Understanding tumor localization in multiparametric MRI of the prostate—effectiveness of 3D printed models

IntroductionUnderstanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors.Methods and Participants20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test).ResultsOverall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [−7.4;41.3] (p < 0.01).ConclusionUrologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension

Porous polymeric microparticles foamed with supercritical CO₂ as scattering white pigments

Nowadays, titanium dioxide (TiO2) is the most commercially relevant white pigment. Nonetheless, it is widely criticized due to its energy-intensive extraction and costly disposal of harmful by-products. Furthermore, recent studies discuss its potential harm for the environment and the human health. Environment-friendly strategies for the replacement of TiO2 as a white pigment can be inspired from nature. Here whiteness often originates from broadband light scattering air cavities embedded in materials with refractive indices much lower than that of TiO2. Such natural prototypes can be mimicked by introducing air-filled nano-scale cavities into commonly used polymers. Here, we demonstrate the foaming of initially transparent poly(methyl methacrylate) (PMMA) microspheres with non-toxic, inert, supercritical CO2. The properties of the foamed, white polymeric pigments with light scattering nano-pores are evaluated as possible replacement for TiO2 pigments. For that, the inner foam structure of the particles was imaged by phase-contrast x-ray nano-computed tomography (nano-CT), the optical properties were evaluated via spectroscopic measurements, and the mechanical stability was examined by micro compression experiments. Adding a diffusion barrier surrounding the PMMA particles during foaming allows to extend the foaming process towards smaller particles. Finally, we present a basic white paint prototype as exemplary application

Testicular manifestation of a transformed mycosis fungoides

Testicular neoplasms occur in more than 90% of cases, due to primary testicular germ cell tumors. Other entities are non germ cell tumors of the testis, testicular manifestation of lymphomas or metastases. International and interdisciplinary co-operation has led to the development of urological guidelines and to good therapeutic success for testicular neoplasms. The gold standard for treatment of a testicular neoplasm is the radical orchiectomy. However, for individual cases with suspected lymphoma, a treatment decision differing from the guidelines may be reasonable. We present the case of a 38-year-old man with testicular manifestation of a transformed mycosis fungoides, which is the most common form of cutaneous T-cell lymphoma

Antioxidant Supplementation on Male Fertility—A Systematic Review

Our aim was to review the current literature regarding the effect of antioxidant supplementation (AS) on male fertility parameters, as AS is commonly used to treat male infertility due to the availability and affordability of antioxidants in many parts of the world. Materials and methods: PubMed, Medline, and Cochrane electronic bibliographies were searched using the modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate studies on the benefit of antioxidant therapy on infertile men. Results were analyzed regarding the following aspects: (a) ingredient and dose; (b) potential mechanism of action and rationale for use; and (c) effect on various reported outcomes. Results: Thus, 29 studies found a substantial positive effect of AS on outcomes of assisted reproductive therapy (ART), WHO semen parameters, and live-birth rate. Carnitines, Vitamin E and C, N-acetyl cysteine, coenzyme Q10, selenium, zinc, folic acid, and lycopene were beneficial ingredients. Nevertheless, some studies did not show a substantial change in one or more factors. Conclusion: AS seems to have a positive effect on male fertility. Environmental factors may play an increasing role in fertility. Further studies are needed to determine the optimal AS combination and the influence of environmental factors

Utilization of surgical safety checklists by urological surgeons in Germany : a nationwide prospective survey

Objectives: We aimed to investigate the contemporary usage rate and habits of the WHO Surgical Safety Checklist (SSC) in German urological departments. Methods: We designed a 26-item questionnaire that was sent to all urological departments in Germany. The primary aim of this study was to evaluate the usage rate of the SSC. Secondary aims were to compare perioperative characteristics of users vs. non-users of the SSC and to assess circumstances of the SSC application. Results: A total of 213 of 234 (91 %) urological departments were users of the SSC, and 21 (9 %) were non-users. SSC users had more often a standard protocol, took less time and had fewer people involved for checking perioperative patient data compared to non-users. Financial budgeting for the SSC existed in 55 (24 %) departments and for patient safety in 73 (32 %) departments. Conclusions: The usage rate of the SSC in urological departments in Germany is high despite restricted financial budgeting. Users of the SSC profit by saving time and manpower for checking perioperative patient data

Robotic Prostatectomy on the Web: A Cross-Sectional Qualitative Assessment

Many patients diagnosed with prostate cancer search for information on robotic prostatectomy on the Web. We evaluated the quality, popularity, accessibility, reliability, and readability of 43 robotic prostatectomy Web sites. Results showed medium to high ratings in all domains of quality and poor readability of Web sites. Physicians should guide their prostate cancer patients to Web sites with high-quality and adequate readability. Background: Many patients diagnosed with prostate cancer search for information on robotic prostatectomy (RobP) on the Web. We aimed to evaluate the qualitative characteristics of the mostly frequented Web sites on RobP with a particular emphasis on provider-dependent issues. Materials and Methods: Google was searched for the term "robotic prostatectomy" in Europe and North America. The mostly frequented Web sites were selected and classified as physician-provided and publically-provided. Quality was measured using Journal of the American Medical Association (JAMA) benchmark criteria, DISCERN score, and addressing of Trifecta surgical outcomes. Popularity was analyzed using Google PageRank and Alexa tool. Accessibility, usability, and reliability were investigated using the LIDA tool and readability was assessed using readability indices. Results: Twenty-eight Web sites were physician-provided and 15 publically-provided. For all Web sites, 88% of JAMA benchmark criteria were fulfilled, DISCERN quality score was high, and 81% of Trifecta outcome measurements were addressed. Popularity was average according to Google PageRank (mean 2.9 +/- 1.5) and Alexa Traffic Rank (median, 49,109; minimum, 7; maximum, 8,582,295). Accessibility (85 +/- 7%), usability (92 +/- 3%), and reliability scores (88 +/- 8%) were moderate to high. Automated Readability Index was 7.2 +/- 2.1 and Flesch-Kincaid Grade Level was 9 +/- 2, rating the Web sites as difficult to read. Physician-provided Web sites had higher quality scores and lower readability compared with publically-provided Web sites. Conclusion: Websites providing information on RobP obtained medium to high ratings in all domains of quality in the current assessment. In contrast, readability needs to be significantly improved so that this content can become available for the populace. (C) 2015 Elsevier Inc. All rights reserved

New Media for Educating Urology Residents: An Interview Study in Canada and Germany

OBJECTIVE: To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. DESIGN: We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. SETTING: The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. PARTICIPANTS: The survey included 58 urology residents from Canada and 170 from Germany. RESULTS: A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p < 0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p < 0.001), apps (p < 0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p < 0.001). CONCLUSIONS: New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency. ((C) 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.