or marine origin. This study analysed the effects of nourishment with relict sand on the subtidal macrobenthic communities and on the surface sediment at 7 sites of the Marche Region (Central Adriatic Sea, Italy). Samples for biological and physical analyses were collected in each site before and after nourishment. One year after nourishment the presence of the relict sands used for the replenishment is still visible in the sediment of each site. In the same period macrobenthic communities are characterised by the dominance of a few species able to avoid burial and suffocation phenomena, showing a low variability respect to the communities present before.

Study of the SRF-derived ashes melting behavior and the effects generated by the optimization of their composition on the furnaces energy efficiency in the incineration plants

As regards the incineration process of the urban solid waste, the composition correct management allows not only the valorization of precise civil and industrial groups of waste as alternative fuels but also a considerable increase of the furnace work temperature leading to a remarkable improvement of the related energy efficiency. In this sense, the study of the melting behavior of ashes deriving from several kinds of fuels that have to be processed to heat treatment is really important. This approach, indeed, ensures to know in depth the features defining the melting behavior of these analyzed samples, and as a consequence, gives us the necessary data in order to identify the best mixture of components to be incinerated as a function of the specific working temperatures of the power plant. Firstly, this study aims to find a way to establish the softening and melting temperatures of the ashes because they are those parameters that strongly influence the use of fuels. For this reason, in this work, the fusibility of waste-derived ashes with different composition has been investigated by means of the heating microscope. This instrument is fundamental to prove the strict dependence of the ashes fusion temperature on the heating rate that the samples experienced during the thermal cycle. In addition, in this work, another technological feature of the instrument has been used allowing to set an instantaneous heating directly on the sample in order to accurately reproduce the industrial conditions which characterize the incineration plants. The comparison between the final results shows that, in effect, the achievement of the best performances of the furnace is due to the a priori study of the melting behavior of the single available components.

Critical appraisal on the identification of Reference Conditions for the evaluation of ecological quality status along the Emilia-Romagna coast (Italy) using M-AMBI

According to the European Water Framework Directive, the ecological status (ES) of a water body is determined by comparing observation data with undisturbed Reference Conditions (RCs). Defining RCs is crucial when evaluating the ES of a water body as it strongly affects the final outcome of any index application. Identifying RCs by observing real sites is not feasible in many marine environments, such as the Emilia-Romagna coast (Italy, N-Adriatic Sea). We used a statistical approach on a large dataset to derive RCs for the application of the benthic index M-AMBI in this area. We then applied M-AMBI to samples collected along a gradient of presumed environmental disturbance. The results put 14.8% of the Emilia-Romagna samples in "High" ES, 60.2% in "Good", 23.0% in "Moderate" and 2.0% in "Poor", showing a spatial gradient of improving quality. These results are in agreement with the extensive ecological knowledge available for this area.

Efficacy of levetiracetam in pharmacoresistant continuous spikes and waves during slow sleep

OBJECTIVE

To evaluate the efficacy of levetiracetam (LEV) in continuous spikes and waves during slow sleep (CSWS). Despite first description dates back to 1971, no agreement exists about CSWS treatment. The condition is rare and controlled clinical trials are very difficult to perform, so the reports about efficacy of different drugs are anecdotal.

PATIENTS AND METHODS

We introduced LEV in three children affected by symptomatic focal epilepsy and pharmacoresistant CSWS and evaluated clinical, neuropsychological and electroencephalographic outcome.

RESULTS

Two cases responded completely, one case showed only a mild reduction of spikes and waves during slow sleep.

CONCLUSION

Even if our report is anecdotal, LEV expands the spectrum of antiepileptic drugs that can be used for the treatment of CSWS. LEV efficacy should be confirmed in larger series.