Analysis of element yield, bacterial community structure and the impact of carbon sources for bioleaching rare earth elements from high grade monazite

Rare earth element (REE) recovery from waste streams, mine tailings or recyclable components using bioleaching is gaining traction due to the shortage and security of REE supply as well as the environmental problems that occur from processing and refining. Four heterotrophic microbial species with known phosphate solubilizing capabilities were evaluated for their ability to leach REE from a high-grade monazite when provided with either galactose, fructose or maltose. Supplying fructose resulted in the greatest amount of REE leached from the ore due to the largest amount of organic acid produced. Gluconic acid was the dominant organic acid identified produced by the cultures, followed by acetic acid. The monazite proved difficult to leach with the different carbon sources, with preferential release of Ce over La, Nd and Pr

Endoscopic urethrotomy versus open urethroplasty for men with bulbar urethral stricture : the OPEN randomised trial cost-effectiveness analysis

Funding: Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research, ref: 10/57/23. Acknowledgements: Contributors: Jing Shen, supervised by Luke Vale, led the health economic evaluation and analysis. Robert Pickard led the study, Beatriz Goulao supervised by Graeme MacLennan performed the statistical analysis, Sonya Carnell and Rebecca Forbes supported by Stephanie Currer and supervised by Jennifer Wilkinson managed the trial. John Norrie contributed to the funding application and statistical analysis plan. He also provided support to the statistical analysis team. Matt Breckons, supervised by Jing Shen, conducted a time trade off experiment reported separately. Paul Whybrow, supervised by Tim Rapley, carried out the qualitative research reported separately. Mark Forrest managed and maintained the trial database. Elaine McColl contributed to the funding application and protocol. Daniela Andrich, Anthony Mundy, James N’Dow and Stephen Payne provided clinician support to the funding application, acted as PIs at key sites. Stewart Barclay contributed a patient view to the trial, including the funding application, the protocol, and all aspects of the analysis. Jonathan Cook was involved in the design of the study and Nick Watkin co-wrote the funding application, contributed clinical insight to the trial management group. We thank the patients and health-care professionals for their participation in the study; Stewart Barclay, the patient and service user representative in the OPEN Trial Management Group; the Trial Steering committee members: Roger Kockelburg (chairperson), John Matthews, Alan McNeil, Howard Kynaston and Neil Campling; Data Monitoring Committee members: Gordon Murray (chairperson), Richard Martin and Thomas Pinkney. We also thank the following people who worked on the trial: Matthew Jackson, Research Fellow; Gladys McPherson, Data Manager; Lee Munro, Trial Manager; Rachel Stephenson, Trial Manager; Sue Tremble, Trial Manager; Robbie Brown, Trial Manager; Mark Deverill, Health Economist; Amy Collins, Project Secretary; Lavinia Miceli, Project Secretary; and Ann Payne, Project Secretary. Members of the Open Trial Group responsible for recruitment and who acted as principle investigators for their centres were: Trevor Dorkin, Freeman Hospital, Newcastle; Nick Watkin, St George’s Hospital, London; Anthony Mundy, University College London Hospitals NHS Foundation Trust, London; Paul Anderson, Russells Hall Hospital, Dudley; Suzie Venn, Queen Alexandra Hospital, Portsmouth; Ian Eardley, St James’s University Hospital, Leeds; Mr David Dickerson, Weston General Hospital, Westonsuper-Mare; Nikesh Thiruchelvam, Addenbrooke’s Hospital, Cambridge; Richard Inman and Chris Chapple, Royal Hallamshire Hospital, Sheeld; Andrew Baird, Aintree University Hospital NHS Foundation Trust, Liverpool; Andrew Sinclair, Stepping Hill Hospital, Stockport; Rajeshwar Krishnanm, Kent and Canterbury Hospital, Canterbury; Rowland Rees, University Hospital Southampton NHS Foundation Trust, Southampton; James N’dow, Aberdeen Royal Inrmary, Aberdeen; Bruce Montgomery, Frimley Park Hospital, Camberley; Michael Swinn, East Surrey Hospital, Redhill; Alastair Henderson and John Donohue, Maidstone Hospital, Maidstone; Suzie Venn, St Richard’s Hospital, Chichester; Robert Mason, Torbay Hospital, Torquay; Sanjeev Madaan, Darent Valley Hospital, Kent; Mustafa Hilmy, York Hospital, York; Vivienne Kirchin, Sunderland Royal Inrmary, Sunderland; Kim Davenport, Cheltenham General Hospital, Cheltenham; John McGrath, Exeter Hospital, Exeter; Tim Porter, Yeovil District Hospital, Yeovil; Ruaraidh MacDonagh and Amerdip Birring, Musgrove Park Hospital, Taunton; Ramachandran Ravi, Basildon University Hospital; Jawad Husain, Royal Albert Edward Inrmary, Wigan; Maj Shabbir, Guy’s Hospital, London; Omer Baldo, Airedale General Hospital, Keighley; Sadhanshu Chitale, Whittington Hospital, London; Mary Garthwaite, James Cook University Hospital, Middlesbrough; Shalom Srirangam, Royal Blackburn Hospital, Blackburn; Liaqat Chowoo, Bedford Hospital, Bedford; Tina Rashid, Charing Cross Hospital, London; Rob Skyrme; Jon Featherstone, Princess of Wales Hospital, Bridgend; Ammar Alhasso, Edinburgh; and Oleg Tatarov, Cardiff. We thank the following trusts for offering participant identication centre support: Basingstoke and Northamptonshire NHS Foundation Trust; Royal Liverpool and Broadgreen University Hospitals NHS Trust; Chelsea and Westminster NHS Foundation Trust; and Wirral University Teaching Hospital NHS Foundation Trust. We thank the following Trusts for offering PIC support: Basingstoke and Northamptonshire NHS Foundation Trust; Royal Liverpool and Broadgreen University Hospitals NHS Trust; Chelsea and Westminster NHS Foundation Trust; Wirral University Teaching Hospitals NHS Foundation Trust.Peer reviewedPublisher PDFPublisher PD

Open urethroplasty versus endoscopic urethrotomy - clarifying the management of men with recurrent urethral stricture (the OPEN trial) : study protocol for a randomised controlled trial

Peer reviewedPublisher PD

Surgical Treatment for Recurrent Bulbar Urethral Stricture: A Randomised Open-label Superiority Trial of Open Urethroplasty Versus Endoscopic Urethrotomy (the OPEN Trial)

BackgroundUrethral stricture affects 0.9% of men. Initial treatment is urethrotomy. Approximately, half of the strictures recur within 4 yr. Options for further treatment are repeat urethrotomy or open urethroplasty.ObjectiveTo compare the effectiveness and cost-effectiveness of urethrotomy with open urethroplasty in adult men with recurrent bulbar urethral stricture.Design, setting, and participantsThis was an open label, two-arm, patient-randomised controlled trial. UK National Health Service hospitals were recruited and 222 men were randomised to receive urethroplasty or urethrotomy.InterventionUrethrotomy is a minimally invasive technique whereby the narrowed area is progressively widened by cutting the scar tissue with a steel blade mounted on a urethroscope. Urethroplasty is a more invasive surgery to reconstruct the narrowed area.Outcome measurements and statistical analysisThe primary outcome was the profile over 24 mo of a patient-reported outcome measure, the voiding symptom score. The main clinical outcome was time until reintervention.Results and limitationsThe primary analysis included 69 (63%) and 90 (81%) of those allocated to urethroplasty and urethrotomy, respectively. The mean difference between the urethroplasty and urethrotomy groups was –0.36 (95% confidence interval [CI] –1.74 to 1.02). Fifteen men allocated to urethroplasty needed a reintervention compared with 29 allocated to urethrotomy (hazard ratio [95% CI] 0.52 [0.31–0.89]).ConclusionsIn men with recurrent bulbar urethral stricture, both urethroplasty and urethrotomy improved voiding symptoms. The benefit lasted longer for urethroplasty.Patient summaryThere was uncertainty about the best treatment for men with recurrent bulbar urethral stricture. We randomised men to receive one of the following two treatment options: urethrotomy and urethroplasty. At the end of the study, both treatments resulted in similar and better symptom scores. However, the urethroplasty group had fewer reinterventions

Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines

Background: Making healthcare treatment decisions is a complex process involving a broad stakeholder base including patients, their families, health professionals, clinical practice guideline developers and funders of healthcare. Methods: This paper presents a review of a methodology for the development of urological cancer care pathways (UCAN care pathways), which reflects an appreciation of this broad stakeholder base. The methods section includes an overview of the steps in the development of the UCAN care pathways and engagement with clinical content experts and patient groups. Results: The development process is outlined, the uses of the urological cancer care pathways discussed and the implications for clinical practice highlighted. The full set of UCAN care pathways is published in this paper. These include care pathways on localised prostate cancer, locally advanced prostate cancer, metastatic prostate cancer, hormone-resistant prostate cancer, localised renal cell cancer, advanced renal cell cancer, testicular cancer, penile cancer, muscle invasive and metastatic bladder cancer and non-muscle invasive bladder cancer. Conclusion: The process provides a useful framework for improving urological cancer care through evidence synthesis, research prioritisation, stakeholder involvement and international collaboration. Although the focus of this work is urological cancers, the methodology can be applied to all aspects of urology and is transferable to other clinical specialties.11 page(s

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Nicorandil-induced penile ulcerations: A case series

OBJECTIVE To report on the largest series to date of ulceration of the external genitalia, related to treatment with nicorandil - a vasodilator for the prevention and long-term treatment of angina - and to review the literature on the subject, focusing on the clinical features and the pathogenesis of this rare, yet marked, side-effect. PATIENTS AND METHODS Three patients (aged 71-83 years) were referred for severe ulceration of the penis. A complete work-up was performed to exclude potential underlying causes, including malignancy and sexually transmitted diseases. After a careful review of the patients' medical history, a potentially causal relationship was noted; all patients had been taking nicorandil for at least 2 years before the development of penile ulceration. RESULTS Penile ulcers associated with nicorandil are characteristically large, deep, painful and have punched-out edges. They usually involve the prepuce or the penile shaft skin. Higher doses of nicorandil (at least 40 mg daily) and surgical procedures seem to increase the risk for nicorandil-related ulceration. Response to topical steroids is poor, but complete healing is achieved by discontinuation of nicorandil, while surgical treatment should be discouraged. CONCLUSION The growing body of literature showing the link between treatment with nicorandil and ulceration at multiple sites has led to the recognition of this side-effect by the World Health Organization. Nicorandil-related ulcers rarely involve the penile skin and constitute a diagnostic and therapeutic challenge. The pathogenesis of this rare side-effect is largely unknown, but mechanisms such as the 'vascular steal phenomenon' and the direct toxic effect of the drug or its metabolites have been implicated. © 2010 BJU INTERNATIONAL.Link_to_subscribed_fulltex

The prognostic value of Ki-67 expression in penile squamous cell carcinoma

Aims: To determine whether Ki-67 immunoexpression in penile squamous cell carcinoma (PSCC) has a prognostic value and correlates with lymph node metastasis, human papillomavirus (HPV) infection and patient survival. Methods: 148 formalin-fixed paraffin-embedded PSCC samples were tissue-microarrayed, including 97 usual-type SCCs, 17 basaloid, 15 pure verrucous carcinomas, 2 warty and 17 mixed-type tumours. All samples were immunostained for Ki-67 protein. HPV DNA was detected with INNO-LiPA assay. Follow-up data were available for 134 patients. Results: Ki-67 was strongly expressed in 57/148 (38.5%) of PSCCs. Different cancer subtypes showed significant difference in Ki-67 expression (p < 0.0001) with highest positivity in basaloid, 16/17 (94%), followed by usual type, 38/97 (39%) and lack of Ki-67 positive cases within verrucous tumours, 0/15. Ki-67 positively correlated with high-risk HPV (p < 0.0001) and showed good specificity (84%) but low sensitivity (61%) for high-risk HPV detection. Ki-67 protein strongly positively correlated with tumour grade (p < 0.0001) but not with stage (p=0.2193), or lymph node status (p=0.7366). Ki-67 showed no prognostic value for cancer-specific survival (HR=1.00, 95%, CI 0.99 to 1.02, p=0.54) or overall survival (HR=1.00, 95%, CI 0.99 to 1.02, p=0.45). High tumour stage, lymph node metastasis, high tumour grade and age at diagnosis were all independent prognostic factors for cancer-specific survival and overall survival. Conclusions: Ki-67 is only a moderate surrogate marker for HPV infection in PSCC. It does not show prognostic value for cancer-specific survival and overall survival in PSCC.Link_to_subscribed_fulltex

Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: A prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution

Background: Dynamic sentinel node biopsy (DSNB) in combination with ultrasound scan (USS) has been the technique of choice at our centre since 2004 for the assessment of nonpalpable inguinal lymph nodes (cN0) in patients with squamous cell carcinoma of the penis (SCCp). Sensitivity and false-negative rates may vary depending on whether results are reported per patient or per node basin, and with or without USS. Objective: To determine the long-term outcome of patients undergoing DSNB and USS-guided fine-needle aspiration cytology (FNAC) in our cohort of newly diagnosed cN0 SCCp patients, as well as to analyse any variation in sensitivity of the procedure. Design, setting, and participants: A series of consecutive patients with newly diagnosed SCCp, over a 6-yr period (2004-2010), were analysed prospectively with a minimum follow-up period of 21 mo. All patients had definitive histology of â¥T1G2 and nonpalpable nodes in one or both inguinal basins. Patients with persistent or untreated local disease were excluded from the study. Intervention: All eligible patients had DSNB and USS with or without FNAC of cN0 groins. Outcome measurements and statistical analysis: The primary end point was no nodal disease recurrence on follow-up. The secondary end point was complications after DSNB. Sensitivity of the procedure was calculated per node basin, per patient, with DSNB alone, and with USS with DSNB combined. Results and limitations: Five hundred inguinal basins in 264 patients underwent USS with or without FNAC and DSNB. Seventy-three positive inguinal basins (14.6%) in 59 patients (22.3%) were identified. Four inguinal basins in four patients were confirmed false negative at 5, 8, 12, and 18 mo. Two inguinal basins had positive USS and FNAC and negative DSNB results. Sensitivity of DSNB with USS, with and without FNAC, per inguinal basin was 95% and per patient was 94%. Sensitivity of DSNB alone per inguinal basin and per patient was 92% and 91%, respectively. The DSNB morbidity rate was 7.6%. Conclusions: DSNB in combination with USS has excellent performance characteristics to stage patients with cN0 SCCp, with a 5% false-negative rate per node basin and a 6% false-negative rate per patient. © 2012 European Association of Urology.Link_to_subscribed_fulltex