Outcomes of lateral approach in robot-assisted radical prostatectomy: insights from a single-surgeon experience

In the era of robotic prostate surgery, various techniques have been developed to improve functional outcomes. Urinary continence has shown satisfactory results, but the preservation of lateral nerves to the periprostatic capsule is only achievable by sparing the pubovesical complex. This study aims to present the first cases of lateral-approach robot-assisted radical prostatectomy (LRRP) performed by a novice surgeon. We conducted a retrospective analysis of 70 prostate cancer patients who underwent LRRP between October 2019 and September 2021, analyzing the perioperative and functional outcomes. The median operative time and intraoperative blood loss were 102 (92–108) minutes and 150 (130–180) mL, respectively. Five minor postoperative complications were reported, and the median hospital stay was 2 (1–2) days. Eleven positive surgical margins occurred. Potency and urinary continence recovery were achieved in 59 (84%) and 66 (94%) patients, respectively, 12 months after surgery. Our analysis shows that LRRP is a safe and effective procedure for prostate cancer surgery. Continence and potency recovery required a short learning curve, with an acceptable recovery rate even in the initial cases

The distribution of deep-sea sponge aggregations (Porifera) in relation to oceanographic processes in the Faroe-Shetland Channel.

Deep-sea sponge aggregations have been identified as potential Vulnerable Marine Ecosystems under United Nations General Assembly Resolution 61/105. Understanding the distribution of these habitats is critical to future spatial management efforts, and central to this understanding are quantitative data on the environmental drivers of that distribution. Accumulations of large suspension feeders are hypothesised to aggregate in regions of internal wave formation. The causal link is thought to be an increase in the supply of food related to the incidence of internal waves, which results in resuspension of particulate organic matter on which the sponges feed. There is, however, almost no empirical evidence to support this hypothesis for deep-sea sponge aggregations, although there is strong circumstantial evidence. We tested the relationship between sponge density and 1) temperature range (as a measure of internal wave presence in this region), and 2) optical backscatter (a measure of particulate flux) for a known sponge aggregation in the Faroe-Shetland Channel where internal wave interaction with the slope is further well-documented. 25 benthic video transects, ranging from 422 to 979 m water depth were conducted in the study region. 225 images were analysed and all taxa identified to morphotypes and quantified. Temperature and optical backscatter data were drawn from archived CTD data, and data from long term (4 months) and 2 seasonal short term (11 days) mooring deployments from the region. A generalised linear model was used to test the relationship between sponge density and temperature range (ΔT), and sponge density and optical backscatter. The results showed a statistically significant positive relationship between sponge density and temperature range, with the highest sponge densities occurring at depths of greatest temperature range. They showed a statistically significant positive relationship between sponge density and optical backscatter for long term and one short term seasonal deployment (Sep–Oct), but a weak negative relationship for the other short term mooring deployment (April-May). We conclude that sponge aggregations in the Faroe-Shetland Channel are associated with slope regions that are subjected to abrupt and pronounced changes in temperature due to intensified internal wave activity over the slope between depths of 400–600 and that lead to intensified near-bed currents and elevated resuspension of particulate. Our data provide empirical evidence of the relationship between internal wave processes and deep-sea sponge aggregations. These data modify current theory on drivers of deep sea sponge aggregation distribution, suggesting aggregations also occur directly within regions of internal wave breaking, rather than simply proximal to these regions

Marine plastics threaten giant Atlantic Marine Protected Areas.

There has been a recent shift in global perception of plastics in the environment, resulting in a call for greater action. Science and the popular media have highlighted plastic as an increasing stressor [1,2]. Efforts have been made to confer protected status to some remote locations, forming some of the world's largest Marine Protected Areas, including several UK overseas territories. We assessed plastic at these remote Atlantic Marine Protected Areas, surveying the shore, sea surface, water column and seabed, and found drastic changes from 2013-2018. Working from the RRS James Clark Ross at Ascension, St. Helena, Tristan da Cunha, Gough and the Falkland Islands (Figure 1A), we showed that marine debris on beaches has increased more than 10 fold in the past decade. Sea surface plastics have also increased, with in-water plastics occurring at densities of 0.1 items m-3; plastics on seabeds were observed at ≤ 0.01 items m-2. For the first time, beach densities of plastics at remote South Atlantic sites approached those at industrialised North Atlantic sites. This increase even occurs hundreds of meters down on seamounts. We also investigated plastic incidence in 2,243 animals (comprising 26 species) across remote South Atlantic oceanic food webs, ranging from plankton to seabirds. We found that plastics had been ingested by primary consumers (zooplankton) to top predators (seabirds) at high rates. These findings suggest that MPA status will not mitigate the threat of plastic proliferation to this rich, unique and threatened biodiversity

Recovery and restoration potential of cold‐water corals: experience from a deep‐sea marine protected area

Cold-water corals (CWCs) are important species that provide habitat for other taxa but are sensitive to mechanical damage from bottom trawling. CWC conservation has been implemented in the form of marine protected areas (MPAs), but recovery from impact may be particularly slow in the deep-sea environment; consequently, the use of restoration techniques has been considered. To gain some insight into CWC recruitment and growth, in 2011 we deployed small seabed moorings in the Darwin Mounds MPA (~1,000 m water depth). This site hosts hundreds of CWC mounds, that had previously (until 2003) been impacted by deep-water trawling. In 2019, we carried out in situ visual surveys of these moorings and the surrounding seabed environment, then recovered two of the moorings. The mooring buoys, glass floats with plastic covers, were extensively colonized by a diverse epifauna that included the CWCs Desmophyllum pertusum and D. dianthus. The presence of coral recruits indicated that environmental conditions, and larval supply, remained favorable for the settlement and growth of CWCs within the MPA. Based on our observations, we consider four possible restoration methods, together with a “do-nothing” option, for the Darwin Mounds CWCs that have shown little, if any, natural recovery despite 16 years of protection. We conclude that seabed emplacement of high-relief artificial substrata is likely to be the most efficient and cost-efficient means of promoting enhanced recovery of the CWCs

Recovery and restoration potential of cold‐water corals: experience from a deep‐sea marine protected area

Cold-water corals (CWCs) are important species that provide habitat for other taxa but are sensitive to mechanical damage from bottom trawling. CWC conservation has been implemented in the form of marine protected areas (MPAs), but recovery from impact may be particularly slow in the deep-sea environment; consequently, the use of restoration techniques has been considered. To gain some insight into CWC recruitment and growth, in 2011 we deployed small seabed moorings in the Darwin Mounds MPA (~1,000 m water depth). This site hosts hundreds of CWC mounds, that had previously (until 2003) been impacted by deep-water trawling. In 2019, we carried out in situ visual surveys of these moorings and the surrounding seabed environment, then recovered two of the moorings. The mooring buoys, glass floats with plastic covers, were extensively colonized by a diverse epifauna that included the CWCs Desmophyllum pertusum and D. dianthus. The presence of coral recruits indicated that environmental conditions, and larval supply, remained favorable for the settlement and growth of CWCs within the MPA. Based on our observations, we consider four possible restoration methods, together with a “do-nothing” option, for the Darwin Mounds CWCs that have shown little, if any, natural recovery despite 16 years of protection. We conclude that seabed emplacement of high-relief artificial substrata is likely to be the most efficient and cost-efficient means of promoting enhanced recovery of the CWCs

Definition of a Structured Training Curriculum for Robot-assisted Radical Cystectomy with Intracorporeal Ileal Conduit in Male Patients: A Delphi Consensus Study Led by the ERUS Educational Board

Robot-assisted radical cystectomy (RARC) continues to expand, and several surgeons start training for this complex procedure. This calls for the development of a structured training program, with the aim to improve patient safety during RARC learning curve. A modified Delphi consensus process was started to develop the curriculum structure. An online survey based on the available evidence was delivered to a panel of 28 experts in the field of RARC, selected according to surgical and research experience, and expertise in running training courses. Consensus was defined as ≥80% agreement between the responders. Overall, 96.4% experts completed the survey. The structure of the RARC curriculum was defined as follows: (1) theoretical training; (2) preclinical simulation-based training: 5-d simulation-based activity, using models with increasing complexity (ie, virtual reality, and dry- and wet-laboratory exercises), and nontechnical skills training session; (3) clinical training: modular console activity of at least 6 mo at the host center (a RARC case was divided into 11 steps and steps of similar complexity were grouped into five modules); and (4) final evaluation: blind review of a video-recorded RARC case. This structured training pathway will guide a starting surgeon from the first steps of RARC toward independent completion of a full procedure. Clinical implementation is urgently needed

Report on the Marine Imaging Workshop 2017

Marine optical imaging has become a major assessment tool in science, policy and public understanding of our seas and oceans. Methodology in this field is developing rapidly, including hardware, software and the ways of their application. The aim of the Marine Imaging Workshop (MIW) is to bring together academics, research scientists and engineers, as well as industrial partners to discuss these developments, along with applications, challenges and future directions. The first MIW was held in Southampton, UK in April 2014. The second MIW, held in Kiel, Germany, in 2017 involved more than 100 attendees, who shared the latest developments in marine imaging through a combination of traditional oral and poster presentations, interactive sessions and focused discussion sessions. This article summarises the topics addressed during the workshop, particularly the outcomes of these discussion sessions for future reference and to make the workshop results available to the open public

A framework for the development of a global standardised marine taxon reference image database (SMarTaR-ID) to support image-based analyses

Video and image data are regularly used in the field of benthic ecology to document biodiversity. However, their use is subject to a number of challenges, principally the identification of taxa within the images without associated physical specimens. The challenge of applying traditional taxonomic keys to the identification of fauna from images has led to the development of personal, group, or institution level reference image catalogues of operational taxonomic units (OTUs) or morphospecies. Lack of standardisation among these reference catalogues has led to problems with observer bias and the inability to combine datasets across studies. In addition, lack of a common reference standard is stifling efforts in the application of artificial intelligence to taxon identification. Using the North Atlantic deep sea as a case study, we propose a database structure to facilitate standardisation of morphospecies image catalogues between research groups and support future use in multiple front-end applications. We also propose a framework for coordination of international efforts to develop reference guides for the identification of marine species from images. The proposed structure maps to the Darwin Core standard to allow integration with existing databases. We suggest a management framework where high-level taxonomic groups are curated by a regional team, consisting of both end users and taxonomic experts. We identify a mechanism by which overall quality of data within a common reference guide could be raised over the next decade. Finally, we discuss the role of a common reference standard in advancing marine ecology and supporting sustainable use of this ecosystem

Active and Passive Immunization Protects against Lethal, Extreme Drug Resistant-Acinetobacter baumannii Infection

Extreme-drug-resistant (XDR) Acinetobacter baumannii is a rapidly emerging pathogen causing infections with unacceptably high mortality rates due to inadequate available treatment. New methods to prevent and treat such infections are a critical unmet medical need. To conduct a rational vaccine discovery program, OmpA was identified as the primary target of humoral immune response after intravenous infection by A. baumannii in mice. OmpA was >99% conserved at the amino acid level across clinical isolates harvested between 1951 and 2009 from cerebrospinal fluid, blood, lung, and wound infections, including carbapenem-resistant isolates, and was ≥89% conserved among other sequenced strains, but had minimal homology to the human proteome. Vaccination of diabetic mice with recombinant OmpA (rOmpA) with aluminum hydroxide adjuvant markedly improved survival and reduced tissue bacterial burden in mice infected intravenously. Vaccination induced high titers of anti-OmpA antibodies, the levels of which correlated with survival in mice. Passive transfer with immune sera recapitulated protection. Immune sera did not enhance complement-mediated killing but did enhance opsonophagocytic killing of A. baumannii. These results define active and passive immunization strategies to prevent and treat highly lethal, XDR A. baumannii infections

Identification of a General O-linked Protein Glycosylation System in Acinetobacter baumannii and Its Role in Virulence and Biofilm Formation

Acinetobacter baumannii is an emerging cause of nosocomial infections. The isolation of strains resistant to multiple antibiotics is increasing at alarming rates. Although A. baumannii is considered as one of the more threatening “superbugs” for our healthcare system, little is known about the factors contributing to its pathogenesis. In this work we show that A. baumannii ATCC 17978 possesses an O-glycosylation system responsible for the glycosylation of multiple proteins. 2D-DIGE and mass spectrometry methods identified seven A. baumannii glycoproteins, of yet unknown function. The glycan structure was determined using a combination of MS and NMR techniques and consists of a branched pentasaccharide containing N-acetylgalactosamine, glucose, galactose, N-acetylglucosamine, and a derivative of glucuronic acid. A glycosylation deficient strain was generated by homologous recombination. This strain did not show any growth defects, but exhibited a severely diminished capacity to generate biofilms. Disruption of the glycosylation machinery also resulted in reduced virulence in two infection models, the amoebae Dictyostelium discoideum and the larvae of the insect Galleria mellonella, and reduced in vivo fitness in a mouse model of peritoneal sepsis. Despite A. baumannii genome plasticity, the O-glycosylation machinery appears to be present in all clinical isolates tested as well as in all of the genomes sequenced. This suggests the existence of a strong evolutionary pressure to retain this system. These results together indicate that O-glycosylation in A. baumannii is required for full virulence and therefore represents a novel target for the development of new antibiotics