Testicular cancer: diagnostic and surgical strategies to improve outcome

Testicular cancer is a rare malignancy, however the most common malignancy in young men. Today, due to new chemotherapy schedules and improved surgical techniques, 90% of these patients can be cured. Is further improvement in diagnostic and treatment of testicular cancer possible? Patient and doctor delay are associated with more advanced disease requiring a more intensive treatment. The most important cause for patient delay is patient's embarrassment and doctor's delay ‘not suspecting a malignant tumor’. There is a need for continuous public and medical education to prevent delay in the diagnosis of testicular cancer. With the use of new computer techniques, reliable volumetric measurement of metastases in the abdomen can be performed, before and after chemotherapy, by non-radiologists. Volumetric measurement is as reliable as the standard radiological measurement by radiologists for determining response after chemotherapy treatment. Automatic and semiautomatic segmentation tools will play an important, cost-effective role in the evaluation of tumor response in cancer treatment in the near future. If residual tumor is still present in the abdomen after chemotherapy treatment, the tumor can be removed by laparoscopy in about half of these patients. In the remaining patients a standard laparotomy is necessary, but sometimes a posterior retroperitoneoscopy can be considered. The study showed that laparoscopic removal of residual testicular metastases in the abdomen after chemotherapy is oncological safe, results in a postoperative hospital stay of only one day, in contrast to the five days after a standard laparotomy, and is accompanied by a very nice cosmetic result; only three small scars instead of a big midline laparotomy scar

The Effect of Remote Collaborative Work on Design Processes During the Pandemic

At the beginning of 2020, the virus called "COVID-19" spread rapidly all over the world. One of the measures taken to prevent the spread of the virus was social distance rules. Hence, employees and students had to work remotely using communication tools. In the design field, professionals and students working remotely during the pandemic, were limited to the possibilities of the communication tools they used while developing the design process, and they found ways to use these facilities in line with their practice routines in the physical environment. In this article, the tools used during the collaborative design processes conducted remotely during the pandemic were examined with a questionnaire study. Even though designers worked digitally due to the necessity to continue their work in this period, it was observed that they had positive experiences with the special tools they used. However, the transfer of tacit knowledge to design projects in the collaborative design process has been restricted in the collaborative design process due to limited spatial communication. While many designers were discovering the tailored tools for this purpose they could already use, many improvements were suggested through the unaware needs became explicit ones

Biomethane Production as an Alternative Bioenergy Source from Codigesters Treating Municipal Sludge and Organic Fraction of Municipal Solid Wastes

Energy recovery potential of a mesophilic co-digester treating OFMSW and primary sludge at an integrated biomethanization plant was investigated based on feasibility study results. Since landfilling is still the main solid waste disposal method in Turkey, land scarcity will become one of the most important obstacles. Restrictions for biodegradable waste disposal to sanitary landfills in EU Landfill Directive and uncontrolled long-term contamination with gas emissions and leachate necessitate alternative management strategies due to rapid increase in MSW production. Moreover, since energy contribution from renewable resources will be required more in the future with increasing oil prices and dwindling supplies of conventional energy sources, the significance of biogas as a renewable fuel has been increased in the last decade. Results indicated that almost 93% of annual total cost can be recovered if 100% renewable energy subsidy is implemented. Besides, considering the potential revenue when replacing transport fuels, about 26 heavy good vehicles or 549 cars may be powered per year by the biogas produced from the proposed biomethanization plant (PE = 100,000; XPS = 61 g TS/PE·day; XSS-OFMSW = 50 g TS/PE·day)

Laparoscopic Resection of Residual Retroperitoneal Tumor Mass in Advanced Nonseminomatous Testicular Germ Cell Tumors; a Feasible and Safe Oncological Procedure

Ten-year oncological experience of the University Medical Center Groningen with conventional laparotomy (C-RRRTM) and laparoscopy (L-RRRTM) is described concerning resection of residual retroperitoneal tumor masses (RRTM) in a large series of patients with advanced nonseminomatous testicular germ cell tumors (NSTGCT). 150 consecutive patients with disseminated NSTGCT required adjunctive surgery after combination chemotherapy. L-RRRTM was scheduled in 89 and C-RRRTM in 61 patients. Median residual tumor diameter was 20 mm in the L-RRRTM versus 42 mm in the C-RRRTM group (p <0.001). Conversion rate was 15% in the L-RRRTM group. Perioperative complications occurred in 5 patients (6%) in the L-RRRTM and 7 (12%, NS) in the C-RRRTM group. Median duration of L-RRRTM was 156 minutes vs. 221 minutes for C-RRRTM (p <0.001). 17/89 patients in the L-RRRTM group had postoperative complications versus 18/61 patients in the C-RRRTM group (NS). Median postoperative stay in the L-RRRTM group was 2 vs. 6 days in the C-RRRTM group (p <0.001). During a median follow-up of 79 months, 27 patients had recurrences: 8 (9%) in the L-RRRTM group and 19 (31%) in the C-RRRTM group (p <0.001). Laparoscopic resection of RRTM for advanced NSTGCT is feasible and an oncologically safe option in appropriately selected patients

Artificial intelligence assisted patient blood and urine droplet pattern analysis for non‑invasive and accurate diagnosis of bladder cancer

Bladder cancer is one of the most common cancer types in the urinary system. Yet, current bladder cancer diagnosis and follow-up techniques are time-consuming, expensive, and invasive. In the clinical practice, the gold standard for diagnosis remains invasive biopsy followed by histopathological analysis. In recent years, costly diagnostic tests involving the use of bladder cancer biomarkers have been developed, however these tests have high false-positive and false-negative rates limiting their reliability. Hence, there is an urgent need for the development of cost-effective, and non-invasive novel diagnosis methods. To address this gap, here we propose a quick, cheap, and reliable diagnostic method. Our approach relies on an artificial intelligence (AI) model to analyze droplet patterns of blood and urine samples obtained from patients and comparing them to cancer-free control subjects.The AI-assisted model in this study uses a deep neural network, a ResNet network, pre-trained on ImageNet datasets. Recognition and classification of complex patterns formed by dried urine or blood droplets under different conditions resulted in cancer diagnosis with a high specificity and sensitivity.Our approach can be systematically applied across droplets, enabling comparisons to reveal shared spatial behaviors and underlying morphological patterns. Our results support the fact that AI-based models have a great potential for non-invasive and accurate diagnosis of malignancies, including bladder cancer

Assessment of Volumetric versus Manual Measurement in Disseminated Testicular Cancer; No Difference in Assessment between Non-Radiologists and Genitourinary Radiologist

The aim of this study was to assess the feasibility and reproducibility of semi-automatic volumetric measurement of retroperitoneal lymph node metastases in testicular cancer (TC) patients treated with chemotherapy versus the standardized manual measurements based on RECIST criteria.21 TC patients with retroperitoneal lymph node metastases of testicular cancer were studied with a CT scan of chest and abdomen before and after cisplatin based chemotherapy. Three readers, a surgical resident, a radiological technician and a radiologist, assessed tumor response independently using computerized volumetric analysis with Vitrea software® and manual measurement according to RECIST criteria (version 1.1). Intra- and inter-rater variability were evaluated with intra class correlations and Bland-Altman analysis.Assessment of intra observer and inter observer variance proved non-significant in both measurement modalities. In particularly all intraclass correlation (ICC) values for the volumetric analysis were > .99 per observer and between observers. There was minimal bias in agreement for manual as well as volumetric analysis.In this study volumetric measurement using Vitrea software® appears to be a reliable, reproducible method to measure initial tumor volume of retroperitoneal lymph node metastases of testicular cancer after chemotherapy. Both measurement methods can be performed by experienced non-radiologists as well

Open-face tunnelling effects on non-displacement piles in clay ii) Tunnelling beneath loaded piles and analytical modelling

Results from centrifuge modelling of tunnelling beneath loaded non-displacement piles in clay are presented in this paper; the principal variables were soil strength, pile loading and pile position relative to the tunnel. The details of the experimental set-up and the importance of understanding the loading history of the soil and the piles are presented in a companion paper. The subsurface pile–soil interaction was captured through particle image velocimetry; the effects of pile loading and pile position were found to have a significant impact on pile settlements. Analysis of tunnel–pile interaction through t–z load-transfer modelling of the pile–soil interface is presented using the approach described in the companion paper. The mechanisms observed in the centrifuge tests are predicted reasonably well. A significant improvement in the prediction of the induced pile loading and settlements was achieved with the inclusion of plasticity and simple power-law non-linearity for the soil.The first author acknowledges financial support provided by Arup Tunnelling and the Engineering and Physical Sciences Research Council for an Industrial Case Studentship