Routine Sampling Research Articles

Significance of the Entire Appendiceal Evaluation in the Diagnosis of Serrated Lesions, Low-Grade Appendiceal Mucinous Neoplasm, and Appendiceal Diverticulosis Disease.

ObjectiveThis study was conducted in order to investigate the significance of the entire appendiceal evaluation in the pathological diagnosis of appendiceal serrated lesions, low-grade appendiceal mucinous neoplasm (LAMN), and appendiceal diverticulosis disease (ADD).MethodsA total of 702 appendectomy specimens diagnosed from 2017 to 2020 were reviewed retrospectively. The specimens were divided into two groups according to the different sampling procedures. In group 1, the vast majority of 337 specimens were partially submitted by routine sampling within 18 months from October 2017 to March 2019. In group 2, 365 of specimens were entirely submitted and examined within 18 months from April 2019 to October 2020. The incidence and pathological features of serrated lesions, LAMN, and ADD in the two groups were compared and analyzed. The clinicopathological characteristics between different entities were also studied.ResultsForty appendiceal serrated lesions, 8 LAMNs, and 21 diverticula were accidentally detected in 702 appendectomy specimens. As compared with group 1, the incidence of appendiceal serrated lesions in group 2 was significantly increased (9.3% vs. 1.8%, P < 0.01), especially for the serrated lesions without dysplasia (7.4% vs. 1.2%, P < 0.01). The entire sampling revealed that loss of lamina propria and replacement with dysplastic mucinous epithelium were statistically significantly associated with LAMN rather than serrated lesions and ADD (P < 0.01 and P < 0.01, respectively). Mural mucin deposition and fibrosis were useful features to distinguish LAMN from simple serrated lesions (P < 0.01 and P < 0.05, respectively), but mucin deposition was useless for the distinction between LAMN and ADD (P > 0.05) or serrated lesions combined with ADD.ConclusionOur study highlights the importance and necessity of careful gross assessment and histologic examination of the entire appendectomy specimen, since the association with unexpected appendiceal lesions is significant and cannot be ignored. The entirely submitted appendix is more sensitive for the detection of appendiceal serrated lesions. In addition, thorough examination and evaluation are essential to distinguish the key pathological features between appendiceal serrated lesions, LAMN, and ADD.

100% visual inspection of tablets produced with continuous direct compression and coating

Visual appearance of tablets is an important property for patients. Since the visual appearance is most strongly influenced by the applied coating, this necessitates a high level of process control and homogeneity in the coating process. In recent years, a number of tablet coaters have been developed that can be used in combination with continuous tablet production lines. In this study, 180 kg of tablets were produced using a continuous direct compaction line with a throughput of 25 kg/h. Tablets were consequently subdivided into 12 lots and coated in a semi-batch drum coater directly after compression. For a detailed understanding of intra-lot and lot-to-lot variability, a 100% visual inspection of the tablets was performed using an automatic tablet inspection and sorting machine. All tablets were analyzed from all 6 sides and the unsuitable tablets were sorted out. In the worst lot, only 1 out of around 300 tablets was sorted out due to color mismatch. For some tablets, edge chipping was also observed, which would presumably not be detected during routine sampling. Root causes for the defects could be found in the intentionally chosen set of old punches and in the operation parameters of the coater. Nonetheless, the lot-to-lot variability according to all criteria was very low.

Vascular Access in Pediatric Oncology and Hematology: State of the Art.

Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.

Utilization of Prognostic Biomarker Soluble Urokinase Plasminogen Activator Receptor in the Emergency Department: A Tool for Safe and More Efficient Decision-making.

Introduction:Risk stratification in the emergency departments (EDs) is in critical need for new applications due to ED overcrowding and hospitalization of older people. We aimed to evaluate the expediency, efficiency and safety of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), as a tool for the risk assessment of patients arriving at the ED.Methods:We performed a comparative cross-sectional study in 2 emergency departments (EDs), suPAR measurements being incorporated into routine blood sampling in the intervention ED. The primary outcome was the number of discharges from the ED. The importance of the outcomes was examined by appropriate multi- or bivariate analysis.Results:The absolute and relative number of discharges were similar between the intervention and control groups [121 (55.3%) vs 62 (55.9%)]. No significant differences between the groups were seen in the length of stays in the ED. Patients with low suPAR values were more likely discharged and patients with high suPAR values more likely admitted to hospital. Two admitted patients with low suPAR values could have been discharged safely.Conclusion:The utilization of suPAR did not increase the risk for neither positive nor negative outcomes. Low suPAR values could be potential in discharging more patients safely. Instead of unselected patient populations, the benefits of suPAR measurements in the ED could emerge in the assessment of a more precisely determined and selected group of patients.

Trends of lymph node sampling and metastasis in pediatric and young adult patients with clear cell, epithelioid, and synovial sarcomas.

Clear cell sarcoma of soft tissue (CCS), epithelioid sarcoma, and synovial sarcoma are rare tumors historically identified as high risk for lymph node metastasis. This study investigates incident nodal metastasis and associated survival in children and young adults with these subtypes. Using the National Cancer Database (2004-2015), we created a retrospective cohort of 1303 patients (aged ≤25years) who underwent local control therapy for CCS, epithelioid sarcoma, and synovial sarcoma. Kaplan-Meier curves estimated overall survival (OS) by subtype. Stratifying on subtype, Cox regressions assessed OS by lymph node sampling status and nodal metastasis. There were 103 (7.9%) patients with CCS, 221 (17.0%) with epithelioid sarcoma, and 979 (75.1%) with synovial sarcoma. Lymph node sampling was more frequent in patients with CCS (56.3%) and epithelioid sarcoma (52.5%) versus synovial sarcoma (20.5%, p<.001). Synovial sarcoma metastasized to lymph nodes less frequently than CCS or epithelioid sarcoma (2.1% vs. 14.6% and 14.9%, p<.001). Across all subtypes, lymph node metastasis was associated with inferior OS (HR 2.02, CI 1.38-2.95, p<.001). Lymph node sampling was associated with improved OS in CCS (HR 0.35, CI: 0.15-0.78, p=.010), inferior OS in synovial sarcoma (HR 1.60, CI: 1.13-2.25, p=.007), and no statistical association with OS in epithelioid sarcoma. Lymph node metastasis is rare in children and young adults with synovial sarcoma. Lymph node sampling procedures were not consistently performed for patients with CCS or epithelioid sarcoma, but improved OS supports routine lymph node sampling in children and young adults with CCS.

2021 Canadian Surgery Forum: Virtual, online Sept. 21-24, 2021.

# 01. Design and validation of a unique endoscopy simulator using a commercial video game {#article-title-2} Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel in-house

Immunological and Genetic Investigation of SARS-CoV-2 Reinfection in an Otherwise Healthy, Young Marine Recruit.

We used epidemiologic and viral genetic information to identify a case of likely reinfection in an otherwise healthy, young Marine recruit enrolled in the prospective, longitudinal COVID-19 Health Action Response for Marines (CHARM) study, and we paired these findings with serological studies. This participant had a positive RT-PCR to SARS-CoV-2 upon routine sampling on study day 7, although he was asymptomatic at that time. He cleared the infection within seven days. On study day 46, he had developed symptoms consistent with COVID-19 and tested positive by RT-PCR for SARS-CoV-2 again. Viral whole genome sequencing was conducted from nares swabs at multiple time points. The day 7 sample was determined to be lineage B.1.340, whereas both the day 46 and day 49 samples were B.1.1. The first positive result for anti-SARS-CoV-2 IgM serology was collected on day 49 and for IgG on day 91. This case appears most consistent with a reinfection event. Our investigation into this case is unique in that we compared sequence data from more than just paired specimens, and we also assayed for immune response after both the initial infection and the later reinfection. These data demonstrate that individuals who have experienced an infection with SARS-CoV-2 may fail to generate effective or long-lasting immunity, similar to endemic human beta coronaviruses.

A First Step towards a Comprehensive Approach to Harmonic Analysis of Synchronous Peripheral Volume Pulses: A Proof-of-Concept Study.

The harmonic analysis (HA) of arterial radial pulses in humans has been widely investigated in recent years for clinical applications of traditional Chinese medicine. This study aimed at establishing the validity of carrying out HA on synchronous peripheral volume pulses for predicting diabetes-induced subtle changes in heart energy. In this study, 141 subjects (Group 1: 63 healthy elderly subjects; Group 2: 78 diabetic subjects) were enrolled at the same hospital. After routine blood sampling, all synchronous electrocardiogram (ECG) and photoplethysmography (PPG) measurements (i.e., at the six locations) were acquired in the morning. HA of synchronous peripheral volume pulses and radial pulse waves was performed and analyzed after a short period of an ensemble averaging process based on the R-wave peak location. This study utilized HA for the peripheral volume pulses and found that the averaged total pulse energy (i.e., the C0 of the DTFS) was identical in the same subject. A logistic regression model with C0 and a waist circumference variable showed a graded association with the risk of developing type 2 diabetes. The adjusted odds ratio for C0 and the waist circumference were 0.986 (95% confidence interval: 0.977, 0.994) and 1.130 (95% confidence interval: 1.045, 1.222), respectively. C0 also showed significant negative correlations with risk factors for type 2 diabetes mellitus, including glycosylated hemoglobin and fasting plasma glucose (r = −0.438, p < 0.001; r = −0.358, p < 0.001, respectively). This study established a new application of harmonic analysis in synchronous peripheral volume pulses for clinical applications. The findings showed that the C0 could be used as a prognostic indicator of a protective factor for predicting type 2 diabetes.

ON-rep-seq as a rapid and cost-effective alternative to whole-genome sequencing for species-level identification and strain-level discrimination of Listeria monocytogenes contamination in a salmon processing plant.

Identification, source tracking, and surveillance of food pathogens are crucial factors for the food‐producing industry. Over the last decade, the techniques used for this have moved from conventional enrichment methods, through species‐specific detection by PCR to sequencing‐based methods, whole‐genome sequencing (WGS) being the ultimate method. However, using WGS requires the right infrastructure, high computational power, and bioinformatics expertise. Therefore, there is a need for faster, more cost‐effective, and more user‐friendly methods. A newly developed method, ON‐rep‐seq, combines the classical rep‐PCR method with nanopore sequencing, resulting in a highly discriminating set of sequences that can be used for species identification and also strain discrimination. This study is essentially a real industry case from a salmon processing plant. Twenty Listeria monocytogenes isolates were analyzed both by ON‐rep‐seq and WGS to identify and differentiate putative L. monocytogenes from a routine sampling of processing equipment and products, and finally, compare the strain‐level discriminatory power of ON‐rep‐seq to different analyzing levels delivered from the WGS data. The analyses revealed that among the isolates tested there were three different strains. The isolates of the most frequently detected strain (n = 15) were all detected in the problematic area in the processing plant. The strain level discrimination done by ON‐rep‐seq was in full accordance with the interpretation of WGS data. Our findings also demonstrate that ON‐rep‐seq may serve as a primary screening method alternative to WGS for identification and strain‐level differentiation for surveillance of potential pathogens in a food‐producing environment.

Use of Slaughterhouses as Sentinel Points for Genomic Surveillance of Foot-and-Mouth Disease Virus in Southern Vietnam.

The genetic diversity of foot-and-mouth disease virus (FMDV) poses a challenge to the successful control of the disease, and it is important to identify the emergence of different strains in endemic settings. The objective of this study was to evaluate the sampling of clinically healthy livestock at slaughterhouses as a strategy for genomic FMDV surveillance. Serum samples (n = 11,875) and oropharyngeal fluid (OPF) samples (n = 5045) were collected from clinically healthy cattle and buffalo on farms in eight provinces in southern and northern Vietnam (2015–2019) to characterize viral diversity. Outbreak sequences were collected between 2009 and 2019. In two slaughterhouses in southern Vietnam, 1200 serum and OPF samples were collected from clinically healthy cattle and buffalo (2017 to 2019) as a pilot study on the use of slaughterhouses as sentinel points in surveillance. FMDV VP1 sequences were analyzed using discriminant principal component analysis and time-scaled phylodynamic trees. Six of seven serotype-O and -A clusters circulating in southern Vietnam between 2017–2019 were detected at least once in slaughterhouses, sometimes pre-dating outbreak sequences associated with the same cluster by 4–6 months. Routine sampling at slaughterhouses may provide a timely and efficient strategy for genomic surveillance to identify circulating and emerging FMDV strains.

Heterotopic Sex Cord-Stromal Proliferation: A Case Report

Abstract Introduction/Objective Sex cord-stromal cells at extraovarian sites are extremely rare and due to the low number of cases reported, the true incidence is unknown. We present the case of a patient with symptomatic uterine fibromas that had a benign extraovarian heterotopic sex cord-stromal proliferation. Methods/Case Report A 44-year-old female presented with pelvic pressure and discomfort. Past medical history is significant for breast cancer treated with bilateral mastectomy in 2019 followed by radiation treatments. The patient had no menses since January 2020 but had begun noticing spotting prior to the onset of her pelvic pressure and discomfort. Pelvic ultrasound revealed an enlarged uterus consistent with fibroids and a right adnexal mass. Endometrial biopsy following the ultrasound was normal. The patient desired definitive treatment and a total abdominal hysterectomy and bilateral salpingo-oophorectomy was subsequently performed. Gross examination of the surgical specimen revealed a fibroid uterus and normal appearing bilateral ovaries and fimbriated fallopian tubes. Histopathology showed a uterus with leiomyomata and serous cystadenofibromas in bilateral ovaries. The left fallopian tube fimbria showed a well-circumscribed proliferation of pale, ovoid cells in a microfollicular pattern. Rare cells with grooved nuclei were present. No significant atypia and no mitotic activity were identified. Immunohistochemical staining was positive for inhibin, WT-1, and vimentin. Negative stains include EMA, GATA-3, GCDFP 15, mammaglobin, chromogranin, and calretinin. Final diagnosis was determined to be benign fallopian tube with heterotopic sex cord-stromal proliferation. Results (if a Case Study enter NA) NA Conclusion This case highlights a rare, incidental finding. These lesions are postulated to represent non-neoplastic embryologic remnants. However, most heterotopic sex cord-stromal proliferations are found in fimbriae, which could suggest that they arise from heterotopic ovarian tissue exposed during ovulation. The incidence of these benign proliferations is expected to increase as routine sampling of adnexal structures is becoming more commonplace, which presents diagnostic challenges for pathologists.

413 The Clinical Efficacy of Intra-Operative Peritoneal Fluid Sampling in Abdominal infections

Abstract Aim To uncover the practical efficacy of intra-operative peritoneal fluid sampling and the impact on antibiotic prescription and clinical outcomes in patients undergoing emergency surgery due to intra-abdominal infections. Method Our retrospective study included all patients undergoing emergency surgery for intra-abdominal infections at Southend University Hospital over 6 months (January – July 2019). Data was collected from electronic patient records, case notes and microbiology reports and included the following information: patient age demographics; type of infection; peritoneal fluid sampling indication; samples taken; details of swab culture report including organisms grown and antibiotic sensitivity; clinical course and incidence of subsequent intra-abdominal infection to include readmission and/or further procedures; the type, duration and route of antibiotic prescribed and duration of hospital stay. This audit was approved by the Departmental Audit Lead. Results 441 patients undergoing emergency surgery for intra-abdominal infection were identified. After exclusions, intra-operative peritoneal fluid samples were indicated in 77 patients (mean age 39.4 years). Of these only 3 had samples taken (3.9%). The most common organisms isolated were mixed anaerobes followed by Streptococcus angiosus. The most common antibiotic sensitivity was Metronidazole and Penicillin. One readmission occurred due to an intra-abdominal tubo-ovarian abscess. Conclusions The study shows that the current practice in our hospital regarding intra-operative peritoneal fluid sampling in intra-abdominal infections reflects the present widely held attitudes regarding its reduced practical utility. Abandoning routine sampling had no significant impact on the clinical course and may be more cost-effective. The study may help surgeons reflect on changing perspectives on this traditional practice.

Parasite load of Atlantic cod Gadus morhua in the Baltic Sea assessed by the liver category method, and associations with infection density and critical condition

AbstractDuring the 2010s, Atlantic cod Gadus morhua L. in the eastern Baltic Sea experienced increasing infection loads of the parasitic nematode Contracaecum osculatum (Rudolphi) in their livers. Starting in 2021, a mandatory part of the routine sampling protocol on Baltic monitoring surveys is to assign a liver category to individual cod livers, based on the number of nematodes visible on the liver surface, to follow spatiotemporal changes in nematode infection loads. The validity of the liver category method has never been evaluated. Based on data from 642 cod livers, the method was verified and found to be a good predictor of the total number of nematodes. Moreover, the probability of cod being in a critical condition increased with the parasite load. In addition to their direct applicability to Baltic cod, the present findings may inspire others working with disease in fish stocks to include parasite monitoring.

A SERS-Active Electrospun Polymer Mesh for Spatially Localized pH Measurements of the Cellular Microenvironment.

Extracellular pH (pHe) is an important chemical factor in many cellular processes and disease pathologies. The routine sampling of pHe in vitro could lead to innovative advances in therapeutics. To this end, we have fabricated a novel gold-coated polymer mesh, which facilitates the real-time measurement of pHe via surface-enhanced Raman scattering (SERS). In this proof of concept study, we apply our SERS sensor to measure metabolically induced changes in the pHe of carcinoma-derived cell line HepG2/C3A. We demonstrate that gold-coated polyurethane electrospun nanofibers (AuNF) have strong and reproducible SERS spectra of surface-adsorbed analytes. By functionalizing AuNF with pH-responsive reporter 4-mercaptobenzoic acid (MBA), we have developed an accurate pH SERS sensor for the extracellular microenvironment. We cultured HepG2/C3A on the surface of MBA-AuNF and measured an acidic shift in pHe at the cell-fiber interface. Following exposure to staurosporine, an apoptosis-inducing drug, we observed changes in the HepG2/C3A cellular morphology indicative of controlled cell death, and detected an increase in the pHe of HepG2/C3A. These results demonstrate how subtle changes in pHe, induced by the metabolic activity of cells, can be measured with our novel SERS sensor MBA-AuNF. The excellent pH measurement performance of MBA-AuNF provides a unique platform to study extracellular pH on the microscale and will help to deepen our understanding of pHe in disease pathology.

Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury.

Purpose of reviewTo date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics.Recent findingsIt is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes.SummaryWe survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.

Deep Learning for Isotope Hydrology: The Application of Long Short-Term Memory to Estimate High Temporal Resolution of the Stable Isotope Concentrations in Stream and Groundwater

Recent advances in laser spectroscopy has made it feasible to measure stable isotopes of water in high temporal resolution (i.e., sub-daily). High-resolution data allow the identification of fine-scale, short-term transport and mixing processes that are not detectable at coarser resolutions. Despite such advantages, operational routine and long-term sampling of stream and groundwater sources in high temporal resolution is still far from being common. Methods that can be used to interpolate infrequently measured data at multiple sampling sites would be an important step forward. This study investigates the application of a Long Short-Term Memory (LSTM) deep learning model to predict complex and non-linear high-resolution (3 h) isotope concentrations of multiple stream and groundwater sources under different landuse and hillslope positions in the Schwingbach Environmental Observatory (SEO), Germany. The main objective of this study is to explore the prediction performance of an LSTM that is trained on multiple sites, with a set of explanatory data that are more straightforward and less expensive to measure compared to the stable isotopes of water. The explanatory data consist of meteorological data, catchment wetness conditions, and natural tracers (i.e., water temperature, pH and electrical conductivity). We analyse the model's sensitivity to different input data and sequence lengths. To ensure an efficient model performance, a Bayesian optimization approach is employed to optimize the hyperparameters of the LSTM. Our main finding is that the LSTM allows for predicting stable isotopes of stream and groundwater by using only short-term sequence (6 h) of measured water temperature, pH and electrical conductivity. The best performing LSTM achieved, on average of all sampling sites, an RMSE of 0.7‰, MAE of 0.4‰, R2 of 0.9 and NSE of 0.7. The LSTM can be utilized to predict and interpolate the continuous isotope concentration time series either for data gap filling or in case where no continuous data acquisition is feasible. This is very valuable in practice because measurements of these tracers are still much cheaper than stable isotopes of water and can be continuously conducted with relatively minor maintenance.

MP26-02 ROLE OF ANTERIOR PROSTATE SAMPLING USING A NOVEL PHILADELPHIA HYBRID ANATOMIC TRANSPERINEAL (PHAT) TEMPLATE: A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-02 ROLE OF ANTERIOR PROSTATE SAMPLING USING A NOVEL PHILADELPHIA HYBRID ANATOMIC TRANSPERINEAL (PHAT) TEMPLATE: A SINGLE CENTER EXPERIENCE Johnathan Drevik, Adams Ako, Jeffrey Ellis, Phillip Abbosh, Jay Simhan, Justin Friedlander, Steven Sterious, Joshua Cohn, Robert Uzzo, and Serge Ginzburg Johnathan DrevikJohnathan Drevik More articles by this author , Adams AkoAdams Ako More articles by this author , Jeffrey EllisJeffrey Ellis More articles by this author , Phillip AbboshPhillip Abbosh More articles by this author , Jay SimhanJay Simhan More articles by this author , Justin FriedlanderJustin Friedlander More articles by this author , Steven SteriousSteven Sterious More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy approach has become more widespread due to lower rate of post-biopsy infections and better anterior gland sampling. Despite its increasing adoption, no universal transperineal template exists and the role of routine anterior gland sampling remains undefined. Here we propose a simplified office-based transperineal biopsy template and describe cancer distribution and the relevance of anterior cores. METHODS: A retrospective chart review of patients that underwent PHAT template transperineal biopsy (Figure 1a) between November 2017 through November 2020 was performed and clinicopathologic data along with relevant multiparametric MRI (mpMRI) data were abstracted. In patients with multiple biopsies only the initial systematic biopsy was included. Clinically significant cancer (csCa) was defined as ≥ GG2. Descriptive statistics were utilized to evaluate cancer detection rate and location. RESULTS: 178 unique patients (median age 64.0, IQR 10, median PSA 9.2, IQR 4.7) comprised the cohort of interest. 148 (83%) were performed in the office under local analgesia. Overall, cancer detection rate (CDR) was 140/178 (79%), while csCa was present in 94/178 (52.8%) The distribution of detected cancer using the PHAT template can be seen in Figure 1b. Cancer in anterior cores only was observed in 21 (11.8%) men, with 57.1% being csCa. mpMRI was available for 13 of 21 (61.9%) patients with anterior-only prostate cancer, of which 8/13 (61.5%) had no anterior lesions detected on MRI. Morbidity of this remained remained low, without any episodes of sepsis. CONCLUSIONS: The PHAT prostate biopsy template provides a high CDR and allows for comprehensive anterior gland sampling with minimal morbidity. Importance of routine anterior gland sampling is underscored, as 2/3 of anterior-only cancers would be missed if mpMRI alone was used to triage anterior gland targeting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e462-e462 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Drevik More articles by this author Adams Ako More articles by this author Jeffrey Ellis More articles by this author Phillip Abbosh More articles by this author Jay Simhan More articles by this author Justin Friedlander More articles by this author Steven Sterious More articles by this author Joshua Cohn More articles by this author Robert Uzzo More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement Loading ...

Cerebrospinal fluid cell count variability is a major confounding factor in external ventricular drain-associated infection surveillance diagnostics: a prospective observational study

BackgroundExternal ventricular drain (EVD)-related infections (EVDIs) are feared complications that are difficult to rapidly and correctly diagnose, which can lead to unnecessary treatment with broad-spectrum antibiotics. No readily available diagnostic parameters have been identified to reliably predict or identify EVDIs. Moreover, intraventricular hemorrhage is common and affect cerebrospinal fluid (CSF) cellularity. The relationship between leukocytes and erythrocytes is often used to identify suspected infection and triggers the use of antibiotics pending results of cultures, which may take days. Cell count based surveillance diagnostics assumes a homogeneous distribution of cells in the CSF. Given the intraventricular sedimentation of erythrocytes on computed tomography scans this assumption may be erroneous and could affect diagnostics.AimsTo evaluate the consistency of cell counts in serially sampled CSF from EVDs, with and without patient repositioning, to assess the effect on infection diagnostics.MethodsWe performed a prospective single-center study where routine CSF sampling was followed by a second sample after 10 min, allocated around a standard patient repositioning, or not. Changes in absolute and pairwise cell counts and ratios were analyzed, including mixed regression models.ResultsData from 51 patients and 162 paired samples were analyzed. We observed substantial changes in CSF cellularity as the result of both resampling and repositioning, with repositioning found to be an independent predictor of bidirectional cellular change. Glucose and lactate levels were affected, however clinically non-significant. No positive CSF cultures were seen during the study. Thirty percent (30%) of patients changed suspected EVDI status, as defined by the cell component of local and national guidelines, when resampling after repositioning.ConclusionsCSF cell counts are not consistent and are affected by patient movement suggesting a heterogeneity in the intraventricular space. The relationship between leukocytes and erythrocytes was less affected than absolute changes. Importantly, cell changes are found to increase with increased cellularity, often leading to changes in suspected EVDI status. Faster and more precise diagnostics are needed, and methods such as emerging next generation sequencing techniques my provide tools to more timely and accurately guide antibiotic treatment.Trial Registration NCT04736407, Clinicaltrials.gov, retrospectively registered 2nd February 2021.

P–383 Cytogenetic analysis of products of conception from miscarriages following natural conception and IVF pregnancy: a comparative study

Abstract Study question Do cytogenetic results from products of conception from miscarriages differ from patients conceiving by natural conception versus IVF? Summary answer: Cytogenetic results were similar, with no statistical difference from miscarriages following natural conception and assisted conception. What is known already Cytogenetic sampling of products of conception (POC) following recurrent miscarriages (RM) are recommended to rule out parental chromosomal rearrangements. The RCOG recommends cytogenetic testing in cases of recurrent miscarriages (3 consecutive miscarriages). However some units routinely request cytogenetic analysis following a single miscarriage following an IVF pregnancy. There is no evidence to support the routine sampling of POCs following assisted conception. Study design, size, duration: Retrospective cohort study of 117 cytogenetic samples, followed up by the outcome of parental karyotyping if applicable. Patients were categorised based on mode of conception into natural conception (NC) with recurrent miscarriages (≥3) or one miscarriage following IVF. Data collected between 2018–2020. Primary Outcome measure: Presence and type of cytogenetic abnormality; individual parental targeted G-band karyotyping result. Participants/materials, setting, methods: A total of 117 cytogenetic results were reviewed, of which 35 were unsuitable for analysis due to contamination (Total n = 79: NC = 60, IVF = 19). Main results and the role of chance: Cytogenetic analysis showed abnormal results in 59% of miscarriages following natural conception and 53% of miscarriages from IVF pregnancy (p = 0.46). Abnormal cytogenetic results were mainly sporadic. Trisomy 16 was the commonest abnormality in both groups. Others included Trisomy 15, 22, 21, 8, 13, 5, 9, 10, 14, 18, single X (Turner’s), all occurring in the same frequency in both groups. As expected 35 out of 45 abnormal cytogenetic results occurred with a maternal age greater than 35 years. One couple from the NC group were referred to a geneticist for a Trisomy 9 imbalance. All other parental karyotyping results were normal. Limitations, reasons for caution This study contains a small sample size, and would benefit from further data collection to account for a percentage of samples being inadequate for analysis. Wider implications of the findings: Cytogenetic results were similar from miscarriages following natural conception and assisted conception. IVF does not increase the risk of miscarriage from abnormal embryonic karyotype. Routine cytogenetic testing following one miscarriage in patients undergoing IVF is not cost effective. Trial registration number Not applicable

Blood biomarkers of progressive atherosclerosis and restenosis after stenting of symptomatic intracranial artery stenosis

In-stent restenosis (ISR) represents a major complication after stenting of intracranial artery stenosis (ICAS). Biomarkers derived from routine blood sampling including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) have been associated with progressive atherosclerosis. We investigated the role of CRP, NLR, PLR and MPV on the development of intracranial ISR and recurrent stroke risk. We retrospectively included all patients who had undergone stenting of symptomatic ICAS at our university hospital between 2005 and 2016. ISR (≥ 50% stenosis) was diagnosed by regular Duplex sonography follow-up studies and confirmed by digital subtraction angiography or computed tomography angiography (mean follow-up duration: 5 years). Laboratory parameters were documented before stenting, at the time of restenosis and at last clinical follow-up. Of 115 patients (mean age: 73 ± 13 years; female: 34%), 38 (33%) developed ISR. The assessed laboratory parameters did not differ between patients with ISR and those without (p > 0.1). While ISR was associated with the occurrence of recurrent ischemic stroke (p = 0.003), CRP, NLR, PLR and MPV were not predictive of such events (p > 0.1). Investigated blood biomarkers of progressive atherosclerosis were not predictive for the occurrence of ISR or recurrent ischemic stroke after ICAS stenting during a 5-year follow-up.