Apolipoprotein E induces pathogenic senescent-like myeloid cells in prostate cancer

Tumor cells promote the recruitment of immunosuppressive neutrophils, a subset of myeloid cells driving immune suppression, tumor proliferation, and treatment resistance. Physiologically, neutrophils are known to have a short half-life. Here, we report the identification of a subset of neutrophils that have upregulated expression of cellular senescence markers and persist in the tumor microenvironment. Senescent-like neutrophils express the triggering receptor expressed on myeloid cells 2 (TREM2) and are more immunosuppressive and tumor-promoting than canonical immunosuppressive neutrophils. Genetic and pharmacological elimination of senescent-like neutrophils decreases tumor progression in different mouse models of prostate cancer. Mechanistically, we have found that apolipoprotein E (APOE) secreted by prostate tumor cells binds TREM2 on neutrophils, promoting their senescence. APOE and TREM2 expression increases in prostate cancers and correlates with poor prognosis. Collectively, these results reveal an alternative mechanism of tumor immune evasion and support the development of immune senolytics targeting senescent-like neutrophils for cancer therapy.

P1245 Polymorphic Variants of HSD3B1 Gene Confer Different Outcome in Specific Subgroups of Patients Infected With SARS-CoV-2

Introduction: Severe respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the androgen receptor (AR), through ACE2 receptor and TMPRSS2, to enter nasal and upper airways epithelial cells. Genetic analyses revealed that HSD3B1 P1245C polymorphic variant increases dihydrotestosterone production and upregulation of TMPRSS2 with respect to P1245A variant, thus possibly influencing SARS-CoV-2 infection. Our aim was to characterize the HSD3B1 polymorphism status and its potential association with clinical outcomes in hospitalized patients with COVID-19 in Southern Switzerland.

Materials and Methods: The cohort included 400 patients hospitalized for COVID-19 during the first wave between February and May 2020 in two different hospitals of Canton Ticino. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue blocks, and HSD3B1 gene polymorphism was evaluated by Sanger sequencing. Statistical associations were verified using different test.

Results:HSD3B1 polymorphic variants were not associated with a single classical factor related to worse clinical prognosis in hospitalized patients with SARS-CoV-2. However, in specific subgroups, HSD3B1 variants played a clinical role: intensive care unit admission was more probable in patients with P1245C diabetes compared with P1245A individuals without this comorbidity and death was more associated with hypertensive P1245A>C cases than patients with P1245A diabetes without hypertension.

Discussion: This is the first study showing that HSD3B1 gene status may influence the severity of SARS-CoV-2 infection. If confirmed, our results could lead to the introduction of HSD3B1 gene status analysis in patients infected with SARS-CoV-2 to predict clinical outcome.

Consensus for Treatment of Metastatic Castration-Sensitive Prostate Cancer: Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC)

PURPOSE

International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios.

METHODS

A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response.

RESULTS

Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms.

CONCLUSION

The treatment recommendations for most topics addressed differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC.

A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer

CONTEXT

The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown.

OBJECTIVE

To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa.

EVIDENCE ACQUISITION

Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed.

EVIDENCE SYNTHESIS

Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains.

CONCLUSIONS

Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed.

PATIENT SUMMARY

We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.

Management and design of biogas digesters: A non-calibrated heat transfer model

A thermal balance modeling framework is developed, based on heat transfer-resistance networks. The heat transfer model accounts for effects of digester- design, location and operation, including effects of solar irradiance, external heating and ambient climate. We demonstrate extendibility of the framework by using the model in dynamic simulations of substrate temperature for digesters comprising two very different designs. Digester designs modeled include fixed-dome, buried, uninsulated and unheated household digesters in Hanoi, Vietnam, and an industrial-scale anaerobic digester located at a wastewater treatment plant in Esbjerg, Denmark. The modeled temperature profiles were evaluated against measured substrate temperatures over long periods, from 7 months and up. For the two Hanoi digesters, root-mean-square-error were 1.43 °C and 0.92 °C, with Nash-Sutcliffe model efficiency coefficients (NS-C) of 0.87 and 0.93 respectively. For the industrial digester in Esbjerg root-mean-square-error was 0.48 °C with an NS-C of 0.94. The model was not calibrated prior simulation, suggesting good predictive performance.

Best available technology for European livestock farms: Availability, effectiveness and uptake

Concerns over the negative environmental impact from livestock farming across Europe continue to make their mark resulting in new legislation and large research programs. However, despite a huge amount of published material and many available techniques, doubts over the success of national and European initiatives remain. Uptake of the more cost-effective and environmentally-friendly farming methods (such as dietary control, building design and good manure management) is already widespread but unlikely to be enough in itself to ensure that current environmental targets are fully met. Some of the abatement options available for intensive pig and poultry farming are brought together under the European IPPC/IED directive where they are listed as Best Available Techniques (BAT). This list is far from complete and other methods including many treatment options are currently excluded. However, the efficacies of many of the current BAT-listed options are modest, difficult to regulate and in some cases they may even be counterproductive with respect to other objectives ie pollution swapping. Evaluation of the existing and new BAT technologies is a key to a successful abatement of pollution from the sector and this in turn relies heavily on good measurement strategies. Consideration of the global effect of proposed techniques in the context of the whole farm will be essential for the development of a valid strategy.

Biogas production within the bioethanol production chain: Use of co-substrates for anaerobic digestion of sugar beet vinasse

Bioethanol production generates large amounts of vinasse, which is suitable for biogas production. In this study, the anaerobic digestion of sugar beet vinasse was optimised using continuous stirred-tank reactors (CSTR) supplemented either with lime fertiliser or with 3% cow manure. In both reactors, the C/N ratio was adjusted by adding straw. The biochemical methane potential (BMP) of vinasse was 267.4±4.5LCH4kgVS(-1). Due to the low content of macro- and micronutrients and low C/N ratio of vinasse, biogas production failed when vinasse alone was fed to the reactor. When co-substrate was added, biogas production achieved very close to the BMP of vinasse, being 235.7±32.2LCH4kgVS(-1) from the fertiliser supplied reactor and 265.2±26.8LCH4kgVS(-1) in manure supplied reactor at steady state. Anaerobic digestion was the most stable when cow manure was supplied to digestion of vinasse.

Life Cycle Assessment of Biogas Production in Small-scale Household Digesters in Vietnam

Small-scale household digesters have been promoted across Asia as a sustainable way of handling manure. The major advantages are that they produce biogas and reduce odor. However their disadvantages include the low recycling of nutrients, because digestate is dilute and therefore difficult to transport, and the loss of biogas as a result of cracks and the intentional release of excess biogas. In this study, life cycle assessment (LCA) methodology was used to assess the environmental impacts associated with biogas digesters in Vietnam. Handling 1,000 kg of liquid manure and 100 kg of solid manure in a system with a biogas digester reduced the impact potential from 4.4 kg carbon dioxide (CO2) equivalents to 3.2 kg CO2 equivalents compared with traditional manure management. However, this advantage could easily be compromised if digester construction is considered in the LCA or in situations where there is an excess of biogas which is intentionally released. A sensitivity analysis showed that biogas digesters could be a means of reducing global warming if methane emissions can be kept low. In terms of eutrophication, farms with biogas digesters had 3 to 4 times greater impacts. In order to make biogas digesters sustainable, methods for recycling digestates are urgently required.

Biogas production from vietnamese animal manure, plant residues and organic waste: influence of biomass composition on methane yield

Anaerobic digestion is an efficient and renewable energy technology that can produce biogas from a variety of biomasses such as animal manure, food waste and plant residues. In developing countries this technology is widely used for the production of biogas using local biomasses, but there is little information about the value of these biomasses for energy production. This study was therefore carried out with the objective of estimating the biogas production potential of typical Vietnamese biomasses such as animal manure, slaughterhouse waste and plant residues, and developing a model that relates methane (CH4) production to the chemical characteristics of the biomass. The biochemical methane potential (BMP) and biomass characteristics were measured. Results showed that piglet manure produced the highest CH4 yield of 443 normal litter (NL) CH4 kg(-1) volatile solids (VS) compared to 222 from cows, 177 from sows, 172 from rabbits, 169 from goats and 153 from buffaloes. Methane production from duckweed (Spirodela polyrrhiza) was higher than from lawn grass and water spinach at 340, 220, and 110.6 NL CH4 kg(-1) VS, respectively. The BMP experiment also demonstrated that the CH4 production was inhibited with chicken manure, slaughterhouse waste, cassava residue and shoe-making waste. Statistical analysis showed that lipid and lignin are the most significant predictors of BMP. The model was developed from knowledge that the BMP was related to biomass content of lipid, lignin and protein from manure and plant residues as a percentage of VS with coefficient of determination (R-square) at 0.95. This model was applied to calculate the CH4 yield for a household with 17 fattening pigs in the highlands and lowlands of northern Vietnam.

Validation and recommendation of methods to measure biogas production potential of animal manure

In developing countries, biogas energy production is seen as a technology that can provide clean energy in poor regions and reduce pollution caused by animal manure. Laboratories in these countries have little access to advanced gas measuring equipment, which may limit research aimed at improving local adapted biogas production. They may also be unable to produce valid estimates of an international standard that can be used for articles published in international peer-reviewed science journals. This study tested and validated methods for measuring total biogas and methane (CH₄) production using batch fermentation and for characterizing the biomass. The biochemical methane potential (BMP) (CH₄ NL kg⁻¹ VS) of pig manure, cow manure and cellulose determined with the Moller and VDI methods was not significantly different in this test (p>0.05). The biodegradability using a ratio of BMP and theoretical BMP (TBMP) was slightly higher using the Hansen method, but differences were not significant. Degradation rate assessed by methane formation rate showed wide variation within the batch method tested. The first-order kinetics constant k for the cumulative methane production curve was highest when two animal manures were fermented using the VDI 4630 method, indicating that this method was able to reach steady conditions in a shorter time, reducing fermentation duration. In precision tests, the repeatability of the relative standard deviation (RSDr) for all batch methods was very low (4.8 to 8.1%), while the reproducibility of the relative standard deviation (RSD_R) varied widely, from 7.3 to 19.8%. In determination of biomethane concentration, the values obtained using the liquid replacement method (LRM) were comparable to those obtained using gas chromatography (GC). This indicates that the LRM method could be used to determine biomethane concentration in biogas in laboratories with limited access to GC.

Sequential use of novel therapeutics in advanced prostate cancer following docetaxel chemotherapy

In the last three years, five novel treatments have been shown to improve survival in metastatic castration-resistant prostate cancer (CRPC). These novel treatments have distinct mechanisms of action: tubulin-binding chemotherapy (cabazitaxel); immunotherapy (sipuleucel-T); CYP-17 inhibition (abiraterone); androgen receptor (AR) blockade (enzalutamide); and radioisotope therapy (radium-223). For a number of years, docetaxel was the only treatment with a proven survival benefit for patients with CRPC. Therefore, somewhat artificially, three treatment spaces for drug development in CRPC have emerged: pre-docetaxel; docetaxel combinations; and post-docetaxel. For patients progressing after docetaxel-based chemotherapy, treatment options available outside of clinical trials now include abiraterone, cabazitaxel and enzalutamide. Prospective data on how to best use these novel agents sequentially are not available. Clinicians face the difficult task of choosing between treatment options for individual patients to maximize patient benefit. Treatment evaluation in patients with CRPC remains challenging due to the predominance of bone metastatic disease and the lack of validated surrogate markers for survival. This review summarizes the data available with regards to sequencing of the novel treatments for CRPC.

The influence of the pig manure separation system on the energy production potentials

Energy recovery from pig manure offers an opportunity for waste utilisation and financial benefit. Samples of the solid fraction of separated pig manure and samples which had undergone chemical or biological pretreatment prior to separation were pyrolysed. A beech wood sample was pyrolysed for comparison. The chemically pre-treated and anaerobically digested materials had similar properties and showed similar behaviour during thermogravimetric analysis. However, the energy content of the gas arising from pyrolysis in a batch reactor at 600 °C comprises about 30% of the original energy of the feedstock in the case of the anaerobically digested materials and double that of the chemically pre-treated material. Therefore, the overall energy balance showed a loss of 595.9 MJ/t for the pyrolysis of the chemically pre-treated manure, while very small positive values of 351.7 MJ/t, 817.3 MJ/t and a significant value of 8935 MJ/t were found for anaerobically digested sample, un-pretreated solid and for wood, respectively.

Management model for assessment of nitrogen flow from feed to pig manure after storage in Vietnam

Nitrogen (N) losses from pig production and the recycling of N from manure to crops can harm the atmosphere, soil and ground water quality. This study intended to build a dynamic management model, adapted to the Vietnamese context, that links the N flow at all stages along the manure management chain from the N in the diets fed to grower-finisher pigs to the application of the manure in the field. The model assesses N contents and losses at each stage of manure management so that application of manure N can be adjusted to ensure optimal fertilizer value, while at the same time minimizing environmental damage. This model provides a tool for examining the N flow on pig farms, to adjust the N content of feeds, the pig population, and to minimize N discharge and emissions. The model is developed using Powersim software and data from feed-excretion, storage and composting experiments. For validation and performance of the model we used sub-datasets from feed-excretion experiments in Denmark and Vietnam that were not used to parameterize in the model. This article presents the development of the model and trial of the model through scenario analyses of pig production in livestock production zones. The objective is that policy makers, extension officers or agricultural advisors will use the model as a support management tool to formulate and adjust manure management practices. This includes assessment of the land carrying capacity in existing livestock production areas and of maximum acceptable manure loads in planned livestock production zones.

Effect of incineration temperature on phosphorus availability in bio-ash from manure

In the near future phosphorus (P) will be a limited resource in high demand. This will increase the incentives for recycling P in animal manure. In this study the dry-matter-rich fraction from slurry separation was incinerated and the P availability of the ash fraction examined. The aim was to adjust incineration temperature to support a high plant-availability of P in ash. The plant-availability of P was approximately halved when the incineration temperature was increased from 400 to 700 degrees C. This decrease in plant-availability was probably due to the formation of hydroxyapatite. Incineration temperatures should therefore be kept below 700 degrees C to ensure a high fertilizer efficiency of P in ash. This may conflict with the energy production, which is optimal at temperatures above 800 degrees C. An alternative to incineration may therefore be thermal gasification of the dry-matter-rich fraction, which can be carried out efficiently at lower temperatures.

Interactions between phosphorus feeding strategies for pigs and dairy cows and separation efficiency of slurry

Phosphorus (P) in manure is a nutrient source for plants, but surplus P amended to fields represents a risk to the environment. This study examines the interactions between low-P diets for pigs and dairy cows and the separation of animal slurry into a solid P fraction and a liquid fraction. Replacing inorganic phosphates with phytase in pig feed reduced the concentration of P in slurry by 35%, but supplementing concentrates to dairy cows did not affect the P concentration in cattle slurry. Particle-size fractions of the slurry were not affected by these dietary changes. The amount of dry matter (DM) in the < 0.025 mm fraction was greater in pig slurry than in cattle slurry, but the relative amounts of P and nitrogen (N) were larger in the > 0.025 mm fraction. Replacing feed phosphate, in the form of mono-calcium phosphate, with phytase in the pig diet reduced the separation index (efficiency) of P from 80% to 60%.

A simple biofilter for treatment of pig slurry in Malaysia

On commercial pig production farms in South East (SE) Asia, the liquid effluent is often discharged into rivers. The discharge is a hazard to the environment and to the health of people using water from the river either for consumption or for irrigation. Therefore, a simple percolation biofilter for treatment of the liquid effluent was developed. Pig slurry was treated in test-biofilters packed with different biomass for the purpose of selecting the most efficient material, thereafter the efficiency of the biofilter was examined at farm scale with demo biofilters using the most efficient material. The effect of using "Effective Microorganisms" (EM) added to slurry that was treated with biofilter material mixed with Glenor KR+ was examined. Slurry treatment in the test-biofilters indicated that rice straw was better than coconut husks, wood shavings, rattan strips and oil palm fronds in reducing BOD. Addition of EM and Glenor KR+ to slurry and biofilter material, respectively, had no effect on the temperature of the biofilter material or on the concentrations of organic and inorganic components of the treated slurry. The BOD of slurry treated in test biofilters is reduced to between 80 and 637 mg O2 I(-1) and in the demo biofilter to between 3094 and 3376 mg O2 l(-1). The concentration of BOD in the effluent is related to the BOD in the slurry being treated and the BOD concentration in slurry treated in test biofilters was lower than BOD of slurry treated in demo biofilters. The demo biofilter can reduce BOD to between 52 an 56% of the original value, and TSS, COD (chemical oxygen demand) and ammonium (NH4+) to 41-55% of the original slurry. The treated effluent could not meet the standards for discharge to rivers. The composted biofilter material has a high content of nitrogen and phosphorus; consequently, the fertilizer value of the compost is high. The investments costs were 123 US dollar per SPP which has to be reduced if this method should be a treatment option in practise.

Separation efficiency and particle size distribution in relation to manure type and storage conditions

Mechanical separation of liquid animal manure can be an effective technique for production of a liquid and a nutrient-rich solid fraction. The efficiency of separators depends on the physical and chemical composition of the animal manure. Therefore, the particle size composition was measured for different types of manure before treatment with a decanting centrifuge and a screw press. Storage of pig manure reduces the total dry matter content, and the content of small particles (< 0.0016 mm) is reduced more than the content of large particles. In consequence, the proportion of large particles will increase, while the portion of small particles will decrease. The separation efficiency of the screw press was found to be low, as this separator only retains particles > 1 mm. The decanter centrifuge retained all the particles > 0.02 mm and was therefore much more efficient than the screw press. Separation efficiency was also found to be highly dependent on the type of manure used.