Hippocampal convergence during anticipatory midbrain activation promotes subsequent memory formation.

The hippocampus has been a focus of memory research since H.M's surgery abolished his ability to form new memories, yet its mechanistic role in memory remains debated. Here, we identify a candidate memory mechanism: an anticipatory hippocampal "convergence state", observed while awaiting valuable information, and which predicts subsequent learning. During fMRI, participants viewed trivia questions eliciting high or low curiosity, followed seconds later by its answer. We reasoned that encoding success requires a confluence of conditions, so that hippocampal states more conducive to memory formation should converge in state space. To operationalize convergence of neural states, we quantified the typicality of multivoxel patterns in the medial temporal lobes during anticipation and encoding of trivia answers. We found that the typicality of anticipatory hippocampal patterns increased during high curiosity. Crucially, anticipatory hippocampal pattern typicality increased with dopaminergic midbrain activation and uniquely accounted for the association between midbrain activation and subsequent recall. We propose that hippocampal convergence states may complete a cascade from motivation and midbrain activation to memory enhancement, and may be a general predictor of memory formation.

To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic.

INTRODUCTION: After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. MATERIAL AND METHODS: An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. RESULTS: 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits. CONCLUSION: The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.

Organ-preserving endoscopic kidney cancer resection.

OBJECTIVE: Recently, minimally invasive therapies for renal cell carcinoma have been devised to minimise operative morbidity yet achieve comparable oncologic and functional outcomes. This video summary of laparoscopic transperitoneal organ-preserving kidney cancer resection shows the procedure from the surgeon's view. METHODS: The video and photos show the main steps of the procedure. The results of 40 transperitoneal and retroperitoneal procedures performed during 2001-2005 are discussed. Preoperative preparation includes abdominal computed tomography and ureteral catheterisation. Tumour margins were determined by laparoscopic renal ultrasonography. Vessel control was done by en bloc clamping or solitary clamping of the artery. For optimal macroscopic evaluation of the resection margins, tumour excision was solely done with cold Endoshears followed by pelvicaliceal suture repair and parenchymal closure over surgical bolsters with a biologic haemostatic agent. RESULTS: In 40 cases, we converted to the open procedure only once. The average patients age was 53 yr and mean tumour size was 26 mm. No patient showed positive surgical margins. The mean warm ischemia time was 21 min. Final histopathology revealed renal clear cell carcinoma as the major cell type followed by papillary renal carcinoma. Two patients required blood transfusion. Estimated mean blood loss was 270 ml. Median time of hospitalisation was 6 d. CONCLUSION: Endoscopic partial nephrectomy can be performed by experienced surgeons in selected patients. Tumour location and size and the surgeons' experience and preference are the main parameters to make the decision of the type of access.