Microhematuria: AUA/SUFU Guideline Barocas, Daniel A; Boorjian, Stephen A; Alvarez, Ronald D ...
The Journal of urology,
10/2020, Letnik:
204, Številka:
4
Journal Article
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Patients presenting with microhematuria represent a heterogeneous population with a broad spectrum of risk for genitourinary malignancy. Recognizing that patient-specific characteristics modify the ...risk of underlying malignant etiologies, this guideline sought to provide a personalized diagnostic testing strategy.
The systematic review incorporated evidence published from January 2010 through February 2019, with an updated literature search to include studies published up to December 2019. Evidence-based statements were developed by the expert Panel, with statement type linked to evidence strength, level of certainty, and the Panel's judgment regarding the balance between benefits and risks/burdens.
Microhematuria should be defined as ≥ 3 red blood cells per high power field on microscopic evaluation of a single specimen. In patients diagnosed with gynecologic or non-malignant genitourinary sources of microhematuria, clinicians should repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause. The Panel created a risk classification system for patients with microhematuria, stratified as low-, intermediate-, or high-risk for genitourinary malignancy. Risk groups were based on factors including age, sex, smoking and other urothelial cancer risk factors, degree and persistence of microhematuria, as well as prior gross hematuria. Diagnostic evaluation with cystoscopy and upper tract imaging was recommended according to patient risk and involving shared decision-making. Statements also inform follow-up after a negative microhematuria evaluation.
Patients with microhematuria should be classified based on their risk of genitourinary malignancy and evaluated with a risk-based strategy. Future high-quality studies are required to improve the care of these patients.
As part of the Deep Convective Cloud and Chemistry (DC3) experiment, the National Science Foundation/National Center for Atmospheric Research (NCAR) Gulfstream‐V (GV) and NASA DC‐8 research aircraft ...probed the chemical composition of the inflow and outflow of two convective storms (north storm, NS, south storm, SS) originating in the Colorado region on 22 June 2012, a time when the High Park wildfire was active in the area. A wide range of trace species were measured on board both aircraft including biomass burning (BB) tracers hydrogen cyanide (HCN) and acetonitrile (ACN). Acrolein, a much shorter lived tracer for BB, was also quantified on the GV. The data demonstrated that the NS had ingested fresh smoke from the High Park fire and as a consequence had a higher VOC OH reactivity than the SS. The SS lofted aged fire tracers along with other boundary layer ozone precursors and was more impacted by lightning NOx (LNOx) than the NS. The NCAR master mechanism box model was initialized with measurements made in the outflow of the two storms. The NS and SS were predicted to produce 11 and 14 ppbv of O3, respectively, downwind of the storm over 2 days. Sensitivity tests revealed that the ozone production potential of the SS was highly dependent on LNOx. Normalized excess mixing ratios, ΔX/ΔCO, for HCN and ACN were determined in both the fire plume and the storm outflow and found to be 7.0 ± 0.5 and 2.3 ± 0.5 pptv ppbv−1, respectively, and 1.4 ± 0.3 pptv ppbv−1 for acrolein in the outflow only.
Key Points
Lightning NOx is a key driver of ozone production in storm outflows
Storms can transport biomass burning emissions to the upper troposphere
Acrolein is shown to be a good tracer for fresh biomass burning emissions
Atmospheric measurements show an increase in CH4 from the 1980s to 1998 followed by a period of near‐zero growth until 2007. However, from 2007, CH4 has increased again. Understanding the variability ...in CH4 is critical for climate prediction and climate change mitigation. We examine the role of CH4 sources and the dominant CH4 sink, oxidation by the hydroxyl radical (OH), in atmospheric CH4 variability over the past three decades using observations of CH4, C2H6, and δ13CCH4 in an inversion. From 2006 to 2014, microbial and fossil fuel emissions increased by 36 ± 12 and 15 ± 8 Tg y−1, respectively. Emission increases were partially offset by a decrease in biomass burning of 3 ± 2 Tg y−1 and increase in soil oxidation of 5 ± 6 Tg y−1. A change in the atmospheric sink did not appear to be a significant factor in the recent growth of CH4.
Plain Language Summary
Methane is the second most important greenhouse gas and is responsible for approximately 17% of the direct radiative forcing from all long‐lived greenhouse gases. Observations of methane in the atmosphere have shown a dramatic increase from 2007 after a period of relative stability between the late 1990s and early 2000s, but the cause of this increase is still under scientific debate. This study uses atmospheric observations of methane and two related tracers, the isotopic ratio of carbon in methane and ethane, to constrain the sources and sinks of methane over the past three decades. The increase in methane between 2007 and 2014 is likely due to an increase in microbial sources, of 24–48 Tg/y (predominantly natural wetlands and agricultural), as well as fossil fuel sources, of 7–23 Tg/y. In contrast to other recent studies, a reduction in the atmospheric sink of methane was found not to be a significant factor in explaining the recent atmospheric increase.
Key Points
Microbial and fossil fuel sources of CH4 have both contributed to the observed increase in atmospheric CH4 from 2007
Fossil fuel sources of CH4 decreased significantly between 1990 and 1996 but increased again from the early 2000s
Variation in the main atmospheric sink of CH4, oxidation by OH radicals, appears not to have significantly contributed to the recent increase in CH4
Androgen receptor (AR)‐dependent transcription is a major driver of prostate tumor cell proliferation. Consequently, it is the target of several antitumor chemotherapeutic agents, including the AR ...antagonist MDV3100/enzalutamide. Recent studies have shown that a single AR mutation (F876L) converts MDV3100 action from an antagonist to an agonist. Here we describe the generation of a novel class of selective androgen receptor degraders (SARDs) to address this resistance mechanism. Molecules containing hydrophobic degrons linked to small‐molecule AR ligands induce AR degradation, reduce expression of AR target genes and inhibit proliferation in androgen‐dependent prostate cancer cell lines. These results suggest that selective AR degradation may be an effective therapeutic prostate tumor strategy in the context of AR mutations that confer resistance to second‐generation AR antagonists.
Making the problem go away: Most prostate tumor growth is driven by the action of the androgen receptor (AR). Resistance to current chemotherapies for prostate cancer can occur when the androgen receptor is either overexpressed or mutated. Coupling of an AR agonist to an adamantyl “hydrophobic tag” resulted in a molecule that induces AR degradation, even in drug‐resistant prostate tumor cells.
Disordered eating behavior differs between the restricting subtype (AN-R) and the binging and purging subtype (AN-BP) of anorexia nervosa (AN). Yet, little is known about how these differences impact ...fatty acid (FA) dysregulation in AN. To address this question, we analyzed 26 FAs and 7 FA lipogenic enzymes (4 desaturases and 3 elongases) in 96 women: 25 AN-R, 25 AN-BP, and 46 healthy control women. Our goal was to assess subtype-specific patterns. Lauric acid was significantly higher in AN-BP than in AN-R at the fasting timepoint (
= 0.038) and displayed significantly different postprandial changes 2 h after eating. AN-R displayed significantly higher levels of n-3 alpha-linolenic acid, stearidonic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid, and n-6 linoleic acid and gamma-linolenic acid compared to controls. AN-BP showed elevated EPA and saturated lauric acid compared to controls. Higher EPA was associated with elevated anxiety in AN-R (
= 0.035) but was linked to lower anxiety in AN-BP (
= 0.043). These findings suggest distinct disordered eating behaviors in AN subtypes contribute to lipid dysregulation and eating disorder comorbidities. A personalized dietary intervention may improve lipid dysregulation and enhance treatment effectiveness for AN.
To evaluate the use of the Spot Vision Screener (Spot; Welch Allyn, Skaneateles Falls, New York, USA) for detection of amblyopia risk factors in children aged 6 months to 3 years, as defined by the ...2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus.
Reliability analysis.
In this study, children seen from June 1, 2012, to April 30, 2016 were tested with the Spot during a routine visit. Enrolled children underwent a comprehensive eye examination including cycloplegic refraction and sensorimotor testing within 6 months of the testing date by a pediatric ophthalmologist masked to the Spot results.
A total of 184 children were included. The Spot successfully obtained readings in 89.7% of patients. Compared with the ophthalmologist's examination, the Spot had an overall sensitivity of 89.8% and a specificity of 70.4%.
The Spot achieved good sensitivity and specificity for detection of amblyopia risk factors in this young cohort, particularly in the older subgroup. Our data offer support for automated vision screening in young children.
The metabolism of bioactive oxylipins by soluble epoxide hydrolase (sEH) plays an important role in inflammation, and sEH may be a risk modifier in various human diseases and disorders. The ...relationships that sEH has with the risk factors of these diseases remain elusive. Herein, sEH protein expression and activity in white blood cells were characterized before and after a high-fat meal in healthy women (HW) and women with anorexia nervosa (AN). sEH expression and sEH activity were significantly correlated and increased in both groups two hours after consumption of the study meal. Fasting sEH expression and activity were positively associated with body mass index (BMI) in both groups, while an inverse association with age was found in AN only (p value < 0.05). sEH was not associated with anxiety or depression in either group at the fasting timepoint. While the anxiety score decreased after eating in both groups, a higher fasting sEH was associated with a lower postprandial anxiety decrease in HW (p value < 0.05). sEH characterization using direct measurements verified the relationship between the protein expression and in vivo activity of this important oxylipin modulator, while a well-controlled food challenge study design using HW and a clinical control group of women with disordered eating elucidated sEH’s role in the health of adult women.
Many intensive care unit patients are awake (ie, alert and engaging in conversation), actively experiencing many facets of their critical care. The Patient Dignity Inventory can be used to elicit ...sources of distress in these patients. We examined the administrative question as to which awake intensive care unit patients should be evaluated and potentially treated (eg, through palliative care consultation) for distress. Should the decision to screen for distress be based on patient demographics or treatment conditions?
This was a retrospective cohort study of 155 adult patients from 5 intensive care units of one hospital from 2019 to 2020. Each patient had ≥48 hours without delirium, dementia, or sedation. The Patient Dignity Inventory has 25 items to which patients responded on a 1 (not a problem) to 5 (an overwhelming problem) scale. Multiple complete, stepwise forward, and stepwise backward logistic regression models were created among patient and treatment variables for predicting thresholds of the mean among the 25 items.
There were 50% (78/155; 95% confidence interval CI, 42-58) of patients with significant dignity-related distress (mean score ≥1.60). There were 34% (52/155; CI, 26-42) of patients with severe dignity-related distress (mean score ≥1.92; previously associated with often feeling like wanting to die). Models including combinations of vasopressor medication (protective of distress), tracheostomy (greater risk of distress), and female gender (greater risk of distress) had some predictive value. However, all combinations of potential predictors had misclassification rates significantly >20%.
Identification of subsets of patients with little potential benefit to screening for dignity-related distress would have a reduced workload of palliative care team members (eg, nurses or social workers). Our results show that this is impractical. Given that approximately one-third of critical care patients who are alert and without delirium demonstrate severe dignity-related distress, all such patients with prolonged intensive care unit length of stay should probably be evaluated for distress.
Climate change scenarios suggest largely detrimental impacts on agricultural production from a deterioration of renewable natural resources. Over the last 15 years, a new field of research has ...focused on the interactions between climate and conflict risk, particularly as it relates to competition over natural resources and livelihoods. Within this field, there has been less attention to the potential for resource competition to be managed in ways that yield greater cooperation, local adaptation capacity, social-ecological resilience, and conflict mitigation or prevention. The challenge of increasing social-ecological resilience in small-scale agriculture is particularly acute in the socioeconomically and agroecologically marginalized Western Highlands of Guatemala. Not only is climate change a threat to agriculture in this region, but adaptation strategies are challenged by the context of a society torn apart by decades of violent conflict. Indeed, the largely indigenous population in the Western Highlands has suffered widespread discrimination for centuries. The armed conflict has left a legacy of a deeply divided society, with communities often suspicious of outsider interventions and in many cases with neighbors pitted against each other. We use the example of the Buena Milpa agricultural development project to demonstrate how grassroots approaches to collective action, conflict prevention, and social-ecological resilience, linking local stakeholder dynamics to the broader institutional and governance context, can bear fruit amidst postconflict development challenges. Examples of microwatershed management and conservation of local maize varieties illustrate opportunities to foster community-level climate adaptation strategies within small-scale farming systems even in deeply divided societies.
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