439 research outputs found

    SEAwise Report on improved predictive models of growth, production and stock quality.

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    The SEAwise project works to deliver a fully operational tool that will allow fishers, managers, and policy makers to easily apply Ecosystem Based Fisheries Management (EBFM) in their fisheries and understanding how ecological drivers impact stock productivity through growth, condition and maturity is essential to this proces. In this SEAwise report, we present the predictive models of fish growth, condition and maturity obtained so far in each of the four regional case studies.The biological processes (fish growth, condition and maturity) were studied in terms of body size (weight-at-age, length-at-age), condition factor, otolith increments and size at first maturity. Underlying data were available at different levels, ranging from individual fish, to sampling haul or stock level. Accordingly, the methods employed varied across case studies to adapt to the specific features of the process under study and the available data.The methodology encompassed statistical models (linear models, generalised additive models, mixed models, Bayesian nested hierarchical models, changepoint models), otolith growth increment analyses and mechanistic models (DEB-IBM model coupled to the environment and mizer model). Some of these models were focused on detecting overall trends, including potential changepoints along the time series or identification of the main intrinsic factors. Other models explored the impact of ecological drivers such as temperature, salinity, food availability or density dependence.In the Baltic Sea, two regimes were identified in the weight-at-age time series of herring in the Gulf of Riga (1961-1988 and 1989-2020). During the first period the main driver of the individual annual growth of the fish was the abundance of the copepod L. macrurus macrurus, while the abundance of the adult stages of E. affinis affinis was the dominating explanatory variable affecting herring growth during the second period. Neither SSB nor summer temperature during the main feeding period were significant drivers of the individual growth in the two distinct ecosystem regimes.In the Mediterranean Sea, the analysis of the impact of the environmental variables on biological parameters like size at first maturity, condition factor and growth in South Adriatic Sea and North-West Ionian Sea showed some significant effects in relation to the different species/area. In most of the cases, the environmental driver was bottom temperature, although some relationships with bottom salinity and primary production were also found. The model outcomes suggested that temperatures prevailing in deeper waters were the most significant factor affecting gonad maturity of hakes, while those in the shallow zone had the main impact on the L50 of red mullets. Condition factor of hake and red mullet in the Eastern Ionian Sea were affected not only by temperature, but also by zooplankton abundance.In the North Sea, mediated length-based growth models, linear mixed models and state-space linear mixed models were applied to four gadoids, two flatfishes and one pelagic stock and their performances were assessed in terms of model fit and predictive capability. For the mediated length-based growth model approach, the best model differed across stocks, but density dependent mediation effects were significant for five out of the seven stocks. Regarding the linear mixed models, the two types of models and the different penalisation procedures led to different models across stocks. Among the additional ecological variables, surface temperature was the most frequently included in the final model, closely followed closely by SSB and to a lesser extent by NAO. Detailed otolith increment analysis was used in the development of multidecadal biochronologies of average annual growth of sole in the North Sea and in the Irish Sea. In the North Sea, the best extrinsic model of sole growth included sea bottom temperature, fishing mortality at age, and stock biomass at maturity stage, and their interactions with age and maturity stage, while in the Irish Sea, the best extrinsic model included sea bottom temperature and fishing mortality at maturity stage and its interaction with maturity stage. These results confirmed the expected positive effect of temperature on adult growth. However, in the North Sea, temperature showed unexpected negative effect on juvenile growth, which might be linked to changes in food availability and/or intraspecific competition and need to be further studied. The mizer model (package for size-spectrum ecological modelling) with environmental forcing was used to study whether warming in the North Sea is responsible for the failure of the cod stock. The simulated fish community response when recruitment and carrying capacity depended on surface temperature fitted better with the assessment data than when the environment was fixed. However, the qualitative differences remain, suggesting that temperature effects were not the main cause of the model-assessment disparity.In the Western Waters, the mediated length-based growth models developed for the North Sea case study were applied to 14 stocks in the Celtic Sea. The best model differed across stocks, but again SSB mediation was significant for most of the stocks. From visual inspection of the plots, however, it was noted that the raw data from certain stock objects showed a reduced growth compared to the model fits, requiring further analyses. The analysis on biological measurements of individuals collected at fish markets, observers at sea or during scientific cruises allowed to study temporal variations in body size and condition factor of benthic, pelagic and demersal species in the Celtic Sea and the Bay of Biscay. The linear models indicated a significant negative monotonic relationship of sizes at all ages for anchovy and pilchard, but variations in size at age were less clear and significant for benthic and demersal species. In contrast, the results of the body condition indices showed a moderate but significant decrease for all the studied 19 species over time. The in-depth analysis for anchovy in the Bay of Biscay based on research surveys confirmed the decline in the length and weight of anchovy in the Bay of Biscay and pointed to a decline in body condition toward slender body shapes. Detected associations between temperature and size became more apparent for adult age classes than for juveniles, whereas the association between anchovy size and the biomass of spawners was more important for juvenile than for adult age classes. Associations between anchovy size and chlorophyll-a concentration were in general weak. Finally, the DEB-IBM model coupled to the environment that is under development for the two main seabass stocks of the North East Atlantic will provide further insights on how growth, condition and maturation can affect the future dynamics and productivity of these stocks.Read more about the project at www.seawiseproject.org</p

    Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up

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    : Purpose: To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods: Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. Results: One hundred fifty-two patients (RAPN, n = 60; PTA, n = 92) were included in the analysis. RAPN group was younger (p < 0.001), had lower American Society of Anesthesiologists score (p = 0.002), and higher baseline estimated glomerular filtration rate (p < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p < 0.001) and minor (p < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min vs -3.1 mL/min; p = 0.005), no difference in ΔeGFR at last follow-up (p = 0.22) was observed. No difference in recurrences (RAPN, n = 2; PTA, n = 6) and RFS was found (p = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; p = 0.004). Conclusions: PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients

    DO OPEN AND MINIMALLY INVASIVE TECHNIQUES AFFECT PROGNOSIS AND SURVIVAL OUTCOMES IN PATIENTS UNDERGOING CURATIVE SURGERY FOR NON-METASTATIC PAPILLARY RENAL CELL CARCINOMA? COMPARATIVE ANALYSIS OF A MATCHED-PAIR COHORT FROM A MULTI-INSTITUTIONAL DATABASE

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    INTRODUCTION AND OBJECTIVE: Open and minimally invasive (MI; laparoscopic or robotic-assisted) surgical techniques are applied to treat renal cell carcinoma (RCC), and their oncological equivalence has been always questionned. This study aimed to compare prognosis and survival outcomes between open and MI techniques in patients undergoing curative surgery for non-metastatic papillary RCC (papRCC). METHODS: This multi-institutional study was conducted by the EAU-YAU Renal Cancer Working Group. A total of 2076 patients undergoing curative surgery for non-metastatic papRCC were collected for the dataset. After exclusion of 380 patients due to incomplete records or loss-to-follow-up, a total of 1696 patients were included into this study. Furthermore, a subgroup of 490 patients was defined by matching 245 patients from each operative technique at 1:1 ratio, in terms of year of surgery, age, nephrectomy type (partial/radical) and clinical tumor stage. The retrospectively collected demographical, clinical, histopathological and oncological data were compared between open and MI techniques in the overall and matched-pair cohorts. Chi-square and Mann-Whitney U tests, and Kaplan-Meier analysis were used for the statistical analyses. RESULTS: In overall, patients who underwent open surgery were more frequently male, with symptomatic disease, had a higher rate of radical nephrectomy, and presented with greater clinical and pathological T stages, tumor sizes, pathologic N1 stage, VENUSS score and risk group, and tumors with necrosis and sarcomatoid dedifferentiation. Follow-up was significantly longer in the open group, and disease free-(DFS), cancer specific-(CSS) and overall survival (OS) were significantly worse. In matched-pair comparison, symptomatic disease, pathologic N1 stage, sarcomatoid differentiation and type 2 papRCC were significantly higher in the open group. During similar follow-up duration (48 vs. 49 months, p=0.925), DFS and CSS were similar between two techniques while OS (p=0.042) was lower in the open group. CONCLUSIONS: In this multi-institutional study, open technique was associated with adverse outcomes and worse prognosis after curative surgery for non-metastatic papRCC in unbalanced overall cohort. However, although some adverse outcomes remained, there were no significant differences between the two techniques in terms of cancer-specific prognosis in a balanced matched-pair cohort

    How to manage renal masses in kidney transplant recipients? A collaborative review by the EAU-YAU kidney transplantation and renal cancer working groups

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    Introduction: Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate. Objective: To explore the current management of the native kidney masses in KT patients. Acquisition of evidence: We performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review. Synthesis of evidence: In frail patients with renal masses below 3 cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft. Conclusions: Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented

    Microwave versus cryoablation and radiofrequency ablation for small renal mass: a multicenter comparative analysis

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    Background: Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. The aim of the study was to compare outcomes of MWA to those of CRYO and RFA. Methods: Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative, and postoperative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes. Results: 739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (P<0.001), but no difference in LOS, postprocedural Hb mean, intraprocedural complications (P=0.180), overall postprocedural complication rates (P=0.126), and in the 30-day re-admission rate (P=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome, no differences were detected in terms of eGFR at 1 year (P=0.182), ΔeGFR at 1 year (P=0.825) and eGFR at latest follow-up (P=0.070). "Technical success" was achieved in 98.6% of the cases (MWA=100%, CRYO/RFA=98.5%; P=0.775), and there was no significant difference in terms of 2-year recurrence rate (P=0.114) and metastatic progression (P=0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs. 69.6% of MWA cases (P=0.719). Conclusions: MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes

    Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study

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    BackgroundCompensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort.MethodsUsing the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP=(1-RAP)xICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12months, based on Glasgow Outcome ScoreExtended (GOSE) (alive/deadGOSE 2/GOSE=1; favorable/unfavorableGOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values.ResultswICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615-0.810, p=0.0002, and AUC 0.642, 95% CI 0.538-746, p<0.0001, respectively; no significant difference on Delong's test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548-0.705, p=0.015, and AUC 0.495, 95% CI 0.413-0.577, p=0.059; significantly different using Delong's test p=0.002), with lower wICP values associated with improved outcomes (p<0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p<0.05 for all via Delong's test).ConclusionsCompensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study

    Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study

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    Background While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as ‘mild’, ‘moderate’ or ‘severe’ based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (< 24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N = 1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results Six stable endotypes were identified with distinct GCS and composite systemic metabolic stress profiles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ‘moderate’ TBI (by traditional classification) and deranged metabolic profile, had a worse outcome than a cluster with ‘severe’ GCS and a normal metabolic profile. Addition of cluster labels significantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p < 0.001). Conclusions Six stable and clinically distinct TBI endotypes were identified by probabilistic unsupervised clustering. In addition to presenting neurology, a profile of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refining current TBI classifications with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care

    Serum biomarkers identify critically ill traumatic brain injury patients for MRI

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    Serum metabolome associated with severity of acute traumatic brain injury

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    Abstract Complex metabolic disruption is a crucial aspect of the pathophysiology of traumatic brain injury (TBI). Associations between this and systemic metabolism and their potential prognostic value are poorly understood. Here, we aimed to describe the serum metabolome (including lipidome) associated with acute TBI within 24 h post-injury, and its relationship to severity of injury and patient outcome. We performed a comprehensive metabolomics study in a cohort of 716 patients with TBI and non-TBI reference patients (orthopedic, internal medicine, and other neurological patients) from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We identified panels of metabolites specifically associated with TBI severity and patient outcomes. Choline phospholipids (lysophosphatidylcholines, ether phosphatidylcholines and sphingomyelins) were inversely associated with TBI severity and were among the strongest predictors of TBI patient outcomes, which was further confirmed in a separate validation dataset of 558 patients. The observed metabolic patterns may reflect different pathophysiological mechanisms, including protective changes of systemic lipid metabolism aiming to maintain lipid homeostasis in the brain
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