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1.
Arch Esp Urol ; 77(7): 718-725, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39238294

RESUMEN

BACKGROUND: Prostate cancer (PCa) remains a significant global health issue, exhibiting a spectrum of clinical behaviours from indolent to aggressive. Biomarkers are crucial for risk assessment, treatment selection and prognosis prediction. Despite their importance, accurately evaluating PCa aggressiveness and guiding personalised treatment strategies present challenges. This review aims to evaluate biomarkers for assessing recurrence risk following radical prostatectomy, with a focus on personalised follow-up and timely intervention for high-risk patients. This review assesses the clinical significance of immunohistochemical biomarkers, including LIM domain kinase 1 (LIMK1), Antigen Kiel 67 (Ki67), PTEN and ERG, in PCa management. A comprehensive literature review examined the correlation between these biomarkers and biochemical recurrence (BCR) in patients undergoing radical prostatectomy. Our search included articles published between 2019 and 2024, yielding 87 articles, with 7 focused on the correlation between LIMK1 and BCR, 46 on Ki67 and 34 on PTEN/ERG biomarkers. After applying the exclusion criteria, 36 articles were included for review. LIMK1, a serine/threonine kinase, is highly expressed in cancers like PCa. It influences cell survival and motility through actin cytoskeleton reorganisation, correlating with poor prognosis, aggressive tumour behaviour and BCR. Similarly, Ki67, a marker of cell proliferation, predicts high-risk PCa and worse prognosis, particularly in castration-resistant cases, although its association with recurrence risk remains debated. PTEN loss and ERG fusion are prevalent genetic alterations in PCa, with PTEN loss linked to poor prognosis and ERG fusion associated with increased disease progression and BCR post-prostatectomy. Integrating these biomarkers into clinical practice can enhance risk stratification and inform personalised treatment strategies for patients with PCa. Despite promising findings, further validation studies and standardisation of detection methods are needed to ensure the clinical utility of these biomarkers. Continued research is essential to validate and optimise the clinical utility of these biomarkers, paving the way for more effective PCa management strategies and improved patient outcomes and quality of life.


Asunto(s)
Biomarcadores de Tumor , Inmunohistoquímica , Recurrencia Local de Neoplasia , Prostatectomía , Neoplasias de la Próstata , Humanos , Masculino , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/metabolismo , Medición de Riesgo , Valor Predictivo de las Pruebas
2.
Med Pharm Rep ; 97(3): 330-337, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39234449

RESUMEN

Background and aims: To evaluate the quality of life in patients treated for prostate cancer in detail, an accessible, extensive, and easy-to-administer questionnaire is needed. The self-administered 50-item "Expanded Prostate Cancer Index Composite" (EPIC) is an instrument used for this purpose, but it is not officially translated into Romanian. The aim of the study was to translate and validate the Romanian version of the EPIC. Methods: We translated and culturally adapted the EPIC into Romanian. For validation, we included a retrospective analysis of 112 patients who underwent robotic radical prostatectomy and a prospective study including 120 consecutive patients hospitalized before surgical treatment. Baseline and follow-up assessments took place before and at six months, two, and five years post-surgery, between January 2014 and December 2015. We performed cross-sectional correlations between the EPIC, AUASI, and SF-12 at baseline, factor analysis, and calculated the internal consistency. Results: For most EPIC domains and subscales, our a priori-defined criteria for reliability were fulfilled (Cronbach's alpha 0.7-0.9). Cross-sectional correlations between EPIC scales and AUASI domain ranged from 0.23-0.69, and SF-12 domains ranged from 0.21-0.53 and 0.22-0.61, respectively. The retrospective analysis showed a medium acceptability and understanding of the EPIC questionnaire. In the prospective study, the revised EPIC draft showed an overall higher acceptability with a responding rate of 66% at a 5-year follow-up. All domains exhibited good internal consistency except for the hormonal section (Cronbach's α = 0.67) at the 6-month follow-up. Conclusion: The Romanian version of the EPIC is reliable, responsive and valid for measuring HRQL in prostate cancer patients. The EPIC questionnaire proved to be an exhaustive and reproducible instrument for evaluating the quality of life in Romanian prostate cancer patients.

3.
Med Pharm Rep ; 97(3): 338-346, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39234455

RESUMEN

Background and aims: To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). Methods: From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. Results: The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. Conclusions: In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

4.
J Clin Med ; 13(16)2024 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-39201005

RESUMEN

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (-0.3 versus -0.6, p < 0.001) and median sodium drop (-0.3 versus -0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.

5.
Surgeon ; 2024 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-39025684

RESUMEN

INTRODUCTION: Infective endocarditis(IE) has a low incidence, but it remains a serious disease with high mortality rates. Only 5 % of these patients will develop a splenic abscess, and the number of patients that have IE and a splenic abscess requiring surgery is low. The current guidelines recommend that splenectomy should be performed prior to valve replacement, but there is no strong evidence to support this statement and no evidence to clearly endorse the order in which the surgical interventions should be performed. The objective of this review and case series is to establish the proper treatment strategy, to assess the adequate order of the surgical interventions and to clarify the role of percutaneous drainage in the management of these patients. MATERIAL AND METHODS: All patients with infective endocarditis and splenic abscess who underwent surgery in our institution, between January 2008 and December 2020 were included in this study, excluding patients which had cardiac device related endocarditis. Literature review on the matter included a number of 30 studies which were selected from the PubMed database. RESULTS: Assessing the literature and case series no reinfection was reported for simultaneously performing splenectomy(S) and valvular surgery(VS) nor for VS followed by S. CONCLUSION: Percutaneous drainage of the splenic abscesses is a feasible solution as definitive therapy in high-risk patients or as bridge therapy. Additional studies are needed, even though they are difficult to conduct, therefore a national/international infectious endocarditis register may be of use to clarify these challenges.

6.
Pulm Circ ; 14(2): e12391, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38784819

RESUMEN

Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty-five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow-up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%-90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease-associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA-to-aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end-diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre-capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA-to-aorta, RV end-diastolic area and PH etiology) and long-term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

7.
Genes (Basel) ; 15(5)2024 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-38790213

RESUMEN

MicroRNAs (miRNAs) are a class of small non-coding RNAs that may function as tumor suppressors or oncogenes. Alteration of their expression levels has been linked to a range of human malignancies, including cancer. The objective of this investigation is to assess the relative expression levels of certain miRNAs to distinguish between prostate cancer (PCa) from benign prostatic hyperplasia (BPH). Blood plasma was collected from 66 patients diagnosed with BPH and 58 patients with PCa. Real-time PCR technology was used to evaluate the relative expression among the two groups for miR-106a-5p and miR-148a-3p. The significant downregulation of both miRNAs in plasma from PCa versus BPH patients suggests their potential utility as diagnostic biomarkers for distinguishing between these conditions. The concurrent utilization of these two miRNAs slightly enhanced the sensitivity for discrimination among the two analyzed groups, as shown in ROC curve analysis. Further validation of these miRNAs in larger patient cohorts and across different stages of PCa may strengthen their candidacy as clinically relevant biomarkers for diagnosis and prognosis.


Asunto(s)
Biomarcadores de Tumor , MicroARNs , Hiperplasia Prostática , Neoplasias de la Próstata , Humanos , Masculino , MicroARNs/genética , MicroARNs/sangre , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/sangre , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/sangre , Anciano , Persona de Mediana Edad , Hiperplasia Prostática/genética , Hiperplasia Prostática/sangre , Hiperplasia Prostática/diagnóstico , Proyectos Piloto , Regulación Neoplásica de la Expresión Génica
8.
Arch Esp Urol ; 77(1): 43-48, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38374012

RESUMEN

PURPOSE: This study aimed to evaluate the indirect effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the surgical outcomes and oncological results of patients who underwent surgery during the lockdown period. METHODS: We analysed data from 423 patients who underwent radical prostatectomy between 2016 and 2022, with a cut-off date of March 16, 2020. Patients were categorised into two groups, namely, pre-lockdown (n = 289) and during lockdown (n = 134). Perioperative variables, histopathological findings and oncological outcomes, including prostate-specific antigen (PSA) levels and biochemical recurrence (BCR), were assessed. RESULTS: The number of radical prostatectomy increased by 24.26% during lockdown. The study included patients with a mean follow-up of 21 months. A nonsignificant trend towards a higher PSA level at presentation was found (14.22 vs. 12.53 ng/dL, p = 0.216). The International Society of Urological Pathology grade was not significantly different among radical prostatectomy specimens (p = 0.669). Lymph node involvement increased during the COVID-19 period (p = 0.046). The pT classification in prostatectomy specimens increased during the pandemic, but the difference from the pre-pandemic value was not statistically significant. The BCR rates were 24.6% pre-lockdown and 29.9% during lockdown (p = 0.136). CONCLUSIONS: The COVID-19 pandemic led to poor postoperative results. Through a 2-year follow-up, this research investigated the effect of the pandemic on the oncological outcomes, particularly BCR, of patients who underwent radical prostatectomy. Further extended investigations and multi-institutional studies should be conducted to quantify the effect of the pandemic on various cancer outcomes and inform crisis management strategies.


Asunto(s)
COVID-19 , Neoplasias de la Próstata , Masculino , Humanos , Antígeno Prostático Específico , Pandemias , Estudios de Seguimiento , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Prostatectomía/métodos , Estudios Retrospectivos , Recurrencia Local de Neoplasia
9.
Arch. esp. urol. (Ed. impr.) ; 77(1): 43-48, 28 jan. 2024. tab
Artículo en Inglés | IBECS | ID: ibc-230497

RESUMEN

Purpose: This study aimed to evaluate the indirect effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the surgical outcomes and oncological results of patients who underwent surgery during the lockdown period. Methods: We analysed data from 423 patients who underwent radical prostatectomy between 2016 and 2022, with a cut-off date of March 16, 2020. Patients were categorised into two groups, namely, pre-lockdown (n = 289) and during lockdown (n = 134). Perioperative variables, histopathological findings and oncological outcomes, including prostate-specific antigen (PSA) levels and biochemical recurrence (BCR), were assessed. Results: The number of radical prostatectomy increased by 24.26% during lockdown. The study included patients with a mean follow-up of 21 months. A nonsignificant trend towards a higher PSA level at presentation was found (14.22 vs. 12.53 ng/dL, p = 0.216). The International Society of Urological Pathology grade was not significantly different among radical prostatectomy specimens (p = 0.669). Lymph node involvement increased during the COVID-19 period (p = 0.046). The pT classification in prostatectomy specimens increased during the pandemic, but the difference from the pre-pandemic value was not statistically significant. The BCR rates were 24.6% pre-lockdown and 29.9% during lockdown (p = 0.136). Conclusions: The COVID-19 pandemic led to poor postoperative results. Through a 2-year follow-up, this research investigated the effect of the pandemic on the oncological outcomes, particularly BCR, of patients who underwent radical prostatectomy. Further extended investigations and multi-institutional studies should be conducted to quantify the effect of the pandemic on various cancer outcomes and inform crisis management strategies (AU)


Asunto(s)
Humanos , Masculino , /epidemiología , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento , Estudios de Seguimiento , Prostatectomía
10.
Urol J ; 21(3): 162-168, 2024 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-38219017

RESUMEN

PURPOSE: To analyze the perioperative factors that influence the risk of biochemical recurrence (BCR) in patients with localized PCa undergoing radical prostatectomy Materials and Methods: A total of 457 patients, operated by 2 surgeons in our high-volume oncological center were included in the initial database. Patients who underwent RP for clinically localized PCa in our clinic from 2016 to 2021 were included in the study. Perioperative data were retrospectively reviewed for this study. Follow-up data including post-operative PSA and adjuvant treatment was prospectively gathered by contacting the patients or from the follow-up consultation. Final database was composed of 366 patients who underwent open or 3D laparoscopic RP. Statistical analysis was performed to emphasize the most powerful parameters that influence the BCR.  Results: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients that received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR. CONCLUSION: Perioperative factors need to be carefully analyzed and a detailed follow-up needs to be conducted in order to assess the risk of biochemical recurrence, resulting in the optimal time for adjuvant treatment implementation.


Asunto(s)
Recurrencia Local de Neoplasia , Antígeno Prostático Específico , Prostatectomía , Neoplasias de la Próstata , Humanos , Prostatectomía/métodos , Masculino , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/patología , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Antígeno Prostático Específico/sangre , Anciano , Medición de Riesgo , Factores de Riesgo , Periodo Perioperatorio
11.
Urology ; 183: e316, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37832832

RESUMEN

OBJECTIVE: To report our step-by-step technique for 3D laparoscopic radical nephrectomy and thrombectomy for a right renal tumor with level IV venous thrombus. Worldwide experience in minimally-invasive approach for such complex cases is limited. MATERIALS AND METHODS: A 66-year-old male was incidentally diagnosed with a right renal tumor. He had a medical history of hypertension and benign prostatic hyperplasia. Blood test analysis showed a hemoglobin of 11.2 g/dL and creatinine of 0.92 mg/dL. Liver function and bilirubin were within normal limits. Contrast-enhanced abdominal CT scan showed an 90/77/85 mm right renal mass with a level IV inferior vena cava (IVC) tumor thrombus. Cardiac MRI showed that the tumor thrombus was extending into the right atrium, through the tricuspid valve and into the right ventricle. There was no evidence of distant metastases. After a multidisciplinary team reviewed the case, the patient was scheduled for 3D laparoscopic radical nephrectomy and thrombectomy by mini-thoracotomy approach RESULTS: Retroperitoneal laparoscopic approach was used to ensure rapid access on the renal artery, with minimal mobilization of the renal vein, and to better isolate the posterior wall of the IVC. Surgery continued with the transperitoneal approach and the isolation of the infrarenal and infrahepatic IVC and left renal vein. Meanwhile the right femoral artery and vein and right jugular vein were cannulated. Mini-thoracotomy was performed and cardiopulmonary by-pass was started. Blood flow through the IVC and left renal vein was stopped, and the right atrium was opened to control the thrombus. Cavotomy was performed at the level of right renal hilum and the tumor thrombus was identified and sectioned. There were no signs of thrombus adherence to the IVC wall. The thoracic segment of the thrombus was completely extracted by the cardiovascular surgeons. Pringle maneuver was not necessary, as there was no retrograde bleeding. No intraoperative adverse events occurred, according to the Intraoperative Complications Assessment and Reporting with Universal Standards Criteria. The operative time was 7 hours. Blood loss was minimal, with no need of intra- or postoperative transfusions. Hospital length of stay was 8 days. Pathology revealed renal cell carcinoma, International Society of Urological Pathology 3, with negative surgical margins. At 9-months follow-up, the patient is doing well, without signs of local or distant recurrence. CONCLUSION: 3D laparoscopy is a feasible alternative to open surgery for the most complex cases, enabling very precise dissection and suturing. We have shown a case of successful 3D laparoscopic radical nephrectomy with IVC thrombectomy combined with mini-thoracotomy achieving complete intracardiac thrombus removal.


Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Laparoscopía , Trombosis , Trombosis de la Vena , Masculino , Humanos , Anciano , Vena Cava Inferior/cirugía , Vena Cava Inferior/patología , Toracotomía , Trombosis de la Vena/cirugía , Trombosis de la Vena/complicaciones , Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Trombosis/cirugía , Trombosis/complicaciones , Trombectomía/métodos , Hemorragia/complicaciones , Nefrectomía/métodos , Laparoscopía/métodos
12.
Med Pharm Rep ; 96(4): 384-391, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37970196

RESUMEN

Background and aims: Prostate adenocarcinoma (PRAD) is a complex disease that can be driven by alterations in both coding and noncoding genes. Recent research has identified coding and non-coding genes that are considered to play important roles in prostate cancer evolution and which may be used as biomarkers for disease diagnosis, prognosis, and treatment. TP53 is a critical hub gene in prostate cancer. Advanced studies have demonstrated the crosstalk between coding and non-coding RNAs, particularly microRNAs (miRNAs). Methods: In this study, we investigated the roundabout of TP53 and their regulatory miRNAs (miR-15a-5p, miR-34a-5p, and miR-141-3p) based on the TCGA data set. We validated an additional patient cohort of 28 matched samples of patients with PRAD at tissue and plasma level. Results: Therefore, using the UALCAN online database, we evaluated the expression level in PRAD of these genes revealing overexpression of TP53. qRT-PCR validation step endorsed the expression level for these genes. Additionally, we evaluated the expression level of the four key miRNAs (miR-15a-5p, miR-34a-5p, and miR-141-3p) interconnected as a network at tissue and plasma levels. Conclusions: Through these results, we demonstrated the essential function of TP53 and its associated miRNAs that play a significant role in tumor control, highlighting miRNAs' potential as future therapeutic targets and biomarkers with important implications in managing prostate cancer.

13.
Chirurgia (Bucur) ; 118(1): 63-72, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36913419

RESUMEN

Radical cystectomy represents the standard surgical treatment in case of muscle invasive bladder cancer. During the last two decades a change in the surgical approach of the MIBC has been observed, from open surgery to minimal invasive surgery. Nowadays, in the majority of tertiary urologic centers, robotic radical cystectomy with intracorporeal urinary diversion represents the standard surgical approach. The aim of the current study is to describe in detail the surgical steps of the robotic radical cystectomy and the reconstruction of the urinary diversion and to present our experience. From the surgical point of view, the most important principles which should guide the surgeon when performing this procedure are: 1. Good working place and access both to the pelvis and abdomen and use of the "technique of spaces" 2. Respect the oncological principles of the surgery with attention to the margin resection and limitation of the risk of tumour spillage; 3. Attention to both the ureter and bowel manipulation in order to avoid grasping lesions; 4. High care in realisation of the uretero-ileal anastomosis so that good long term functional results are achieved. We analyzed our database of 213 patients diagnosed with muscle invasive bladder cancer who underwent minimally invasive radical cystectomy (laparoscopic and robotic approaches) between January 2010 and December 2022. We identified 25 patients for whom the robotic approach was used to perform the surgery. Despite being one of the most challenging urologic surgical procedures, with careful preparation and training, the surgeon is able to achieve the maximum oncological and functional results by performing robotic radical cystectomy with intracorporeal urinary.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento , Derivación Urinaria/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología
14.
Diagnostics (Basel) ; 12(7)2022 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-35885631

RESUMEN

The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.

15.
Cancers (Basel) ; 14(13)2022 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-35804993

RESUMEN

It is possible to obtain diagnostically relevant data on the changes in biochemical elements brought on by cancer via the use of multivariate analysis of vibrational spectra recorded on biological fluids. Prostate cancer and control groups included in this research generated almost similar SERS spectra, which means that the values of peak intensities present in SERS spectra can only give unspecific and limited information for distinguishing between the two groups. Our diagnostic algorithm for prostate cancer (PCa) differentiation was built using principal component analysis and linear discriminant analysis (PCA-LDA) analysis of spectral data, which has been widely used in spectral data management in many studies and has shown promising results so far. In order to fully utilize the entire SERS spectrum and automatically determine the most meaningful spectral features that can be used to differentiate PCa from healthy patients, we perform a multivariate analysis on both the entire and specific spectral intervals. Using the PCA-LDA model, the prostate cancer and control groups are clearly distinguished in our investigation. The separability of the following two data sets is also evaluated using two alternative discrimination techniques: principal least squares discriminant analysis (PLS-DA) and principal component analysis-support vector machine (PCA-SVM).

16.
Pharmgenomics Pers Med ; 15: 177-193, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35300057

RESUMEN

Prostate cancer biology is complex, and needs to be deciphered. The latest evidence reveals the significant role of non-coding RNAs, particularly microRNAs (miRNAs), as key regulatory factors in cancer. Therefore, the identification of altered miRNA patterns involved in prostate cancer will allow them to be used for development of novel diagnostic and prognostic biomarkers. PATIENTS AND METHODS: We performed a miRNAs transcriptomic analysis, using microarray (10 matched pairs tumor tissue versus normal adjacent tissue, selected based on inclusion criteria), followed by overlapping with TCGA data. A total of 292 miRNAs were differentially expressed, with 125 upregulated and 167 downregulated in TCGA patients' cohort with PRAD (prostate adenocarcinoma), respectively for the microarray experiments; 16 upregulated and 44 downregulated miRNAs were found in our cohort. To confirm our results obtained for tumor tissue, we performed validation with qRT-PCR at the tissue and plasma level of two selected transcripts, and finally, we focused on the identification of altered miRNAs involved in key biological processes. RESULTS: A common signature identified a panel of 12 upregulated and 1 downregulated miRNA, targeting and interconnected in a network with the TP53, AGO2, BIRC5 gene and EGFR as a core element. Among this signature, the overexpressed transcripts (miR-20b-5p, miR-96-5p, miR-183-5p) and the downregulated miR-542-5p were validated by qRT-PCR in an additional patients' cohort of 34 matched tumor and normal adjacent paired samples. Further, we performed the validation of the expression level for miR-20b-5p, miR-96-5p, miR-183-5p plasma, on the same patients' cohort versus a healthy control group, confirming the overexpression of these transcripts in the PRAD group, demonstrating the liquid biopsy as a potential investigational tool in prostate cancer. CONCLUSION: In this pilot study, we provide evidence on miRNA dysregulation and its association with key functional components of the PRAD landscape, where an important role is acted by miR-20b-5p, miR-542-5p, or the oncogenic cluster miR-183-96-182.

17.
Clin Res Cardiol ; 111(7): 816-826, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35290496

RESUMEN

OBJECTIVE: Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A meta-analysis of LMCo cases could fill the knowledge gaps in this topic. METHODS: Electronic databases were searched for all LMCo/PAH studies, abstracts and case reports including pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis was used to evaluate LMCo-associated factors. Specificity, sensitivity and accuracy of PA size thresholds for diagnosis of LMCo were calculated. Treatment options and outcomes were summarized. RESULTS: A total of five case-control cohorts and 64 case reports/series (196 LMCo and 438 controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46 [1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA pressure or vascular resistance. A 40 mm cut-off for the PA diameter had balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after non-conservative treatment (n = 150, predominantly stenting) was 2.7% at up to 22 months of mean follow-up, with 83% survivors having no angina at follow-up. CONCLUSION: PA diameter, PA/aorta ratio and CHD are associated with LMCo, while hemodynamic parameters are not. Data from this study support that a PA diameter cut-off between 40 and 44 mm can offer optimal accuracy for LMCo screening. Preferred treatment was coronary stenting, associated with low mid-term mortality and symptom relief. Diagnosis and management of left main coronary artery compression (LMCo) in patients with pulmonary arterial hypertension (PAH).


Asunto(s)
Hipertensión Pulmonar , Hipertensión Arterial Pulmonar , Angina de Pecho/etiología , Vasos Coronarios/diagnóstico por imagen , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Arteria Pulmonar/diagnóstico por imagen
18.
Med Pharm Rep ; 94(Suppl No 1): S47-S50, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34527910

RESUMEN

We present the case of a 51-year-old male with Zinner syndrome, which is a rare disease, resulting from an abnormal evolution of the mesonephric (Wolffian) duct. It consists in cystic dilations of one seminal vesicle and/or ejaculatory duct and ipsilateral renal agenesis. It leads to symptoms related to urination, ejaculation, even infertility, and to low-abdomen and perineal pain. The diagnosis is set by ultrasonography, CT scan and, mainly, MRI. Usually it is treated conservatively, but certain cases require surgery, nowadays minimally invasive.

19.
Diagnostics (Basel) ; 11(6)2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-34206055

RESUMEN

Systemic sclerosis (SSc) is a rare disease, with unfavorable clinical course and prognosis, characterized by progressive multisystemic involvement. SSc associated pulmonary hypertension (SSc-PAH) and interstitial lung disease (ILD) are the most important factors for morbi-mortality in these patients, being responsible for more than 60% of total deaths. Though pulmonary arterial hypertension (PAH) is the dominant subtype seen in SSc, PH secondary to ILD, left-heart pathology, and pulmonary veno-occlusive disease (PVOD) are also possible occurrences. Initial evaluation of a SSc case is complex and should be performed with a multidisciplinary approach. Early detection of SSc-PAH is imperative, given the fact that new and effective medications are available and early treatment was shown to improve outcomes. Therefore, screening algorithms must be used adequately and in a cost-effective manner. Sensitivity and negative predictive value (NPV) are the most important performance measures in a screening test. Several algorithms were developed in the last decade (e.g., DETECT and ASIG) and demonstrated higher efficiency when compared to older algorithms. The present manuscript details the risk factors for SSc-PAH and includes a critical description of current detection algorithms, as a primer for clinicians working in the field of cardio-rheumatology.

20.
J BUON ; 26(3): 1088-1093, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34268976

RESUMEN

PURPOSE: To evaluate the safety of 3D laparoscopic off clamp simple enucleation (SE) of kidney tumors versus standard laparoscopic on-clamp partial nephrectomy (PN) in terms of perioperative, oncological and functional outcomes. METHODS: All patients that underwent 3D laparoscopic nephron sparing surgery (NSS) in our department for clinical T1 tumors between January 2019-September 2020 were included. Of the total of 84 patients, 38 (45.24%) underwent SE (SE group) and 46 (54.76%) PN (PN group). Perioperative data was collected and analyzed. Oncological outcomes were evaluated by the positive surgical margin (PSM) rate and follow-up at 6 months after surgery. RESULTS: Mean age, gender, tumor size, PADUA score and length of hospital stay were comparable between the two groups. Estimated intraoperative blood loss (284.21 ml vs 151.52 ml, p=0.0001) and hemoglobin drop (p=0.0001) were significantly lower for the PN group. Patients that underwent SE showed a better preservation of renal function (eGFR drop of 4.4 ml/min vs 1.78 ml/min, p=0.75). No significant differences were found regarding the PSM, although the PSM rate was lower in the SE group when compared with the PN group (2.63% vs 4.34%, p= 0.07). CONCLUSION: Off-clamp simple enucleation of renal masses is feasible by laparoscopic approach and has produced comparable oncologic outcomes with standard on-clamp partial nephrectomy, with an incremental advantage for the preservation of renal function.


Asunto(s)
Imagenología Tridimensional , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía/métodos , Anciano , Estudios de Factibilidad , Femenino , Humanos , Neoplasias Renales/patología , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano
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