Renal Tumor Biopsies: A Shift towards Improving Outcomes in the Management of Small Renal Masses

This chapter reviews the current literature in view of varying clinical practices surrounding the diagnostic role of renal tumor biopsies of small renal masses. Surgical management of small renal masses without pretreatment biopsy is a routine strategy in many urological centres around the world. This is in spite of improvements in techniques, accuracies and biomarkers to diagnose the neoplasm. Apart from its effectiveness, renal tumor biopsies avoid the risks of surgically treating benign renal masses and may also prove cost-effective to healthcare systems. Interdisciplinary communication between urologists, interventional radiologists and pathologists will facilitate the process of making this biopsy-driven management the standard of care

Terrorism and Foreign Direct Investment: An Empirical Analysis of SAARC Countries

The current state of terrorism has posed serious challenges to stability of macroeconomic environment causing the displacement of foreign direct investment (FDI). This study aims to find the impact of terrorism along with other important location variables such as market size, economic growth, exchange rate, infrastructure and trade openness on FDI inflows in five SAARC member nations, namely, Bangladesh, India, Nepal, Pakistan and Sri Lanka. Utilising a panel econometric estimation model on annual data from 1980-2012 the results of the study showed a significant positive impact of market size, trade openness, infrastructure availability and economic growth on inward FDI in these SAARC countries. Whereas, exchange rate volatility exhibited a negative relationship with FDI inflows. The results revealed that terrorism has statistically significant and negative rapport with FDI inflows. This empirically establishes the fact that terrorism is a serious threat to FDI and economic growth for the economies in this region

Terrorism and Foreign Direct Investment: An Empirical Analysis of SAARC Countries

The current state of terrorism has posed serious challenges to stability of macroeconomic environment causing the displacement of foreign direct investment (FDI). This study aims to find the impact of terrorism along with other important location variables such as market size, economic growth, exchange rate, infrastructure and trade openness on FDI inflows in five SAARC member nations, namely, Bangladesh, India, Nepal, Pakistan and Sri Lanka. Utilising a panel econometric estimation model on annual data from 1980-2012 the results of the study showed a significant positive impact of market size, trade openness, infrastructure availability and economic growth on inward FDI in these SAARC countries. Whereas, exchange rate volatility exhibited a negative relationship with FDI inflows. The results revealed that terrorism has statistically significant and negative rapport with FDI inflows. This empirically establishes the fact that terrorism is a serious threat to FDI and economic growth for the economies in this region

Situational Analysis of Public Sector Schools in Rural Areas of Southern Punjab, Pakistan

Training assumes an imperative part in the improvement of the nation and people. Pakistan is among the most thickly populated countries of the world. Pakistan has a standout amongst the most insignificant capability rates on the planet and as showed by the United Nations Educational, Scientific and Cultural Organization (UNESCO), it is 55 for each penny and stays at 160th in total countries of the world. The target of this examination is to distinguish the reason of low proficiency rate in rustic territories and to recognize physical structure we likewise checkout essential security courses of action in government schools and break down effect of missing offices on youngsters. We likewise discover the reason of dropout youngsters from school and recognize Staff nearness at school. A Situational logical examination was led in region Punjab and in multi arranges testing system was utilized in local Muzaffargarh. Two tehsils from locale were chosen purposively for information accumulation. Tehsil jatoi and Alipur were chosen from locale Muzaffargarh. 150 respondents were selected as a specimen size of the examination. Rate, chi square, gamma, examinations were utilized to investigate the connection between various factors. The outcomes with respect to sexual orientation, age, territory, instruction level, wage level, among various factors are tried by utilizing SPSS for discoveries of the examination. Government should actualize the instructive arrangements from the gross root level. Guys and females ought to incorporate equivalent level for instructive basic leadership process. Conventional esteems, financial obstructions and some other social imperatives ought to be debilitated at all levels in instruction segment particularly in provincial southern Punjab

Shrinking Employees Turnover Intention by applying Tools of Job Embeddedness (Used as a Mediator)

The current research study examined the association among the HRM practices through job embeddedness (as a mediator) and employee turnover intentions. In this study, the researchers used new construct i.e. job embeddedness to explore its mediating impact on the relationship between employee turnover intentions and HRM practices such as training, compensation, career planning, performance appraisal and supervisor support. Job embeddedness was studied in terms of fit, links, and sacrifice organization. Job embeddedness plays a crucial role to reduce turnover. If organization applies these HRM practices in true letter and spirit, then their employees will be more satisfied, committed, and loyal to that organization. If employees are more embedded to the organization in a positive manner, so that employees are more committed, satisfied and impacts their performance

Protocol for a mixed-method study to assess chronic cough in patients with renal cell carcinoma: the prevalence, impact on quality of life, trigger and potential clinical application of chronic cough as an early screening tool in patients with kidney cancer

Introduction: Cough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these patients, as well as cough being discussed in forums for patients with kidney cancer, few clinicians are aware of this association. The cough has been described as unusual in nature, resolving rapidly after treatment with nephrectomy/embolisation but returning if the tumour recurs. // Methods and analysis: A prospective study using a questionnaire will identify the prevalence of cough in patients with suspected or confirmed RCC attending the Specialist Centre for Kidney Cancer (London, UK). A longitudinal study in a representative sample of these patients, using EQ-5D-5L and Leicester Cough Questionnaires, together with the use of semi-structured interviews with patients, will identify the impact of cough in addition to having a diagnosis of suspected or confirmed RCC on quality of life. To investigate cough mechanisms, a pilot study using cough hypersensitivity testing will be performed on patients with RCC, with and without a cough. Clinical samples (urine, blood, phlegm and breath condensate) from patients with RCC, with and without a cough, will be collected and analysed for the presence of substances known to trigger or enhance cough and compared with the results obtained from healthy volunteers. Ethics and dissemination: Ethical approval has been granted (UK HR REC 22/PR/0791 dated 25/08/2022). Study outputs will be presented and published nationally and internationally at relevant conferences. This study will establish the prevalence of cough in patients with suspected or confirmed kidney cancer and support the education of clinicians to consider this diagnosis in patients with chronic cough (eg, recommending protocols to include both kidneys when investigating respiratory symptoms with chest CT scans). If substances known to trigger or enhance cough are identified and elevated in clinical samples, this research could offer potential targets for treatment for this distressing symptom. // Trial registration number: NIHR CRN portfolio CPMS ID:53 372

Nephron Sparing Treatment (NEST) for Small Renal Masses: A Feasibility Cohort-embedded Randomised Controlled Trial Comparing Percutaneous Cryoablation and Robot-assisted Partial Nephrectomy

There is a paucity of high-level evidence on small renal mass (SRM) management, as previous classical randomised controlled trials (RCTs) failed to meet accrual targets. Our objective was to assess the feasibility of recruitment to a cohort-embedded RCT comparing cryoablation (CRA) to robotic partial nephrectomy (RPN). A total of 200 participants were recruited to the cohort, of whom 50 were enrolled in the RCT. In the RCA intervention arm, 84% consented (95% confidence interval [CI] 64-95%) and 76% (95% CI 55-91%) received CRA; 100% (95% CI 86-100%) of the control arm underwent RPN. The retention rate was 90% (95% CI 79-96%) at 6 mo. In the RPN group 2/25 (8%) were converted intra-operative to radical nephrectomy. Postoperative complications (Clavien-Dindo grade 1-2) occurred in 12% of the CRA group and 29% of the RPN group. The median length of hospital stay was shorter for CRA (1 vs 2 d; p = 0.019). At 6 mo, the mean change in renal function was -5.0 ml/min/1.73 m2 after CRA and -5.8 ml/min/1.73 m2 after RPN. This study demonstrates the feasibility of a cohort-embedded RCT comparing CRA and RPN. These data can be used to inform multicentre trials on SRM management. PATIENT SUMMARY: We assessed whether patients with a small kidney tumour would consent to a trial comparing two different treatments: cryoablation (passing small needles through the skin to freeze the kidney tumour) and surgery to remove part of the kidney. We found that most patients agreed and a full trial would therefore be feasible

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio