Oncological cases and complications in Urology.

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of left hydronephrosis referred four years after a right radical mastectomy for lobular breast carcinoma was described. Computed tomography scan revealed a left hydronephrosis with dilated ureter up to the proximal third. An exploratory laparoscopy was performed and the definitive histopathology examination showed a recurrence of the carcinoma with a right tubal metastasis and peritoneal carcinosis. Case 2: A rare case of an extensive penile squamous cell carcinoma in a young man. The patient was treated with radical surgery and modified inguinal lymphadenectomy. No recurrence was noticed so far. Case 3: A rare case of left sided Inferior Vena Cava (IVC) in a patient diagnosed with renal cell cancer who underwent open left partial nephrectomy. Case 4: A case of urethrorrhagia, caused by a recent trauma from an urinary catheter placed in a patient submitted to gastric resection due to a neoplastic pathology. Urethrorrhagia only temporarily responded to conservative treatment and ultimately resolved by coagulation with an endoscopic approach

An integrated open-coastal biogeochemistry, ecosystem and biodiversity observatory of the eastern Mediterranean – the Cretan Sea component of the POSEIDON system

There is a general scarcity of oceanic observations that concurrently examine air–sea interactions, coastal–open-ocean processes and physical–biogeochemical processes, in appropriate spatiotemporal scales and under continuous, long-term data acquisition schemes. In the Mediterranean Sea, the resulting knowledge gaps and observing challenges increase due to its oligotrophic character, especially in the eastern part of the basin. The oligotrophic open Cretan Sea's biogeochemistry is considered to be representative of a greater Mediterranean area up to 106&thinsp;km2, and understanding its features may be useful on even larger oceanic scales, since the Mediterranean Sea has been considered a miniature model of the global ocean. The spatiotemporal coverage of biogeochemical (BGC) observations in the Cretan Sea has progressively increased over the last decades, especially since the creation of the POSEIDON observing system, which has adopted a multiplatform, multivariable approach, supporting BGC data acquisition. The current POSEIDON system's status includes open and coastal sea fixed platforms, a Ferrybox (FB) system and Bio-Argo autonomous floats that remotely deliver fluorescence as a proxy of chlorophyll-a (Chl-a), O2, pH and pCO2 data, as well as BGC-related physical variables. Since 2010, the list has been further expanded to other BGC (nutrients, vertical particulate matter fluxes), ecosystem and biodiversity (from viruses up to zooplankton) variables, thanks to the addition of sediment traps, frequent research vessel (R/V) visits for seawater–plankton sampling and an acoustic Doppler current profiler (ADCP) delivering information on macrozooplankton–micronekton vertical migration (in the epipelagic to mesopelagic layer). Gliders and drifters are the new (currently under integration to the existing system) platforms, supporting BGC monitoring. Land-based facilities, such as data centres, technical support infrastructure, calibration laboratory and mesocosms, support and give added value to the observatory. The data gathered from these platforms are used to improve the quality of the BGC-ecosystem model predictions, which have recently incorporated atmospheric nutrient deposition processes and assimilation of satellite Chl-a data. Besides addressing open scientific questions at regional and international levels, examples of which are presented, the observatory provides user-oriented services to marine policy makers and the society, and is a technological test bed for new and/or cost-efficient BGC sensor technology and marine equipment. It is part of European and international observing programs, playing a key role in regional data handling and participating in harmonization and best practices procedures. Future expansion plans consider the evolving scientific and society priorities, balanced with sustainable management.</p

Evolving and sustaining ocean best practices and standards for the next decade

The oceans play a key role in global issues such as climate change, food security, and human health. Given their vast dimensions and internal complexity, efficient monitoring and predicting of the planet's ocean must be a collaborative effort of both regional and global scale. A first and foremost requirement for such collaborative ocean observing is the need to follow well-defined and reproducible methods across activities: from strategies for structuring observing systems, sensor deployment and usage, and the generation of data and information products, to ethical and governance aspects when executing ocean observing. To meet the urgent, planet-wide challenges we face, methods across all aspects of ocean observing should be broadly adopted by the ocean community and, where appropriate, should evolve into "Ocean Best Practices." While many groups have created best practices, they are scattered across the Web or buried in local repositories and many have yet to be digitized. To reduce this fragmentation, we introduce a new open access, permanent, digital repository of best practices documentation (oceanbestpractices.org) that is part of the Ocean Best Practices System (OBPS). The new OBPS provides an opportunity space for the centralized and coordinated improvement of ocean observing methods. The OBPS repository employs user-friendly software to significantly improve discovery and access to methods. The software includes advanced semantic technologies for search capabilities to enhance repository operations. In addition to the repository, the OBPS also includes a peer reviewed journal research topic, a forum for community discussion and a training activity for use of best practices. Together, these components serve to realize a core objective of the OBPS, which is to enable the ocean community to create superior methods for every activity in ocean observing from research to operations to applications that are agreed upon and broadly adopted across communities. Using selected ocean observing examples, we show how the OBPS supports this objective. This paper lays out a future vision of ocean best practices and how OBPS will contribute to improving ocean observing in the decade to come

Methods and Best Practice to Intercompare Dissolved Oxygen Sensors and Fluorometers/Turbidimeters for Oceanographic Applications

In European seas, ocean monitoring strategies in terms of key parameters, space and time scale vary widely for a range of technical and economic reasons. Nonetheless, the growing interest in the ocean interior promotes the investigation of processes such as oxygen consumption, primary productivity and ocean acidity requiring that close attention is paid to the instruments in terms of measurement setup, configuration, calibration, maintenance procedures and quality assessment. To this aim, two separate hardware and software tools were developed in order to test and simultaneously intercompare several oxygen probes and fluorometers/turbidimeters, respectively in the same environmental conditions, with a configuration as close as possible to real in-situ deployment. The chamber designed to perform chlorophyll-a and turbidity tests allowed for the simultaneous acquisition of analogue and digital signals of several sensors at the same time, so it was sufficiently compact to be used in both laboratory and onboard vessels. Methodologies and best practice committed to the intercomparison of dissolved oxygen sensors and fluorometers/turbidimeters have been used, which aid in the promotion of interoperability to access key infrastructures, such as ocean observatories and calibration facilities. Results from laboratory tests as well as field tests in the Mediterranean Sea are presented

FERRYBOXES WITHIN EUROPE: STATE-OF-THE-ART AND INTEGRATION IN THE EUROPEAN OCEAN OBSERVATION SYSTEM (EOOS)

The development and use of FerryBox systems as a cost-effective instrument for continuous observations of the marine environment has been well established since more than 15 years. The systems have evolved to maturity and are since widely used around the coastal ocean of Europe. The availability of newly developed sensors allows the extension of FerryBox measurements to more biogeochemical parameters which are of interest for the requirements of the Marine Strategy Framework Directive (MSFD). The FerryBox community initially formed from the partners of an EU funded FerryBox project provides mutual exchange of experience and is now organized within EuroGOOS as a so called FerryBox Task Team (www.ferrybox.org). Within the EU funded infrastructure projects JERICO and JERICO-NEXT the technical harmonization as well as the developing of best practise guides for FerryBox systems have been a step further to high quality environmental data products. Within JERICO-NEXT it has been decided to build up a common FerryBox database and data portal in order to make the FerryBox data more available and visible. Furthermore this database will be function as a close link to the Copernicus Marine Environmental Monitoring Services (CMEMS) and the EMODnet portal

Proteome-based classification of Nonmuscle Invasive Bladder Cancer

DNA/RNA-based classification of bladder cancer (BC) supports the existence of multiple molecular subtypes, while investigations at the protein level are scarce. Here, we aimed to investigate if Nonmuscle Invasive Bladder Cancer (NMIBC) can be stratified to biologically meaningful groups based on the proteome. Tissue specimens from 117 patients at primary diagnosis (98 with NMIBC and 19 with MIBC), were processed for high-resolution proteomics analysis by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The proteomics output was subjected to unsupervised consensus clustering, principal component analysis (PCA) and investigation of subtype-specific features, pathways, and gene sets. NMIBC patients were optimally stratified to three NMIBC proteomic subtypes (NPS), differing in size, clinicopathologic and molecular backgrounds: NPS1 (mostly high stage/grade/risk samples) was the smallest in size (17/98) and overexpressed proteins reflective of an immune/inflammatory phenotype, involved in cell proliferation, unfolded protein response and DNA damage response, whereas NPS2 (mixed stage/grade/risk composition) presented with an infiltrated/mesenchymal profile. NPS3 was rich in luminal/differentiation markers, in line with its pathological composition (mostly low stage/grade/risk samples). PCA revealed a close proximity of NPS1 and conversely, remoteness of NPS3 to the proteome of MIBC. Proteins distinguishing these two extreme subtypes were also found to consistently differ at the mRNA levels between high and low-risk subtypes of the UROMOL and LUND cohorts. Collectively, our study identifies three proteomic NMIBC subtypes and following a cross-omics validation in two independent cohorts, shortlists molecular features meriting further investigation for their biomarker or potentially therapeutic value. © 2019 UIC

Referral for “neoadjuvant chemotherapy” for muscle-invasive bladder cancer to a multidisciplinary board: Patterns, management and outcomes

Background: Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for “neoadjuvant chemotherapy”, treatment and outcomes in a multi-disciplinary tumor board. Methods: This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate. Results: Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51–79.2) and 65.2 (95% CI: 44.9–79.6), respectively. Conclusion: Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II–IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged. © 2021 Dellis et al

Risk for Venous Thromboembolic Events in Patients With Advanced Urinary Tract Cancer Treated With First-Line Chemotherapy

We identified the incidence and risk factors of venous thromboembolism in 335 chemotherapy-treated patients with urothelial cancer. The Khorana risk score did not accurately predict risk for thromboembolic events; on the contrary, history of vascular events was associated with a 3-fold increase of this risk. The role of prophylaxis in this group should be further studied. © 2020 Elsevier Inc. Background: Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs. Patients and Methods: Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed. Results: A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score. Conclusion: Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group. © 2020 Elsevier Inc