Objective We aimed to determine which aspects of the COVID-19 national response are independent predictors of COVID-19 mortality and case numbers. Design Comparative observational study between nations using publically available data Setting Worldwide Participants Covid-19 patients Interventions Stringency of 11 lockdown policies recorded by the Blavatnik School of Government database and earliness of each policy relative to first recorded national cases Main outcome measures Association with log10 National deaths (LogD) and log10 National cases (LogC) on the 29th April 2020 corrected for predictive demographic variables Results Early introduction was associated with reduced mortality (n=137) and case numbers (n=150) for every policy aside from testing policy, contact tracing and workplace closure. Maximum policy stringency was only found to be associated with reduced mortality (p=0.003) or case numbers (p=0.010) for international travel restrictions. A multivariate model, generated using demographic parameters (r2=0.72 for LogD and r2=0.74 for LogC), was used to assess the timing of each policy. Early introduction of first measure (significance p=0.048, regression coefficient β=-0.004, 95% confidence interval 0 to -0.008), early international travel restrictions (p=0.042, (β=-0.005, -0.001 to -0.009) and early public information (p=0.021, β=-0.005, -0.001 to -0.009) were associated with reduced LogC. Early introduction of first measure (p=0.003, β=-0.007, -0.003 to -0.011), early international travel restrictions (p=0.003, β=-0.008, -0.004 to-0.012), early public information (p=0.003, β=-0.007, 0.003 to -0.011), early generalised workplace closure (p=0.031, β=-0.012, -0.002 to -0.022) and early generalised school closure (p=0.050, β=-0.012, 0 to -0.024) were associated with reduced LogC. Conclusions At this stage in the pandemic, early institution of public information, international travel restrictions, and workplace closure are associated with reduced COVID-19 mortality and maintaining these policies may help control the pandemic.

Gastrin-releasing peptide (GRP), the mammalian counterpart of bombesin, was first identified in the nervous system of the gastrointestinal tract. Little is known about its distribution in the human skin or about its function in certain diseases such as malignant melanoma. Recently functional GRP receptors have been found on human melanoma cell lines. We therefore investigated, using immunohistochemistry, whether human melanoma cells express GRP and whether there is a significant change in its distribution among the different clinical types of melanoma and a connection to histopathological features such as growth phase, type of malignant cells, Breslow thickness and Clark level of invasion. We demonstrated the existence of GRP in all clinicopathological types of melanoma; a predilection for quantitatively increased GRP immunostaining was noticed in nodular melanomas (P = 0.007). As well as this, we observed a restriction of GRP expression at a specific level of invasion, i.e. within the reticular dermis (Clark IV) (P = 0.032). GRP immunoreactivity was found to be associated with an increased amount of melanin pigment in malignant cells (P = 0.054). The presence of GRP in malignant melanocytes, along with its association with the various histopathological features, suggests that GRP may play a role in the pathophysiology of this type of cutaneous tumour.

Objectives To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low‐ and high‐volume PCNL centres, and between grade of lead surgeon. Patients/Subjects and Methods In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1‐year period. Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure. Results Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm2; FT, 49 s); URS (DAP, 2.8 Gy/cm2; FT, 57 s); PCNL (DAP, 24.1 Gy/cm2; FT, 431 s). Significant variations in the median DAP and FT were identified between individual centres for all procedures (P < 0.001). For PCNL, there was a statistically significant difference between DAP for low‐ (<50 cases/annum) and high‐volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm2 vs 4.2 Gy/cm2 (P < 0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP, 2.17 Gy/cm2; FT, 41 s) vs Registrar (DAP, 1.38 Gy/cm2; FT, 26 s; P < 0.001). Conclusion This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure ‘as low as reasonably achievable’. This snapshot of real‐time data shows significant variation around the country, as well as significant differences between low‐ and high‐volume centres for PCNL, and grade of lead surgeon for stent procedures.

Introduction: The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives: We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods: 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results: Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion: Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.

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