Hidden diversity in high-latitude Southern Hemisphere environments: Reinstatement of the genus Rama and description of Vandenhoekia gen. nov. (Cladophoraceae, Ulvophyceae, Chlorophyta), two highly variable genera.

The continental coasts and remote islands in the high-latitude Southern Hemisphere, including the subantarctic region, are characterized by many endemic species, high abundance of taxa, and intermediate levels of biodiversity. The macroalgal flora of these locations has received relatively little attention. Filamentous green algae are prolific in the intertidal of southern islands, but the taxonomy, distribution, and evolutionary history of these taxa are yet to be fully explored, mostly due to the difficulty of access to some of these locations. In this study, we examined specimens of the order Cladophorales from various locations in the high-latitude Southern Hemisphere including the subantarctic (the Auckland Islands, Bounty Islands, Campbell Island, Macquarie Island, and Kerguelen Islands), as well as mainland New Zealand, the Chatham Islands, Chile, and Tasmania. The analyses of the rDNA sequences of the samples revealed the existence of two new clades in a phylogeny of the Cladophoraceae. One of these clades is described as the novel genus Vandenhoekia gen. nov., which contains three species that are branched or unbranched. The amended genus Rama is reinstated to accommodate the other clade, and contains four species, including the Northern Hemisphere "Cladophora rupestris." In Rama both branched and unbranched morphologies are found. It is remarkable that gross morphology is not a predictor for generic affiliations in these algae. This study illustrates that much can still be learned about diversity in the Cladophorales and highlights the importance of new collections, especially in novel locations.

Molecular and morphological analyses reveal new taxa additions to the tribe Streblocladieae (Rhodomelaceae, Rhodophyta).

The recent segregation of 12 genera in the tribe Streblocladieae suggests that the taxonomy of some species belonging to Polysiphonia sensu lato is updated with the transfer and the proposal of new combinations. Accordingly, six new additions to the tribe Streblocladieae on the basis of morphological and molecular analyses are presented as a consequence of this new segregation. These additions include the description of the new species Carradoriella platensis sp. nov., the proposal of the following new combinations Eutrichosiphonia paniculata comb. nov., E. tapinocarpa comb. nov., and the reinstatement of Vertebrata curta, V. decipiens, and V. patersonis. Additionally, our morphological observations identified additional diagnostic features for two genera of the Streblocladieae. Carradoriella has branches with sexual reproductive structures arranged adaxially on branchlets, and the recently described Eutrichosiphonia has rhizoids with multicellular digitate haptera. Our study gives insights in regards to the distribution, the diagnostic features for delimiting genera morphologically, and the molecular evolutionary relationships in the Streblocladieae.

Crouania pumila sp. nov. (Callithamniaceae: Rhodophyta), a new species of marine red algae from the Seaflower International Biosphere Reserve, Caribbean Colombia.

In the Colombian Caribbean, the marine macroalgal flora of the Seaflower International Biosphere Reserve has been little studied, despite its ecological importance. Historical records have reported only 201 macroalgae species within its area of almost 350,000 km2. However, recent surveys have shown a diversity of small algae previously overlooked. With the aim to determine the macroalgal diversity in the Reserve, we undertook field surveys in different ecosystems: coral reefs, seagrass beds, and rocky and sandy substrates, at different depths, from intertidal to 37 m. During these field surveys, we collected a small described species belonging to the genus Crouania (Callithamniaceae, Rhodophyta), Crouania pumila sp. nov. that is decribed in this paper. This new species was distinguished from other species of the genus by a distinctive suite of traits including its diminutive size (to only 3.5 mm in length), its decumbent, slightly calcified habit (epiphytic on other algae), its ramisympodial branching, the ecorticate main axes, and the elongate shape of the terminal cells of the cortical filaments. The observations were provided for both female (cystocarpic) and tetrasporangiate thalli; however, male thalli were not seen. Further studies have to be undertaken in this Reserve in order to carry out other macroalgal analysis and descriptions.

Patient Demand for Urologists in the United States: A Google Trends Analysis.

INTRODUCTION: We sought to quantify patient demand for urologists on a state-by-state basis in the United States. METHODS: Google Trends data were analyzed from 2004-2019 to determine average relative search volume for the term "urologist" in each state. The 2019 American Urological Association Census was used to determine the number of practicing urologists per state. A per capita concentration of urologists was calculated by dividing the number of providers by the estimated population in each state as reported by the 2019 Census Bureau. Relative search volume values were then divided by the concentration of urologists to estimate a physician demand index for each state scaled 0-100. RESULTS: The physician demand index was highest in Mississippi (100), Nevada (89), New Mexico (87), Texas (82), and Oklahoma (78). The concentration of urologists per 10,000 people was greatest in New Hampshire (0.537), New York (0.529), and Massachusetts (0.514), and lowest in Utah (0.268), New Mexico (0.248), and Nevada (0.234). Relative search volume was highest in New Jersey (100.00), Louisiana (91.67), and Alabama (87.67), and lowest in Wisconsin (31.17), Oregon (29.17), and North Dakota (28.50). CONCLUSIONS: The findings of this study suggest that demand is greatest in the Southern and Intermountain regions of the United States. Facing a shortage in the urology workforce, these data may aid physicians and policy makers in focusing interventions. These findings may further aid in future job allocation and practice distribution.

Role of Race and Insurance Status in Prostate Cancer Diagnosis-to-Treatment Interval.

INTRODUCTION: Numerous studies have shown that both race and insurance status may affect prostate cancer (PCa) workup and treatment. Preliminary investigations have shown that these factors may be associated with treatment delays, which may indicate inequitable care and increase risk of tumor progression. This investigation aimed to assess whether race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy, and biopsy-to-prostatectomy. MATERIALS AND METHODS: A single-institution analysis of 261 patients with recorded race and insurance data was performed using an Institutional Review Board-compliant database with information spanning from 2016 to 2022. Race was self-reported during intake, and insurance status was retrieved from the electronic medical record. Insurance was sub-divided into private, Medicare, and Medicaid. Diagnostic or treatment latency was defined as time between mpMRI-to-biopsy, or biopsy-to-surgery. RESULTS: Stratified by race, there was no difference in either latency period when comparing African American (AA) and white patients. Stratified by insurance status, there was no difference in time from mpMRI-to-biopsy (P = .50), but there was a significantly longer interval from biopsy-to-prostatectomy for patients with Medicaid insurance (P = .02). Patients with Medicaid waited on average 168 days to receive surgery, in contrast to 92 days for private and 87 for Medicare. Notably, 82% of Medicaid patients were AA. CONCLUSION: Insurance status, which is inherently linked to race and social determinants of health, portended a significantly increased interval between biopsy and surgery. Physicians should be aware of the relationship between insurance status and treatment delay, as well as its potential downstream consequences.

Post traumatic internal iliac arteriovenous fistula presenting with persistent gross hematuria.

Traumatic pelvic arteriovenous fistulas (AVFs) are exceedingly rare and can lead to significant morbidity. Herein, we describe the case of a 31 year-old male who presented with two months of recurrent gross hematuria following a gluteal gun-shot wound and was found to have a right internal iliac AVF. To our knowledge, this is the first reported case of a post traumatic pelvic AVF presenting with gross hematuria.

Metastasis to the Bladder: A Rare Site of Recurrence of Renal Cell Carcinoma.

Renal cell carcinoma (RCC) is considered to be the deadliest urologic cancer with high rates of metastasis and recurrence after nephrectomy. RCC can metastasize to nearly any organ but most commonly metastasizes to the liver, lung, brain, and bone. To date, there are only about 40 reported cases of RCC with solitary bladder metastasis. The following report contributes to this limited data set of patients with RCC who develop solitary metastasis to the bladder. A 69-year-old male presented with occasional gross hematuria and was found to have a left renal mass infiltrating the collecting system. Ureteroscopic biopsy revealed clear cell RCC, and the patient subsequently underwent radical left nephrectomy. Eight months after nephrectomy, the patient presented to the clinic with gross hematuria. In-office cystoscopy demonstrated a nodular lesion in the bladder arising from the left ureteral orifice. The patient underwent transurethral resection of the bladder mass and pathology demonstrated clear cell RCC. Subsequent imaging showed no evidence of metastatic disease. Five months after transurethral resection, the patient was found to have a left distal ureteral mass and underwent left ureterectomy with partial cystectomy. Pathology again demonstrated clear cell RCC. RCC with solitary metastasis to the bladder is rare, and there are no targeted guideline recommendations for management. Per standard of care, patients with painless hematuria and risk factors for malignancy should undergo cystoscopy. In patients with a history of RCC, metastasis to the bladder should be considered in the differential diagnosis. Patients with metastatic RCC to the bladder should undergo a thorough work-up for additional sites of metastasis. In patients with RCC who develop solitary bladder metastasis amenable to resection following nephrectomy, there is a lack of evidence to guide therapy and a multidisciplinary discussion is warranted. However, if the tumor is amenable to resection, metastasectomy is a reasonable therapeutic approach and offers the patient an improved quality of life and an opportunity for remission.

Cochlear implantation with large vestibular aqueduct syndrome.

OBJECTIVES: In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine. STUDY DESIGN: This is a retrospective case-control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med-El (MED-EL Corp., Innsbruck, Austria) cochlear implants. METHODS: Performance data on pure-tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre- or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a chi2 test. RESULTS: The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects. CONCLUSIONS: This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.

Changes in quality of life and the cost-utility associated with cochlear implantation in patients with large vestibular aqueduct syndrome.

OBJECTIVE: A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine. The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome, as well as the cost-utility of cochlear implantation in this group. SETTING: A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center. Data collected from the medical records for each patient included demographic data, hearing-related statistics, implantation data, and audiometric data. Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study, and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss. Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index, Mark III. The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center, as well as from costs associated with implantation published in the medical literature. METHODS: Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss. Two groups were formed. These groups comprised either cochlear implant patients with large vestibular aqueduct syndrome or patients with large vestibular aqueduct syndrome currently using hearing aids. Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria. Mark III health utility indexes were distributed to patients in each group and scored. Those health utility indexes not completed by the patients were scored by proxy, using the audiologist at this center who was the most familiar with the patient. Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups. Cost-utility measures were then made using discounted costs per quality-of-life years (QALYs) (5%), and a sensitivity analysis was performed that evaluated changes in scoring done by proxy. The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states. RESULTS: Although both groups of patients had significant hearing loss, the hearing aid group had a better mean pure-tone average. The mean pure-tone average for the hearing aid group was 70.8 dB (SD 24.4), and the mean pure-tone average for the cochlear implant group was 107.0 dB (SD 21.7). Seven of the 20 health utility indexes were scored by proxy. Results from the base case indicate a 0.20 gain in health utility from cochlear implantation (hearing aid = 0.62, cochlear implant = 0.82, p = 0.037), resulting in a discounted cost per QALY of $12,774. Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index resulted in a gain in health utility with cochlear implantation of 0.15, resulting in a discounted cost per QALY of $17,832. A decrease of the hearing score by two levels on the health utility survey resulted in no significant gain in quality of life with cochlear implantation. CONCLUSION: This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome. By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group, further strength can be given to this conclusion. This gain in quality of life, as well as the results derived for the cost-utility of cochlear implantation, was similar to that in previous published studies of cochlear implantation in all types of patients. These results also indicate a favorable cost-utility when compared with published data about other disease states. As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss, these results indicate that cochlear implantation can be offered as a beneficial, life-improving therapy.

Transient-evoked otoacoustic emissions from ears with tympanostomy tubes.

OBJECTIVE: Otoacoustic emissions (OAEs) are low-level acoustic signals which emanate from the cochlea and can be recorded in the ear canal. The two types of OAEs are spontaneous and evoked otoacoustic emissions. METHODS: In this retrospective study, transient-evoked otoacoustic emissions (TEOAEs) were measured in 385 ears from 204 children with normal hearing and tympanostomy tubes. RESULTS: The results indicate that, when using the Quick Screen option on the Oto-Dynamics ILO88 Otoacoustic Emission Analyzer, postoperative TEOAEs were present at all measured frequencies in 81% of the ears. The remaining 19% of ears showed the absence of an observable emission at one or more of the measured response frequencies. The overwhelming factor contributing to an absent emission was insufficient stimulus energy at 4 kHz. The use of T-type tympanostomy tubes also appeared to decrease the probabilities obtaining normal TEOAEs in ears with normal peripheral auditory function. The use of grommet-type tympanostomy tubes, the type of middle ear effusion, the age and gender of the child, and the physical volume of the ear canal as measured by tympanometry with the tympanostomy tube patent and in place had negligible effects on the measurement of TEOAEs. CONCLUSIONS: Clinicians must be cautious when interpreting click-evoked TEAOEs if the patient has a T-tube in place and may need to modify this testing to rule out high-frequency hearing loss when using TEOAEs with these patients. For those patients who have tympanostomy tubes and fail to meet the "pass criteria" for TEOAEs at 4 kHz in the Quick Screen option, TEOAE should be repeated either in the Diagnostic mode or by using a 4 kHz tone-burst stimulus centered at 4 kHz to recover the loss of energy in this region due to the high-frequency roll-off of the stimuli used in the Quick Screen option.

The status of the name Alysium holtingii C. Agardh, a red alga described from Brazil, and a depiction of the type specimen.

The type specimen of the red alga Alysium holtingii C. Agardh, described from Brazil, is located in the Lund Herbarium, and it is depicted for the first time in a publication. It is taxonomically identical to Dichotomaria obtusata (J. Ellis and Solander) Lamarck and thus can be treated as a later taxonomic synonym. Alysium is regarded as congeneric with Dichotomaria.

Crouania pumila sp. nov. (Callithamniaceae: Rhodophyta), a new species of marine red algae from the Seaflower International Biosphere Reserve, Caribbean Colombia / Crouania pumila sp. nov. (Callithamniaceae: Rhodophyta), una nueva especie de alga roja marina de la Reserva Internacional de la Biosfera Seaflower, Caribe colombiano

In the Colombian Caribbean, the marine macroalgal flora of the Seaflower International Biosphere Reserve has been little studied, despite its ecological importance. Historical records have reported only 201 macroalgae species within its area of almost 350 000km². However, recent surveys have shown a diversity of small algae previously overlooked. With the aim to determine the macroalgal diversity in the Reserve, we undertook field surveys in different ecosystems: coral reefs, seagrass beds, and rocky and sandy substrates, at different depths, from intertidal to 37m. During these field surveys, we collected a small described species belonging to the genus Crouania (Callithamniaceae, Rhodophyta), Crouania pumila sp. nov. that is decribed in this paper. This new species was distinguished from other species of the genus by a distinctive suite of traits including its diminutive size (to only 3.5mm in length), its decumbent, slightly calcified habit (epiphytic on other algae), its ramisympodial branching, the ecorticate main axes, and the elongate shape of the terminal cells of the cortical filaments. The observations were provided for both female (cystocarpic) and tetrasporangiate thalli; however, male thalli were not seen. Further studies have to be undertaken in this Reserve in order to carry out other macroalgal analysis and descriptions.

Crouania pumila sp. nov. (Ceramiaceae, Rhodophyta) es descrita para la isla de Providencia, en el Caribe colombiano. La nueva especie se destaca de las otras especies del género por características como su tamaño diminuto (hasta 3.5mm de largo), su hábito decumbente y poco calcificado (epífita sobre otras algas), su ramificación ramisimpodial, la ausencia de corticación y la forma alargada de las células terminales de los filamentos corticales. Se proveen observaciones sobre talos femeninos (cistocárpicos) y tetraspóricos. No se observaron talos masculinos.

The status of the name Alysium holtingii C. Agardh, a red alga described from Brazil, and a depiction of the type specimen

The type specimen of the red alga Alysium holtingii C. Agardh, described from Brazil, is located in the Lund Herbarium, and it is depicted for the first time in a publication. It is taxonomically identical to Dichotomaria obtusata (J. Ellis and Solander) Lamarck and thus can be treated as a later taxonomic synonym. Alysium is regarded as congeneric with Dichotomaria.

O espécime tipo da alga vermelha Alysium holtingii C. Agardh, descrito para o Brasil, está localizado no Herbário Lund, e é aqui apresentado. Ele é taxonomicamente idêntico a Dichotomaria obtusata (J. Ellis e Solander) Lamarck e portanto deve ser tratado como um sinônimo taxonômico posterior. Alysium é considerado como congenérico com Dichotomaria.