The Use of Molecular Analyses in Voided Urine for the Assessment of Patients with Hematuria

Introduction:Patients presenting with painless hematuria form a large part of the urological patient population. In many cases, especially in younger patients, the cause of hematuria is harmless. Nonetheless, hematuria could be a symptom of malignant disease and hence most patients will be subject to cystoscopy. In this study, we aimed to develop a prediction model based on methylation markers in combination with clinical variables, in order to stratify patients with high risk for bladder cancer.Material and Methods:Patients (n=169) presenting with painless hematuria were included. 54 patients were diagnosed with bladder cancer. In the remaining 115 patients, the cause of hematuria was non-malignant. Urine samples were collected prior to cystoscopy. Urine DNA was analyzed for methylation of OSR1, SIM2, OTX1, MEIS1 and ONECUT2. Methylation percentages were calculated and were combined with clinical variables into a logistic regression model.Results:Logistic regression analysis based on the five methylation markers, age, gender and type of hematuria resulted in an area under the curve (AUC) of 0.88 and an optimism corrected AUC of 0.84 after internal validation by bootstrapping. Using a cut-off value of 0.307 allowed stratification of patients in a low-risk and high-risk group, resulting in a sensitivity of 82% (44/54) and a specificity of 82% (94/115). Most aggressive tumors were found in patients in the high-risk group. The addition of cytology to the prediction model, improved the AUC from 0.88 to 0.89, with a sensitivity and specificity of 85% (39/46) and 87% (80/92), retrospectively.Conclusions:This newly developed prediction model could be a helpful tool in risk stratification of patients presenting with painless hematuria. Accurate risk prediction might result in less extensive examination of low risk patients and thereby, reducing patient burden and costs. Further validation in a large prospective patient cohort is necessary to prove the true clinical value of this model

Density Dependent Hadron Field Theory

A fully covariant approach to a density dependent hadron field theory is presented. The relation between in--medium NN interactions and field--theoretical meson--nucleon vertices is discussed. The medium dependence of nuclear interactions is described by a functional dependence of the meson--nucleon vertices on the baryon field operators. As a consequence, the Euler--Lagrange equations lead to baryon rearrangement self--energies which are not obtained when only a parametric dependence of the vertices on the density is assumed. It is shown that the approach is energy--momentum conserving and thermodynamically consistent. Solutions of the field equations are studied in the mean--field approximation. Descriptions of the medium dependence in terms of the baryon scalar and vector density are investigated. Applications to infinite nuclear matter and finite nuclei are discussed. Density dependent coupling constants obtained from Dirac--Brueckner calculations with the Bonn NN-potentials are used. Results from Hartree calculations for energy spectra, binding energies and charge density distributions of $^{16}O$, $^{40,48}Ca$ and $^{208}Pb$ are presented. Comparisons to data strongly support the importance of rearrangement in a relativistic density dependent field theory. Most striking is the simultanuous improvement of charge radii, charge densities and binding energies. The results indicate the appearance of a new "Coester line" in the nuclear matter equation of state.Comment: 48 LateX pages, 12 Figures, figures and full paper are available as postscript files by anonymous ftp at ftp://theorie.physik.uni-giessen.de/dd

Relativistic Mean Field Model with Generalized Derivative Nucleon-Meson Couplings

The quantum hadrodynamics (QHD) model with minimal nucleon-meson couplings is generalized by introducing couplings of mesons to derivatives of the nucleon field in the Lagrangian density. This approach allows an effective description of a state-dependent in-medium interaction in the mean-field approximation. Various parametrizations for the generalized couplings are developed and applied to infinite nuclear matter. In this approach, scalar and vector self-energies depend on both density and momentum similarly as in the Dirac-Brueckner theory. The Schr\"{o}diger-equivalent optical potential is much less repulsive at high nucleon energies as compared to standard relativistic mean field models and thus agrees better with experimental findings. The derivative couplings in the extended model have significant effects on properties of symmetric nuclear matter and neutron matter.Comment: 35 pages, 1 table, 10 figure

Efeitos da aplicação de retardador (CCC) e acelerador (GA) de crescimento na morfologia e produtividade do feijoeiro (Phaseolus vulgaris L. cv. Carioca)

Verificou-se os efeitos de CCC e GA quando aplicados sob a forma de pulverização das plântulas, na morfologia, florescimento e produtividade do feijoeiro cultivar Carioca, em condições de casa de vegetação. Estudou-se as concentrações de 500, 2000 e 4000 ppm de CCC juntamente com 50 pprn de GA; sendo que CCC 500 + GA 50 ppm promoveu aceleração no crescimento da haste principal e CCC 4000 + GA 50 ppm retardou esse crescimento em relação ao controle. Aplicação de CCC 500 + GA 50 ppm aumentou o número de folhas do feijoeiro. Num período de 2 semanas após o tratamento com CCC 500 + GA 50 ppm ocorreu aumento no comprimento dos meritalos, sendo que 30 dias após a aplicação de CCC 4000 + GA 50 ppm verificou-se diminuição no comprimento dos mesmos. Observou-se aumento no comprimento do limbo foliar 5 dias após os tratamentos com CCC 500 + GA 50 ppm ou CCC 2000 + GA 50 ppm. Ocorreu aumento no número médio de flores com aplicação de CCC 500 + GA 50 ppm. Não ocorreram diferenças significativas entre a produtividade das plantas tratadas com relação ao controle.In this paper the autors tested the effects of (2 - chloroethyl) trimethylammonium chloride (CCC) and gibberellic acid (GA) on the cultivar Carioca of bean, in three different concentrations (500, 2000, and 4000 ppm) of CCC and one concentration of GA (50 ppm). Treatment with CCC 500 ppm + GA 50 ppm increased the height of bean plant and CCC 4000 ppm + GA 50 ppm reduced the height of Phaseolus vulgaris. Application of CCC 500 ppm + GA 50 ppm or CCC 2000 ppm + GA 50 ppm increased the leaf number of bean plant. CCC 500 ppm + GA 50 ppm promoted a increase in the internode length and CCC 4000 ppm + GA 50 ppm reduced the length of internodcs. Application of CCC 500 ppm + GA 50 ppm or CCC 2000 ppm + GA 50 ppm increased the leaf length 5 days after the treatment. CCC 500 ppm + GA 50 ppm promoted higher flowering in relation to the check.

On the origin and evolution of the material in 67P/Churyumov-Gerasimenko

International audiencePrimitive objects like comets hold important information on the material that formed our solar system. Several comets have been visited by spacecraft and many more have been observed through Earth- and space-based telescopes. Still our understanding remains limited. Molecular abundances in comets have been shown to be similar to interstellar ices and thus indicate that common processes and conditions were involved in their formation. The samples returned by the Stardust mission to comet Wild 2 showed that the bulk refractory material was processed by high temperatures in the vicinity of the early sun. The recent Rosetta mission acquired a wealth of new data on the composition of comet 67P/Churyumov-Gerasimenko (hereafter 67P/C-G) and complemented earlier observations of other comets. The isotopic, elemental, and molecular abundances of the volatile, semi-volatile, and refractory phases brought many new insights into the origin and processing of the incorporated material. The emerging picture after Rosetta is that at least part of the volatile material was formed before the solar system and that cometary nuclei agglomerated over a wide range of heliocentric distances, different from where they are found today. Deviations from bulk solar system abundances indicate that the material was not fully homogenized at the location of comet formation, despite the radial mixing implied by the Stardust results. Post-formation evolution of the material might play an important role, which further complicates the picture. This paper discusses these major findings of the Rosetta mission with respect to the origin of the material and puts them in the context of what we know from other comets and solar system objects

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1�70.8) million) to 6.4 (58.3 (47.6�70.7) million), but is predicted to remain above the World Health Organization�s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8�38.5) million) in 2000 to 6.0 (55.5 (44.8�67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries