ARTICLE Download: 42| View: 38| Comments: 0 | doi:10.20944/preprints201911.0017.v1
Subject: Medicine & Pharmacology, Urology Keywords: lymphadenectomy; magnetometer; prostate cancer; sentinel lymph node dissection; spion; superparamagnetic iron oxide nanoparticles
Online: 3 November 2019 (15:38:28 CET)
Targeted radioisotope-guided sentinel lymph node dissection (sLND) has shown high diagnostic accuracy in prostate cancer (PCa). To overcome the downsides of the radioactive tracers, magnetometer-guided sLND using superparamagnetic iron oxide nanoparticles (SPIONs) was successfully applied in PCa. This prospective study (SentiMag Pro II, DRKS00007671) determined the diagnostic accuracy of magnetometer-guided sLND in intermediate- and high-risk PCa. Fifty intermediate- or high-risk PCa patients (PSA≥10 ng/ml and/or Gleason score ≥7; median PSA 10.8 ng/ml, IQR 7.4–19.2 ng/ml) were enrolled. After intraprostatic SPIONs injection a day earlier, patients underwent magnetometer-guided sLND and eLND, followed by radical prostatectomy. SLNs were detected in vivo and in ex vivo samples. Diagnostic accuracy of sLND was assessed using eLND as the reference. SLNs were detected in all patients (detection rate 100%), with 447 SLNs (median 9, IQR 6–12) being identified and 966 LNs (median 18, IQR 15-23) being removed. Thirty-six percent (18/50) of patients had LN metastases (median 2, IQR 1–3). Magnetometer-guided sLND had 100% sensitivity, 97.0% specificity, 94.4% positive predictive value, 100% negative predictive value, 0.0% false negative rate, and 3.0% additional diagnostic value (LN metastases only in SLNs outside the eLND template). In vivo, one positive SLN/LN-positive patient was missed, resulting in a sensitivity of 94.4%. In conclusion, this new magnetic sentinel procedure has high accuracy for nodal staging in intermediate- and high-risk PCa. The reliability of intraoperative SLN detection using this magnetometer system requires verification in further multicentric studies.
Mon, 19 August 2019
ARTICLE Download: 59| View: 159| Comments: 0 | doi:10.20944/preprints201908.0191.v1
Subject: Medicine & Pharmacology, Urology Keywords: nephrectomy; acute kidney injury; chronic kidney disease; sevoflurane; desflurane; propofol
Online: 19 August 2019 (03:47:48 CEST)
The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal function after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) stage 3a and CKD upstaging were compared between different general anesthetic agent groups: propofol, sevoflurane, and desflurane. Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs sevoflurane; propofol vs desflurane; sevoflurane vs desflurane; propofol vs volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of CKD stage 3a between groups up to 36 months after nephrectomy before and after matching. Propofol was associated with a lower incidence of AKI, CKD upstaging and a higher three-year renal survival after nephrectomy compared to sevoflurane or desflurane group after matching (AKI: propofol 23.2% vs. sevoflurane 39.5%, P=0.004, vs. desflurane 34.3%, P=0.031; CKD upstaging: propofol 27.2% vs. sevoflurane 58.4%, P<0.001, vs. desflurane 48.6%, P=0.017; Log-rank test propofol vs. sevoflurane P<0.001, vs. desflurane P=0.015). Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (P<0.001). However, there were no significant differences between sevoflurane and desflurane. In conclusion, propofol, compared to volatile agents, may be the reasonable choice of general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. Randomized prospective trials are warranted to test this hypothesis.
Wed, 3 July 2019
ARTICLE Download: 58| View: 192| Comments: 0 | doi:10.20944/preprints201907.0059.v1
Subject: Medicine & Pharmacology, Urology Keywords: Residual Renal Function, Middle Molecules, Beta 2 Microglobulin, Cystatin C, Population Kinetic Model, Dialysis, Simulator Calibration Framework, Equation, Biomarkers, Urea Clearance
Online: 3 July 2019 (09:42:07 CEST)
In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.808 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.
Thu, 11 April 2019
ARTICLE Download: 118| View: 199| Comments: 0 | doi:10.20944/preprints201904.0142.v1
Subject: Medicine & Pharmacology, Urology Keywords: NGF/TrkA signaling; mitogenesis; invasiveness; EMT; 3D models; castrate-resistant prostate cancers
Online: 11 April 2019 (12:55:18 CEST)
Resistance to hormone therapy and disease progression is the major challenge in clinical management of prostate cancer (PC). Drugs currently used in PC therapy initially show a potent antitumor effect. Nevertheless, PC gradually develops resistance, relapses and spreads. Most patients develop, indeed, castrate-resistant PC (CRPC), which is almost incurable. The nerve growth factor (NGF) acts on a variety of non-neuronal cells by activating the NGF tyrosine-kinase receptor, TrkA. NGF signaling is deregulated in PC. In androgen-dependent PC cells, TrkA mediates the proliferative action of NGF through its cross talk with the androgen receptor (AR). Epithelial PC cells, however, acquire the ability to express NGF and TrkA, as the disease progresses, indicating a role for NGF/TrkA axis in PC progression and androgen-resistance. We here report that once activated by NGF, TrkA mediates proliferation, invasiveness and epithelial-mesenchyme transition (EMT) in various CRPC cells. NGF promotes organoid growth in 3D models of CRPC cells, and specific inhibition of TrkA impairs all these responses. Thus TrkA represents a new biomarker to target in CRPC.
Tue, 6 November 2018
REVIEW Download: 86| View: 101| Comments: 0 | doi:10.20944/preprints201811.0143.v1
Subject: Medicine & Pharmacology, Urology Keywords: clear cell renal cell carcinoma; tumor evolution; tumor ecology; intratumor heterogeneity; multisite tumor sampling; targeted therapy
Online: 6 November 2018 (13:30:54 CET)
Malignant tumors behave dynamically as cell communities governed by ecological principles. Massive sequencing tools are unveiling the true dimension of the heterogeneity of these communities along their evolution in most human neoplasms, clear cell renal cell carcinomas (CCRCC) included. Although initially thought to be purely stochastic processes, very recent genomic analyses have shown that temporal tumor evolution in CCRCC may follow some deterministic pathways that give rise to different clones and sub-clones randomly spatially distributed across the tumor. This fact makes each case unique, unrepeatable and unpredictable. Precise and complete molecular information is crucial for patients with cancer since it may help in establishing a personalized therapy. Intratumor heterogeneity (ITH) detection relies on the correctness of tumor sampling and this is part of the pathologist’s daily work. International protocols for tumor sampling are insufficient today. They were conceived decades ago, when ITH was not an issue, and have remained unchanged until now. Noteworthy, an alternative and more efficient sampling method for detecting ITH has been developed recently. This new method, called multisite tumor sampling (MSTS), is specifically addressed to large tumors that are impossible to be totally sampled, and represent an opportunity to improve ITH detection without extra costs.
Fri, 3 August 2018
REVIEW Download: 190| View: 164| Comments: 0 | doi:10.20944/preprints201808.0077.v1
Subject: Medicine & Pharmacology, Urology Keywords: sarcopenia; prognosis; biomarker; bladder cancer; urothelial carcinoma
Online: 3 August 2018 (16:05:54 CEST)
Sarcopenia, the degenerative and systemic loss of skeletal muscle mass, indicates patient frailty and impaired physical function. Sarcopenia can be caused by multiple factors, including advanced age, lack of exercise, poor nutritional status, inflammatory diseases, endocrine diseases, and malignancies. Recently, growing evidence has indicated the importance of sarcopenia in the management of patients with various cancers. Sarcopenia is associated with not only higher rates of treatment-related complications but also worse prognosis in cancer-bearing patients. In this article, we conducted a systematic literature review regarding the significance of sarcopenia as a prognostic biomarker of bladder cancer. We also reviewed recent studies focusing on the prognostic role of changes in skeletal muscle mass during the course of treatment in bladder cancer patients.
Mon, 23 July 2018
ARTICLE Download: 172| View: 185| Comments: 0 | doi:10.20944/preprints201807.0424.v1
Subject: Medicine & Pharmacology, Urology Keywords: neurogenic bladder, botulinum toxin, bladder overactivity, urodynamics, child
Online: 23 July 2018 (12:48:56 CEST)
The aim of this study was to evaluate the usefulness of cystoscopic injection of Botulinum-A toxin (BTX) in the detrusor wall in the treatment of children with decreased bladder capacity due to neurogenic bladder. The prospective, randomized non placebo controlled trial is conducted in our institution since year 2006 with the approval of the local Ethics Committee. 556 cystoscopic injections of BTX were performed in 141 children with neurogenic bladder in age 1 to 18 years. In all cases decreased bladder capacity and bladder overactivity with urine incontinence were estimated. The pre-and post-treatment evaluations included determination of urinary continence status, bladder function in frequency/volume chart of catheterized urine and in urodynamic studies. Parameters measured in urodynamic investigations included maximal cystometric capacity, detrusor reflex volume, maximal detrusor pressure. Parameters were analyzed before the cystoscopy and during the follow-up examinations in 5 age groups. Values of all measured parameters improved significantly and equally after therapy in every from 5 age groups. The results obtained from the study confirmed that endoscopic administration of BTX improves function of urinary bladder in children with neurogenic bladder, and the method represents an alternative approach to conservative treatment and surgical augmentation.
Mon, 22 January 2018
ARTICLE Download: 270| View: 348| Comments: 0 | doi:10.20944/preprints201801.0196.v1
Subject: Medicine & Pharmacology, Urology Keywords: comorbid diseases; erectile dysfunction; penile duplex doppler ultrasound; penile pathology; phosphodiesterase type 5 inhibitors
Online: 22 January 2018 (09:03:17 CET)
Relationship between the results of penile duplex doppler ultrasound (PDDU) and response to vardenafil was investigated in patients diagnosed with erectile dysfunction (ED). Data of 148 patients with ED were analysed retrospectively. Patients who did not respond to therapy were classified as Group I (n = 32), those responded partially were classified as Group II (n = 40) and complete responders were classified as Group III (n = 76). Age, comorbid diseases, vascular and penile pathology were compared among the three groups. While diabetes mellitus (DM) and dyslipedimia positivity adversely affect the response to treatment, the presence of hypertension (HT), peyronie's disease and priapism increase the therapeutic response to the treatment (p < 0.05). Arterial insufficiency was present in 20(30.3%), 25(37,9%) and 21(31.8%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Venous insufficiency was observed in 3(14.3%) patients in Group I and in 8(85.7%) patients in Group III (p = 0.001). Arterial/venous insufficiency was seen in 9(30%), 14(46.7%) and 7(23.3%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Response rate to treatment was highest in normal patients according to PDDU, followed by patients with venous insuffiency. Besides, it was found that DM decreased the response to treatment, whereas response was increased in cases with HT, priapism and Peyronie’s disease.
Tue, 7 November 2017
ARTICLE Download: 448| View: 459| Comments: 0 | doi:10.20944/preprints201711.0043.v1
Subject: Medicine & Pharmacology, Urology Keywords: superparamagnetic iron oxide nanoparticles (SPION); prostate cancer; sentinel node; magnetometer; lymphadenectomy
Online: 7 November 2017 (02:50:25 CET)
Sentinel lymph node dissection (sLND) using a magnetometer and superparamagnetic iron oxide nanoparticles (SPIONs) as a tracer was successfully applied in prostate cancer (PCa). Radioisotope-guided sLND combined with extended pelvic LND (ePLND) achieved better node removal, increasing the number of affected nodes or the detection of sentinel lymph nodes outside the established ePLND template. We determined the diagnostic value of additional magnetometer-guided sLND after intraprostatic SPION-injection in high-risk PCa. This retrospective study included 104 high-risk PCa patients (PSA >20 ng/ml and/or Gleason score ≥8 and/or cT2c) from a prospective cohort who underwent radical prostatectomy with magnetometer-guided sLND and ePLND. The diagnostic accuracy of sLND was assessed using ePLND as a reference standard. Lymph node metastases were found in 61 of 104 patients (58.7%). sLND had a 100% diagnostic rate, 96.6% sensitivity, 95.6% specificity, 96.6% positive predictive value, 95.6% negative predictive value, 3.4% false negative rate, and 4.4% false positive rate (detecting lymph node metastases outside the ePLND template). These findings demonstrate the high sensitivity and additional diagnostic value of magnetometer-guided sLND, exceeding that of ePLND through the individualized extension of PLND or the detection of sentinel lymph nodes / lymph node metastases outside the established node template in high-risk PCa.
Mon, 27 February 2017
ARTICLE Download: 731| View: 635| Comments: 0 | doi:10.20944/preprints201702.0097.v1
Subject: Medicine & Pharmacology, Urology Keywords: LUTS; stress urinary incontinence; perimenopause; pelvic floor
Online: 27 February 2017 (17:41:42 CET)
Stress urinary incontinence (SUI) influences the quality of life of women. The research applied ICIQ LUTS qol (The International Consultation Incontinence Questionnaire Lower Urinary Tract Symptoms quality of life) as a tool to measure the quality of life (QOL) of patients with stage 1 SUI in many areas. 140 perimenopausal women who participated in a urodynamic test at Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Police, Poland in the years 2013-2015 were enrolled in the study. Patients were divided into two groups: A and B. Two questionnaires were applied: the author’s original questionnaire and the standardized ICIQ LUTS qol. Gymnastic plans were recommended 4 times per week for the period of 3 months. The plan for group A included the exercises of pelvic floor muscles (PFM) with the simultaneous tension of the transverse abdominal muscle (TrA) and for group B included the exercises of PMF without TrA. The evaluation of the quality of life of patients with stage 1 SUI with the use of ICIQ LUTS qol among patients from groups A and B after therapy showed a significant improvement in most areas. More impact is observed in the physiotherapy of both PFM with TrA.