Publications by authors named "Juan Gomez Rivas"

115 Publications

Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow up.

Minerva Urol Nephrol 2021 Jul 15. Epub 2021 Jul 15.

Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.

Introduction: Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure).

Evidence Acquisition: A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the Preferred Reporting Items for Systematic Review and Meta-Analyses process.

Evidence Synthesis: We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when post-operative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (p=0.01), resection depth (p=0.006 and p=0.03), and low surgical experience (p=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumour seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (p=0.0003) and bladder closure (p<0.001) were found as independent predictors of extravesical tumour recurrence.

Conclusions: BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.
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http://dx.doi.org/10.23736/S2724-6051.21.04436-0DOI Listing
July 2021

Active surveillance in renal tumors: Clinical and oncological outcomes.

J Cancer Res Ther 2021 Apr-Jun;17(2):414-419

Department of Urology, La Paz University Hospital; Universidad Autonoma de Madrid; La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.

Context: Some patients diagnosed with small renal solid masses or complex cystic lesions may benefit from active surveillance (AS) instead of immediate treatment.

Aims: Report our series of patients undergoing AS for small renal solid and complex cystic lesions, and compare growth rates and outcomes between both types of lesions.

Materials And Methods: A retrospective review AS database for renal lesions was conducted. From 1995 to 2017, a total of 82 patients with 89 renal lesions were included. We describe our AS protocol, patient and tumor characteristics, comparisons between solid and cystic lesions, and final outcome of patients who underwent delayed intervention (DI).

Statistical Analysis Used: Categorical and continuous data were analyzed by the Chi-square and the Student's t-test, respectively. The Wilcoxon/Kruskal-Wallis test was used for growth rate comparisons of solid and complex cystic lesions.

Results: Median age of patients at the beginning of AS was 77-year-old, median size for solid and cystic lesions was 2.3 cm (0.08-3.8) and 2.6 cm (1.2-4.0), respectively. No differences in annual growth rate between solid and complex cystic lesions (0.04 cm [0.00-1.5] and 0.05 cm [0.01-1.7]) were observed at a similar median follow-up of 61 months for both groups (range: 15-182, and 14-254). Five patients with solid lesions underwent DI, 3 for rapid growth (>0.5 cm/year), 1 demanded treatment, and 1 due to hematuria. Adherence to AS protocol was high (94%). No cancer-related deaths or metastatic progression was observed, six patients died of another medical condition, being cardiovascular disease the most frequent cause.

Conclusions: AS is a reasonable and safe option for the management of small renal masses. No difference was observed in the growth rate between solid and complex cystic lesions during AS. Centers offering AS should present a standardized protocol and give exhaustive information to patients regarding benefits and risks.
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http://dx.doi.org/10.4103/jcrt.JCRT_562_18DOI Listing
June 2021

Robotic Repair of Ureteral Strictures: Techniques and Review.

Curr Urol Rep 2021 Jun 9;22(8):39. Epub 2021 Jun 9.

Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain.

Purpose Of Review: To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures.

Recent Findings: The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and Firefly to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.
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http://dx.doi.org/10.1007/s11934-021-01056-8DOI Listing
June 2021

A Quantitative Analysis Investigating the Prevalence of "Manels" in Major Urology Meetings.

Eur Urol 2021 Jun 3. Epub 2021 Jun 3.

Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain.

Background: Female representation in urological meetings is important for gender equity.

Objective: Our objective was to examine the prevalence of "manels" or all-male speaking panels at urological meetings.

Design, Setting, And Participants: Urology meetings organized by major urological associations/societies from December 2019 to November 2020 were reviewed. Meeting information and details of the faculty were retrieved.

Outcome Measurements And Statistical Analysis: Primary outcomes were: (1) the percentage of male faculty in all included sessions and (2) the overall proportion of manels. We made further comparisons between manel and multigender sessions. Male and female faculty were stratified by quartiles of publications, citations, and H-index, and their mean numbers of sessions were compared.

Results And Limitations: Among 285 meeting sessions, 181 (63.5%) were manels. The mean percentage of male faculty was 86.9%. Male representation was very high in urology meetings for most disciplines and urological associations/societies, except for female urology meeting sessions and those organized by the International Continence Society. Nonmanel sessions had higher numbers of chairs/moderators (p = 0.027), speakers (p < 0.001), and faculty (p < 0.001) than manel sessions. A total of 1037 faculty members were included, and 900 of them (86.8%) were male. Male faculty had longer mean years of practice (23.8 vs 17.7 yr, p < 0.001) and was more likely to include professors (43.2% vs 17.5%, p < 0.001) than female faculty. Male faculty within the first quartile (ie, lower quartile) of publications and H-index had a significantly higher number of sessions than female faculty within the same quartile.

Conclusions: Our study showed that manels are prevalent in urology meetings. There is evidence showing that males received more opportunities than females. A huge gender imbalance exists in urology meetings; urological associations and societies should actively strive for greater gender parity.

Patient Summary: Women are under-represented in urology meetings. Urological associations and societies should play an active role to ensure a more balanced gender representation.
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http://dx.doi.org/10.1016/j.eururo.2021.05.031DOI Listing
June 2021

The Uro-oncology Patient and Vaccination Against SARS-CoV-2.

Eur Urol Open Sci 2021 Jul 27;29:77-81. Epub 2021 May 27.

Department of Urology, Hospital Clínico San Carlos, Madrid, Spain.

As of April 13, 2021, 137 million cases of COVID-19 and 2.95 million deaths have been reported worldwide. On December 21, 2020, the Pfizer-BioNTech vaccine was approved for use in the European Union, with efficacy of 95% protection against COVID-19 infection. Several other vaccines are at different stages of assessment by the European Medicines Agency. In addition to the elderly, oncology patients are a vulnerable population in which COVID-19 infection may be more severe. However, owing to the design of the initial studies, evidence on the safety and efficacy of vaccination against SARS-CoV-2 in these patients is scarce and recommendations are based on the opinion of associations, stakeholders, and experts via extrapolation of information and experience for other vaccines, especially influenza vaccines. Despite the limited evidence, the consensus is that SARS-CoV-2 vaccines are safe and vaccination of oncology patients and their close relatives is recommended, although efficacy may be lower in patients with an impaired immune response and the need for additional booster doses is not yet clear. Recommendations include avoiding the use of vaccines based on viral vectors for patients with an impaired immune response, deferring vaccination for immunosuppressed patients or administering the vaccine before immunosuppression, and avoiding chemotherapy receipt between the two doses of a vaccine or on the same day that the vaccine is administered. These recommendations can be extrapolated to urology patients and although evidence is lacking, there should not be greater interference with SARS-CoV-2 vaccines from androgen deprivation therapy or intravesical bacillus Calmette-Guérin. However, large studies to provide strong evidence for uro-oncology patients are needed.

Patient Summary: We looked at the effects of COVID-19 vaccination for patients with urological cancers. The consensus is that the vaccines are safe, and vaccination of cancer patients and their close relatives is recommended.
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http://dx.doi.org/10.1016/j.euros.2021.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156907PMC
July 2021

New Technologies for Kidney Surgery Planning 3D, Impression, Augmented Reality 3D, Reconstruction: Current Realities and Expectations.

Curr Urol Rep 2021 May 25;22(7):35. Epub 2021 May 25.

Department of Urology, Campus Bio-Medico University, Rome, Italy.

Purpose Of Review: We aim to summarize the current state of art about 3D applications in urology focusing on kidney surgeries. In addition we aim to provide a snapshot about future perspective of intraoperative applications of augmented reality (AR).

Recent Findings: A variety of applications in different fields have been proposed. Many applications concern current realities and 3D reconstruction, while some others are about future perspective. The majority of recent studies have focused their attention on preoperative surgical planning, patient education, surgical training, and AR. The disposability of 3D models in healthcare scenarios might improve surgical outcomes, learning curves of novice surgeons and residents, as well as patients' understanding and compliance, allowing a more shared surgical decision-making.
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http://dx.doi.org/10.1007/s11934-021-01052-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143991PMC
May 2021

Retroperitoneal Robot-Assisted Partial Nephrectomy (rRAPN): Surgical Technique and Review.

Curr Urol Rep 2021 May 20;22(6):33. Epub 2021 May 20.

Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO, Madrid, Spain.

Purpose Of Review: We aim to offer a description of the surgical technique and to review the current state retroperitoneal robot-assisted partial nephrectomy (rRAPN).

Recent Findings: Partial nephrectomy is the standard treatment for localized kidney tumours. rRAPN is especially useful for kidney tumours of posterior location. It offers advantages such as direct access to the renal artery and no need for bowel mobilization. The disadvantages are the small working space and the less familiar anatomical landmarks. It is a reproducible technique that achieves similar oncological and functional results to the more traditional transperitoneal route (tRAPN). High-quality randomized studies are needed to ascertain the role of new technologies as modern high-flow insufflation systems, intracavitary ultrasound, 3D planning, and augmented reality (AR), in the performance of this operation. rRAPN is especially useful for kidney tumours of posterior location. Robotic surgeons ideally should become familiar with both approaches, transperitoneal or retroperitoneal.
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http://dx.doi.org/10.1007/s11934-021-01051-zDOI Listing
May 2021

The IDENTIFY Study: The Investigation and Detection of Urological Neoplasia in Patients Referred with Suspected Urinary Tract Cancer; A multicentre observational study.

BJU Int 2021 May 14. Epub 2021 May 14.

Great Western Hospitals NHS Foundation Trust, Swindon, UK.

Objective: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer (UTUC) and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation.

Patients And Methods: This was an international multicentre prospective observational study. We included patients aged 16 and over, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex and smoking. We used a multivariable mixed effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals and countries.

Results: Of the 11,059 patients assessed for eligibility, 10,896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n=2257) was 28.2% (95% CI 22.3-34.1), bladder cancer (n=1951) 24.7% (19.1-30.2), UTUC (n=128) 1.14% (0.77-1.52), renal cancer (n=107) 1.05% (0.80-1.29) and prostate cancer (n=124) 1.75% (1.32-2.18). Odds ratios for patient risk markers in the model for all cancers were: Age 1.04 (95% CI 1.03-1.05) p<0.001, visible haematuria 3.47 (2.90-4.15) p<0.0001, male sex 1.30 (1.14-1.50) p<0.001 and smoking 2.70 (2.30-3.18) p<0.001.

Conclusions: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.
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http://dx.doi.org/10.1111/bju.15483DOI Listing
May 2021

Androgen Deprivation Therapy in Patients With Prostate Cancer Increases Serum Levels of Thromboxane A: Cardiovascular Implications.

Front Cardiovasc Med 2021 13;8:653126. Epub 2021 Apr 13.

Grupo de Investigación en Urología, IdiPAZ, Madrid, Spain.

Androgens have been described as important players in the regulation of vascular function/structure through their action on the release and effect of vasoactive factors, such as prostanoids. Patients with prostate cancer (PCa) under androgen deprivation therapies (ADTs) present increased risk of cardiovascular mortality. Since thromboxane A (TXA) is one of the most studied prostanoids and its involvement in different cardiovascular diseases has been described, the aim of this study was to investigate: (i) the effect of ADT on the serum levels of TXA in PCa patients and its possible link to the redox status and (ii) the effect of the non-hydrolyzable TXA analog U-46619 on the function of the aorta of male rats. The levels of TXA and total antioxidant status in 50 healthy subjects, 54 PCa patients, and 57 PCa under ADT were evaluated. These determinations were accompanied by levels of testosterone and C-reactive protein as an inflammation marker. In aortic segments from male rats, the U46619-induced effects on: (i) the vasomotor responses to acetylcholine (ACh), to the NO donor sodium nitroprusside (SNP), to the carbon monoxide-releasing molecule-3 (CORM-3), and to noradrenaline (NA) and (ii) the expression of cyclooxygenase-2 (COX-2), heme oxygenase-1 (HO-1), and phosphorylated ERK1/2 were analyzed. The serum level of TXA in patients with PCa was increased with respect to healthy subjects, which was further increased by ADT. There was no modification in the total antioxidant status among the three experimental groups. In aortic segments from male rats, the TXA analog decreased the endothelium-dependent relaxation and the sensitivity of smooth muscle cells to NO, while it increased the vasoconstriction induced by NA; the expression of COX-2, HO-1, and pERK1/2 was also increased. ADT increased, along with other inflammatory/oxidative markers, the serum levels of TXA. The fact that TXA negatively impacts the vascular function of the aorta of healthy male rats suggests that inhibition of TXA-mediated events could be considered a potential strategy to protect the cardiovascular system.
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http://dx.doi.org/10.3389/fcvm.2021.653126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076684PMC
April 2021

Biomarkers for Renal Cell Carcinoma Recurrence: State of the Art.

Curr Urol Rep 2021 Apr 22;22(6):31. Epub 2021 Apr 22.

Department of Urology, Campus Bio-Medico University, Rome, Italy.

Purpose Of Review: We aim to summarize the current state of art about the possible use of biomarkers for predicting renal cell carcinoma (RCC) recurrence after curative treatment. In addition, we aim to provide a snapshot about the clinical implication of biomarkers use for follow-up planification.

Recent Findings: A wide variety of biomarkers have been proposed. RCC biomarkers have been individuated in tumoral tissue, blood, and urine. A variety of molecules, including proteins, DNA, and RNA, warrant a good accuracy for RCC recurrence and progression prediction. Their use in prediction models might warrant a better patients' risk stratification. Future prognostic models will probably include a combination of classical features (tumor grade, stage, etc.) and novel biomarkers. Such models might allow a more accurate treatment and follow-up planification.
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http://dx.doi.org/10.1007/s11934-021-01050-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062344PMC
April 2021

A systematic review and meta-analysis of Histoscanning™ in prostate cancer diagnostics.

World J Urol 2021 Apr 7. Epub 2021 Apr 7.

Institute for Urology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya str. 2 bld. 1, Moscow, 119991, Russia.

Context: The value of Histoscanning™ (HS) in prostate cancer (PCa) imaging is much debated, although it has been used in clinical practice for more than 10 years now.

Objective: To summarize the data on HS from various PCa diagnostic perspectives to determine its potential.

Materials And Methods: We performed a systematic search using 2 databases (Medline and Scopus) on the query "Histoscan*". The primary endpoint was HS accuracy. The secondary endpoints were: correlation of lesion volume by HS and histology, ability of HS to predict extracapsular extension or seminal vesicle invasion.

Results: HS improved cancer detection rate "per core", OR = 16.37 (95% CI 13.2; 20.3), p < 0.0001, I = 98% and "per patient", OR = 1.83 (95% CI 1.51; 2.21), p < 0.0001, I = 95%. The pooled accuracy was markedly low: sensitivity - 0.2 (95% CI 0.19-0.21), specificity - 0.12 (0.11-0.13), AUC 0.12. 8 of 10 studiers showed no additional value for HS. The pooled accuracy with histology after RP was relatively better, yet still very low: sensitivity - 0.56 (95% CI 0.5-0.63), specificity - 0.23 (0.18-0.28), AUC 0.4. 9 of 12 studies did not show any benefit of HS.

Conclusion: This meta-analysis does not see the incremental value in comparing prostate Histoscanning with conventional TRUS in prostate cancer screening and targeted biopsy. HS proved to be slightly more accurate in predicting extracapsular extension on RP, but the available data does not allow us to draw any conclusions on its effectiveness in practice. Histoscanning is a modification of ultrasound for prostate cancer visualization. The available data suggest its low accuracy in screening and detecting of prostate cancer.
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http://dx.doi.org/10.1007/s00345-021-03684-8DOI Listing
April 2021

Penile length and circumference dimensions: A large study in young Italian men.

Andrologia 2021 Jul 21;53(6):e14053. Epub 2021 Mar 21.

Centro Integrato di Sessuologia Il Ponte, Florence, Italy.

The aim of the present study was to evaluate the size of the penis in flaccidity and in erection of Italian men. A total of 4,685 men living in Italy and who have been visited at the Italian urology operating units were involved in the study between January 2019 and January 2020. Each patient was given details on how to measure their penis (erect length and circumference) in flaccidity and in erection, from the lower base to the distal penile tip. Mean (standard deviation [SD]) flaccid penis length was 9.47 (2.69), mean (SD) flaccid penis circumference was 9.59 (3.08), mean (SD) erect penis length was 16.78 (2.55) and mean (SD) erect penis circumference was 12.03 (3.82). At the linear regression analysis, height was associated with flaccid penis length (β = 0.04; p-value = .01), and erect penis length was (β = 0.05; p-value < .01) and erect penis circumference was (β = 0.06; p-value < .01). Height is proportional to the length of the penis in flaccidity and in erection, and to the circumference in erection. The increase in BMI leads to a reduction in the length of the erect penis, as well as weight gain reduces the length of the flaccid penis.
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http://dx.doi.org/10.1111/and.14053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243978PMC
July 2021

Psychological Health of Surgeons in a Time of COVID-19: A Global Survey.

Ann Surg 2021 Jan 22. Epub 2021 Jan 22.

Department of Urology, National University Hospital, National University Health System, Singapore Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore Department of Psychological Medicine, National University of Singapore Department of Urology, CiptoMangunkusumo Hospital, Jakarta, Indonesia General Surgery and Digestive System Service, Alfredo Espinosa Hospital, Urduliz, Vizcaya, Spain Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Italy Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom Hospital Israelita Albert Einstein, Sao Paulo, Brazil; BP-a Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, India Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR Eastern Health and Monash University Eastern Health Clinical School, Box Hill, VIC, Australia Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China Department of Urology, Marmara University Research and Training Hospital, Turkey Conselleria de Sanidad Universal y salud Publica, Spain Hospital Universitario Parc Taulí Sabadell, Spain Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Malaysia Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy Department of Urology, Campus Biomedico University of Rome, Italy Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain Division of Urology, University Health Network, Department of Surgery, University of Toronto, Canada Macquarie University Hospital and Royal North Shore Hospital, Department of Urology, Sydney, New South Wales, Australia Department of Urology- Luzerner Kantonsspital- Luzern, CH, Switzerland Instituto de Investigación Sanitaria San Carlos, Hospital Clinico San Carlos, Madrid, Spain Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS).

Objective: To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic.

Summary Background Data: The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19.

Methods: We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the Depression Anxiety Stress Scale-21 (DASS-21) and Impact of Event Scale-Revised (IES-R) scores.

Results: 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9% and 24.0% screened positive for depression, anxiety, stress and Post-Traumatic Stress Disorder (PTSD) respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress and PTSD (OR 1.3, 1,6, 1.4, 1.7 respectively, all p < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress and PTSD (OR 1.2, 1.2 and 1.3 respectively, all p < 0.05). Surgical specialities that operated in the Head and Neck region had higher psychological distress among its surgeons. Deployment for COVID-19-related work was not associated with increased psychological distress.

Conclusions: The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.
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http://dx.doi.org/10.1097/SLA.0000000000004775DOI Listing
January 2021

Beneficial Effects of Spirulina Aqueous Extract on Vasodilator Function of Arteries from Hypertensive Rats.

Int J Vasc Med 2020 8;2020:6657077. Epub 2020 Dec 8.

Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.

Hypertension is a multifactorial disorder considered one of the major causes of premature death worldwide. This pathology is associated with vascular functional/structural alterations in which nitric oxide (NO) and oxygen reactive species participate. On the other hand, the use of microalgae extracts in the treatment of cardiovascular diseases is increasing. Based on the antioxidant and antihypertensive properties of Spirulina, this study aims to investigate the effect of an aqueous extract of Spirulina on the vasodilator function of the aorta from spontaneously hypertensive rats (SHR), analyzing the functional role of NO. For this, aortic segments from male SHR were divided into two groups, one control and the other exposed to an Spirulina aqueous extract (0.1% w/v, for 3 hours), to analyze (i) the production of NO, superoxide anion, and hydrogen peroxide; (ii) the vasodilator response induced by acetylcholine (ACh), by the NO donor and sodium nitroprusside (SNP), and by the K channel opener and pinacidil; and (iii) the expression of the p-Akt, p-eNOS, and HO-1 proteins. The results showed that the aqueous Spirulina extract (i) increased the production of NO, did not significantly modify that of superoxide, while decreased that of hydrogen peroxide; (ii) increased the vasodilatory responses induced by ACh, NPS, and pinacidil; and (iii) increased the expression of p-Akt and HO-1. These results suggest that incubation with the aqueous Spirulina extract improves the vascular function of arteries from SHR by increasing the release/bioavailability/function of NO. Increased K channel activation and expression of pAkt and HO-1 appear to be participating in these actions.
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http://dx.doi.org/10.1155/2020/6657077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787865PMC
December 2020

A systematic review of nerve-sparing surgery for high-risk prostate cancer.

Minerva Urol Nephrol 2021 Jun 13;73(3):283-291. Epub 2021 Jan 13.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Introduction: We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa).

Evidence Acquisition: We have undertaken a systematic search of original articles using 3 databases: Medline/PubMed, Scopus, and Web of Science. Original articles in English containing outcomes of nerve-sparing radical prostatectomy (RP) for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: erectile function (EF) and urinary continence.

Evidence Synthesis: The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on odds ratio (OR) for positive margin and biochemical relapse. The presented results showed no effect of nerve sparing (NS) on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (hazard ratio [HR]=0.93, 0.52-1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with and without NSS.

Conclusions: NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.
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http://dx.doi.org/10.23736/S0393-2249.20.04178-8DOI Listing
June 2021

Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society.

Minerva Urol Nefrol 2021 01 13. Epub 2021 Jan 13.

Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy.

Background: Focal Therapy (FT) for Prostate Cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localised PCa.

Materials And Methods: A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, i) the current/present role; ii) the potential/future role; iii) the recommended features for future studies. Consensus was defined using a 70% agreement threshold.

Results: Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (n=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (n=3), a consensus on a partial agreement (n=1), and a consensus on uncertainty (n=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localised PCa. Research efforts in this field should be considered a priority.

Conclusions: The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
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http://dx.doi.org/10.23736/S0393-2249.20.04160-0DOI Listing
January 2021

Autonomous robots: a new reality in healthcare? A project by European Association of Urology-Young Academic Urologist group.

Curr Opin Urol 2021 03;31(2):155-159

Eastern Maine Medical Center, Bangor, Maine, USA.

Purpose Of Review: Artificial intelligence appears as a potential revolution in the general process of medical training, disease diagnosis and treatment. A novel disruptive technology of the 21st century will be 'learner' robots from artificial intelligence systems able to use all the combination of the available knowledge in medical repositories to give the best standard of care.

Recent Findings: The autonomy level of robots depends on three factors: the complexity of the task; the environment in which the robot operates, and the required level of human-robot interaction. Autonomous robots in healthcare may be classified in delivery, nurse, and surgical robots. The increasing capability of robots to perform independent actions and complex tasks raises responsibility and accountability issues in a wide variety of application domains. Ethical analyses of these issues are underway and are mostly oriented toward the development of ethical policies requiring a law frame on robotic autonomous behaviors.

Summary: Autonomous robots have the potential to improve current medical practice offering a more secure, reliable, and reproducible medicine. Many advancements are required for these new technologies to be fully integrated. Furthermore, the ethical implications of these technologies are yet to be evaluated.
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http://dx.doi.org/10.1097/MOU.0000000000000842DOI Listing
March 2021

Organ-sparing cystectomy techniques: Functional and oncological outcomes, review and current recommendations.

Arch Esp Urol 2020 12;73(10):961-970

Department of Urology. La Paz University Hospital. Madrid. Spain. Instituto de Investigación Hospital Universitario La Paz (IdiPAZ). Madrid. Spain.

Introduction: With increasing survival from bladder cancer, quality of life, should be one of the main goals following radical cystectomy and bilateral pelvic lymph node dissection (PLND). This techniqueis associated with significant morbidity, which may have a critical effect on quality of life. Concerns about functional outcomes, such as continence, potency, and sexual function in women, play a role in decision making for urologists and younger patients with muscle-invasive bladder cancer. Several modifications to the classic radical cystectomy technique, include preservation of genital or pelvic organs, developing in the improvement of postoperative continence, potency rates and sexual functionin female patients. OBJECTIVE: This review summarizes the organ-sparing cystectomy techniques and its functional and oncological outcomes.

Evidence Acquisition: A PubMed-based literature search was conducted up to April 2020. We selected the most recent and relevant original articles, metanalysis and reviews that have provided relevant information to guide organ-sparing cystectomy techniques and its functional and oncological outcomes.

Evidence Synthesis: In this review, we discuss selection criteria for male and female patients, organ-sparing cystectomy surgical techniques and its functional and oncological outcomes.

Conclusions: Radical cystectomy is associated with significant morbidity, which may have a critical effect on quality of life. Preservation of genital or pelvic organsin men and women, yield better sexual outcomes compared to radical cystectomy without compromising oncological outcomes in well selected patients. But no one of these techniques can be recommended over the classical standard radical cystectomy. Large-scale of prospective and multi-institutional studies are needed to conclude which patients are suitable for these techniques.
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December 2020

Immunotherapy toxicity. Diagnosis and treatment.

Arch Esp Urol 2020 12;73(10):906-917

Department of Urology. La Paz University Hospital. Madrid. Spain. Autonomous University of Madrid. Madrid. Spain. La Paz University Hospital Institute for Health Research (IdiPaz). Madrid. Spain.

Anti CTLA-4, anti PD-L1 and anti PD-1immune check point inhibitors (ICI) down regulate natural inhibitory pathways of the immune system, in turn increasing tumour surveillance and elimination. Cancer treatment through immune regulation has revolutionised many cancer therapies. However, these new treatments have also brought unique immune related adverse events (irAEs).

Objective: This paper presents a review of the available knowledge regarding irAE grading, incidence, diagnosis and management, serving as a clinical aid forall clinicians involved with ICI therapy.

Evidence Acquisition: A comprehensive English-language literature research of original and review articles in the Medline database until June 2020 has been carried out, using the MeSH terms: "immune checkpoint inhibitor toxicities" and "immune related adverseevent".

Conclusions: Further research should aim to investigate if the greater effect of combining ICI treatments issufficient to justify the increased risk of complications, as well as to identify specific subgroups that will benefit the most from these.
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December 2020

Precave: Immediate neoadjuvant instillation of chemotherapy for the prevention of non-muscle invasive bladder carcinoma recurrence: A prospective randomized clinical trial protocol.

Int J Surg Protoc 2020 17;24:21-26. Epub 2020 Oct 17.

Department of Urology, La Paz University Hospital, Madrid, Spain.

Introduction And Objectives: Recurrence rates for patients presenting with non-muscle invasive bladder carcinoma (NMIBC) can be as high as 60% during the first year after a transurethral resection of bladder tumor (TURBT). Currently, an immediate postoperative instillation of chemotherapy (IPOIC) is recommended for the prevention of recurrences in patients with low to intermediate risk disease. Although in real clinical practice this specific instillation of chemotherapy has many difficulties to be standardized, including its contraindications (suspected or confirmed bladder perforation, wide or extensive resection and, continuous bladder irrigation requirement), which will only make it feasible for around 30% of patients.We propose in this controlled study, to administer an immediate neoadjuvant instillation of chemotherapy (INAIC), which can be applied technically to all patients, no matter the surgical outcomes and compare it with a control group. We expect to find a reduction in the recurrence rate in the experimental group of at least 15%.

Methods: We designed a phase IV, randomized, controlled, open label clinical trial. Main inclusion criteria are: patients with a clinical diagnosis of localized, papillary-type bladder cancer (suspected low to intermediate risk) with a disease-free interval of at least 6 months. Eligible patients will be allocated into group A (INAIC plus TURBT) or group B (TURBT) using a computer-generated block randomization sequence/ratio 1:1. Time to recurrence of both groups will be analyzed and compared using Kaplan-Meier estimates, log-rank tests and, Cox-regression. Univariate and multivariate analyzes will be performed to determine factors which influence recurrence. The study has received the approval of the Ethics Committee for Drug Research (CEIm) of La Paz University Hospital and the Spanish Agency for Medicines and Health Products.
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http://dx.doi.org/10.1016/j.isjp.2020.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644741PMC
October 2020

Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study.

J Med Internet Res 2020 11 5;22(11):e21875. Epub 2020 Nov 5.

SH Ho Urology Centre, Prince of Wales Hospital, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel.

Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists' perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation.

Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only.

Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients' lack of technological comprehension, patients' lack of access to the required technology, and reimbursement concerns.

Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.
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http://dx.doi.org/10.2196/21875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647472PMC
November 2020

[Laser in prostate cancer. Applicability.]

Arch Esp Urol 2020 Oct;73(8):724-734

Servicio de Urología. Hospital Universitario La Paz. Madrid. España. Universidad Autónoma de Madrid. Madrid. España. Instituto de Investigación IdiPAZ. Hospital Universitario La Paz. Madrid. España.

Objectives: In recent years, there has been a rise concerning the research and development of focal prostate cancer therapies as a consequence of the high percentage of low-risk and localized prostate cancers. These focal therapies aim at preserving the gland in selected patients to avoid overtreatment. The application of lasers for focal ablation and photodynamic therapy has shown promising results in exchange for a minimal rate of adverse events compared to radical treatments.

Material And Methods: An extensive review of the available literature on focal laser treatments for localized prostate cancer was conducted. A search in PubMed and Embase was carried out by the following keywords: "Localised prostate cancer", "Low-risk prostate cancer", "Focal therapy", "Magnetic Resonance in localized prostate cancer", "Focal laser ablation" , "Photodynamic therapy" and "TOOKAD".

Results: Photodynamic therapy with TOOKAD is the only focal therapy evaluated in a phase III clinical trial,showing a lower rate of progression and a longer time to progression compared to active surveillance. Other studies carried out have revealed a percentage up to 80% of negative biopsies 6 months after TOOKAD. Likewise, the quality of life of patients treated using focal laser ablation techniques and photodynamic therapy has been minimally altered, as most adverse effects have been shown to be mild and transient, with dysuria and hematuria being the most frequent.

Conclusions: Despite the fact that focal therapies are still not recommended outside the context of clinical trials and the lack of comparative studies between the different techniques, laser focal therapies seem to havea future within the new approaches for localized prostate cancer.
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October 2020

En bloc MoLEP (MOSES HoLEP) with early apical dissection and preservation of the sphincter's mucosa. Surgical technique and technology developments that allow a new paradigm of endoscopic prostate enucleation.

Arch Esp Urol 2020 10;73(8):689-698

Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO. Madrid. España.

Endoscopic enucleation of the prostate was first described by Hiraoka in 1986, using a monopolar resectoscope. His contribution was largely ignored until Gilling and Fraundorfer published their three-lobe enucleation technique with the Holmium laser in 1998 ,that ended establishing itself as a reliable option for the treatment of HBP, backed by ample scientific evidence. Later on, enucleation performed with other lasers, as well as bipolar energy, have shown concordance in their clinical results. As a result, the term AEEP (anatomic endoscopic enucleation of the prostate) emerged to encompass all these techniques. During the last few years there have been significant advances in two areas: first, technology, with the development of pulse modulation for Holmium generators (MOSES) as well as high-speed morcellators. Second, the development of new surgical techniques that recognize the importance of the early release of the sphincter from the apex of the adenoma during the operation as well as the careful preservation of the external sphincter's mucosa, to avoid early stress incontinence. In this paper,we review the recent evolution of both technology and surgical technique. AEEP has been risen to a new level, reducing operative time significantly, usually under one hour, and radically reducing the incidence of early temporary stress incontinence, and maybe also facilitating the learning curve of AEEP.
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October 2020

VR and machine learning: novel pathways in surgical hands-on training.

Curr Opin Urol 2020 11;30(6):817-822

University Hospital Southampton NHS Trust, Southampton, UK.

Purpose Of Review: Surgical training has dramatically changed over the last decade. It has become not only the way to prepare surgeons for their everyday work, but also a way to certify their skills thus increasing patient safety. This article reviews advances in the use of machine learning and artificial intelligence applied to virtual reality based surgical training over the last 5 years.

Recent Findings: Eight articles have been published which met the inclusion criteria. This included six articles about the use of machine learning and artificial intelligence for assessment purposes and two articles about the possibility of teaching applications, including one review and one original research article. All the research articles pointed out the importance of machine learning and artificial intelligence for the stratification of trainees, based on their performance on basic tasks or procedures simulated in a virtual reality environment.

Summary: Machine learning and artificial intelligence are designed to analyse data and use them to take decisions that typically require human intelligence. Evidence in literature is still scarce about this technology applied to virtual reality and existing manuscripts are mainly focused on its potential to stratify surgical performance and provide synthetic feedbacks about it. In consideration of the exponential growth of computer calculation capabilities, it is possible to expect a parallel increase of research about this topic within the next few years.
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http://dx.doi.org/10.1097/MOU.0000000000000824DOI Listing
November 2020

Global Survey of the Roles and Attitudes Toward Social Media Platforms Amongst Urology Trainees.

Urology 2021 Jan 18;147:64-67. Epub 2020 Sep 18.

Department of Urology, La Paz University Hospital, Madrid, Spain, Autonomous University of Madrid, Madrid, Spain.

Objectives: To perform a global survey assessing the role of and the attitudes toward media platforms amongst training Urologists METHODS: We distributed a 21-item online survey on social medial (SoMe) and other media platforms to current Urology trainees by email via individual institutions and multiple Urological associations. The survey acquired data including baseline characteristics, the role of and attitudes toward SoMe and other media platforms in training and assessed the prevalence of Social Media Disorder (SMD) based on the validated 9-item SMD Scale. Stata IC was used for statistical analysis.

Results: Three hundred and seventy-two urology trainees in 6 continents participated in the survey. Overall, 99.4% used SoMe and 27.3% listened to healthcare-focused podcasts. Most trainees (85.5%) are using guideline apps for education purposes, with the top 3 most utilized apps being the EAU, AUA, and UpToDate applications. There was mixed sentiment regarding the impact of SoMe on the patient-physician relationship, wherein most felt it challenges the doctor's authority (56.7%) but also empowers the patient (62.7%) and encourages shared-care (57.3%). Unfortunately, 11.3% of urology trainees met criteria for SMD while 65.4% had not reviewed professional guidelines on appropriate SoMe use.

Conclusion: Despite practically all urology trainees using SoMe and guideline applications, the majority of trainees have not reviewed or have been educated on professional guidelines for SoMe usage. There is a small but significant number of trainees who are at risk for SMD which may be contributing to higher rates of physician burnout amongst urologists.
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http://dx.doi.org/10.1016/j.urology.2020.09.007DOI Listing
January 2021

Reply by Authors.

J Urol 2020 10 30;204(4):733. Epub 2020 Jul 30.

Department of Urology, Instituto Cirugía Urológica Avanzada (ICUA), Madrid, Spain.

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http://dx.doi.org/10.1097/JU.0000000000001083.03DOI Listing
October 2020

Knowledge gap across continents: the andrology and male infertility exposure among urology residents in the United States and Europe.

Int J Impot Res 2020 Aug 21. Epub 2020 Aug 21.

Department of Urology, University of Illinois at Chicago, Chicago, USA.

It is well established that resident's exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents' self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents' perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.
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http://dx.doi.org/10.1038/s41443-020-00342-2DOI Listing
August 2020
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