The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

An Assessment of Heavy Metal Pollution Within a Public Nature Park, Greencastle, IN

Heavy metal contamination has potentially harmful health effects. Thus, it is critical to evaluate the concentrations of these metals within public spaces. In this study, we investigated heavy metal concentrations in soil and sediment samples collected from a public nature park located in Greencastle, IN. Given the close spatial proximity of the park to local anthropogenic activities (i.e. a firearms range, a solid waste yard, a county road, and the county highway department), there is a concern that this public area has elevated heavy metal concentrations that may pose a risk to park visitors. To assess the magnitude of heavy metal contamination in the park, soil and sediment samples (n = 10) were collected along the park’s eastern boundary. This area is transitional between the park and these local anthropogenic activities. To characterize background concentrations of these metals, two additional samples were collected along the far western edge of the park. All samples were sieved to less than 180µm and analyzed for Pb, Zn, As, Cr, and Cu using a Bruker CTX benchtop XRF unit. Concentrations of Zn, As, Cr, and Cu are generally within or near typical background concentrations for soils found in central Indiana (and the U.S.). However, Pb concentrations are slightly elevated, especially near the firearms range. Our preliminary analysis also reveals that the concentrations of these metals generally decrease with increasing distance from these anthropogenic sources. Although the measured concentrations within the park are not considered dangerous by EPA standards, our analyses reveal that these anthropogenic activities are likely contributing harmful metals to their surroundings

Avaliação do risco para o desenvolvimento de lesões perioperatórias decorrentes do posicionamento cirúrgico

Objetivo: Avaliar o risco de desenvolvimento de lesões perioperatórias decorrentes doposicionamento cirúrgico em pacientes submetidos a cirurgias eletivas.Métodos: Trata-se de um estudo analítico e longitudinal realizado com 45 pacientes em umhospital público de média e alta complexidade no estado do Piauí. Foram utilizados para acoleta de dados: instrumento de avaliação perioperatória, Escala Visual Numérica, Escala deBraden e da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes doPosicionamento Cirúrgico (ELPO).Resultados: Participantes com idade ≥46 anos apresentaram maior risco, com 33,4% dehipertensos dentre 35,6% dos que apresentaram comorbidades. A posição mais prevalentecom 64,5% foi a supina, com apenas 2,2% casos de lesão pré-cirúrgica. Em relação ao riscopara lesões por posicionamento, 68,9% apresentaram baixo risco.Conclusão: 31,1% dos participantes foram submetidos a risco elevado para desenvolverlesões por posicionamento, relacionado a idade e comorbidades.Palavras-chave: Enfermagem perioperatória. Posicionamento do paciente. Segurança dopaciente. Medição de risco

Next-generation RNA sequencing of archival formalin-fixed paraffin-embedded urothelial bladder cancer

Molecular profiling of individual cancers is key to personalised medicine. While sequencing technologies have required stringent sample collection and handling, recent technical advances offer sequencing from tissues collected in routine practice and tissues already stored in archives. In this paper, we establish methods for whole-transcriptome RNA sequencing (RNA-seq) from formalin-fixed paraffin-embedded tissues. We obtain average RNA-seq reads of >100 million per sample using the Illumina HiSeq2000 platform. We find high concordance with results from matching fresh frozen samples (>0.8 Spearman correlation). For validation, we compared low- and high-grade bladder cancer transcriptomes in 49 tumour samples after transurethral resection of bladder tumour. We found 947 differentially expressed protein-coding genes. While high-grade lesions exhibited distinct intertumour transcriptome heterogeneity, the transcriptome of low-grade tumours was homogeneous. PATIENT SUMMARY: In this report, we show that it is now possible to use universally available bladder cancer samples that have been fixed in formalin to perform high-quality transcriptome analysis. This ability will facilitate the development of transcriptome-wide tests based on gene expression correlated with clinical outcome