bluuebunny/crossref_metadata_2025 huggingface dataset:
Personalized Dietary Management of Overweight and Obesity Based on Measures of Insulin and Glucose
Authors: Hjorth Mads F. , Zohar Yishai , Hill James O. , Astrup Arne
Published: June 2018

During the past several decades, numerous trials have compared various diets for the management of overweight and obesity, assuming that a single dietary strategy would be appropriate for all individuals. These studies have failed to provide strong evidence for the efficacy of any particular diet, and it is likely that different people will have different levels of success on different diets. We identified studies investigating pretreatment glycemia or insulinemia status, or both, of the individual as prognostic markers of weight loss during periods in which the composition of a participant's diet was known. Overall, research suggests that providing specific diets for weight management based on pretreatment glycemia and insulinemia statuses holds great promise for advancing personalized nutrition.
Estimating Accurate Target Coordinates with Magnetic Resonance Images by Using Multiple Phase-Encoding Directions during Acquisition
Authors: Kim Minsoo , Jung Na Young , Park Chang Kyu , Chang Won Seok , Jung Hyun Ho , Chang Jin Woo
Published: June 2018

Background: Stereotactic procedures are image guided, often using magnetic resonance (MR) images limited by image distortion, which may influence targets for stereotactic procedures. Objectives: The aim of this work was to assess methods of identifying target coordinates for stereotactic procedures with MR in multiple phase-encoding directions. Methods: In 30 patients undergoing deep brain stimulation, we acquired 5 image sets: stereotactic brain computed tomography (CT), T2-weighted images (T2WI), and T1WI in both right-to-left (RL) and anterior-to-posterior (AP) phase-encoding directions. Using CT coordinates as a reference, we analyzed anterior commissure and posterior commissure coordinates to identify any distortion relating to phase-encoding direction. Results: Compared with CT coordinates, RL-directed images had more positive x-axis values (0.51 mm in T1WI, 0.58 mm in T2WI). AP-directed images had more negative y-axis values (0.44 mm in T1WI, 0.59 mm in T2WI). We adopted 2 methods to predict CT coordinates with MR image sets: parallel translation and selective choice of axes according to phase-encoding direction. Both were equally effective at predicting CT coordinates using only MR; however, the latter may be easier to use in clinical settings. Conclusion: Acquiring MR in multiple phase-encoding directions and selecting axes according to the phase-encoding direction allows identification of more accurate coordinates for stereotactic procedures.
Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: Can Cytology Face the Challenge of Diagnosis in the Light of the New Classification?
Authors: Díaz del Arco Cristina , Fernández Aceñero M. Jesús
Published: June 2018

Objectives: To assess the cytological findings of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), conventional papillary thyroid carcinomas (C-PTC), and invasive follicular variants of papillary thyroid carcinomas (IFV-PTC) to determine if there are cytological differences between groups. Study Design: We have reviewed all thyroid fine-needle aspiration cytology samples diagnosed between 2000 and 2017. We have included all NIFTP cases (n = 6) and randomly selected cases of C-PTC (n = 14) and IFV-PTC (n = 8). Results: Comparing NIFTP and C-PTC cases, NIFTP cases showed significantly less papillary or pseudopapillary architecture, more bidimensional groups and microfollicles, and less tridimensionality, giant cells, and nuclear folds. We observed a trend towards significance for smear cellularity and amount of cytoplasm. Presence of nuclear folds was the only significant difference between NIFTP and IFV-PTC cases. The differences between groups in percent papillary or pseudopapillary architecture, cellularity, and tridimensionality showed a trend towards significance. Amount of colloid, dirty background, pleomorphism or atypia, nuclear pseudoinclusions, type of chromatin, and nucleolus were not significant. Conclusions: No cytopathological feature can differentiate between invasive and encapsulated IFV-PTC. In accordance with the recently accepted category, PTC smears with cells arranged in a predominantly follicular architecture should be reported as Bethesda IV category with descriptive terms to avoid false-positive cases.
B Cell–Activating Factor Neutralization Aggravates Atherosclerosis
Authors: Tsiantoulas Dimitrios , Sage Andrew P. , Göderle Laura , Ozsvar-Kozma Maria , Murphy Deirdre , Porsch Florentina , Pasterkamp Gerard , Menche Jörg , Schneider Pascal , Mallat Ziad , Binder Christoph J.
Published: June 2018

Background:

Atherosclerotic cardiovascular disease (heart attacks and strokes) is the major cause of death globally and is caused by the buildup of a plaque in the arterial wall. Genomic data showed that the B cell–activating factor (BAFF) receptor pathway, which is specifically essential for the survival of conventional B lymphocytes (B-2 cells), is a key driver of coronary heart disease. Deletion or antibody-mediated blockade of BAFF receptor ablates B-2 cells and decreases experimental atherosclerosis. Anti-BAFF immunotherapy is approved for treatment of autoimmune systemic lupus erythematosus, and can therefore be expected to limit their associated cardiovascular risk. However, direct effects of anti-BAFF immunotherapy on atherosclerosis remain unknown.

Methods:

To investigate the effect of BAFF neutralization in atherosclerosis, the authors treated
Apoe
−/−
and
Ldlr
−/−
mice with a well-characterized blocking anti-BAFF antibody. Moreover, to investigate the mechanism by which BAFF impacts atherosclerosis, the authors studied atherosclerosis-prone mice that lack the alternative receptor for BAFF: transmembrane activator and calcium modulator and cyclophilin ligand interactor.

Results:

The authors demonstrate here that anti-BAFF antibody treatment increased atherosclerosis in mice, despite efficient depletion of mature B-2 cells, suggesting a unique mechanism of action. Indeed, myeloid cell–specific deletion of transmembrane activator and calcium modulator and cyclophilin ligand interactor also results in increased atherosclerosis, while B cell–specific transmembrane activator and calcium modulator and cyclophilin ligand interactor deletion had no effect. Mechanistically, BAFF–transmembrane activator and calcium modulator and cyclophilin ligand interactor signaling represses macrophage IRF7-dependent (but not NF-κB–dependent) Toll-like receptor 9 responses including proatherogenic CXCL10 production.

Conclusions:

These data identify a novel B cell–independent anti-inflammatory role for BAFF in atherosclerosis and may have important clinical implications.
Left Ventricular Diastolic Dysfunction in the Community: Impact of Diagnostic Criteria on the Burden, Correlates, and Prognosis
Authors: Nayor Matthew , Cooper Leroy L. , Enserro Danielle M. , Xanthakis Vanessa , Larson Martin G. , Benjamin Emelia J. , Aragam Jayashri , Mitchell Gary F. , Vasan Ramachandran S.
Published: June 2018

Background

Left ventricular diastolic dysfunction (
DD
) is common, particularly in women and older individuals, and it is associated with adverse cardiovascular outcomes. We evaluated the impact of age‐ and sex‐specific diagnostic criteria on the assessment of
DD
in the community‐based Framingham Heart Study.

Methods and Results

We estimated age‐ and sex‐specific reference limits for echocardiographic measures of
DD
in a healthy reference subsample (N=2355, mean age 44 years, 66% women). The prevalence, correlates, and association with future cardiovascular disease were compared for
DD
using age‐ and sex‐specific versus single cut point reference limits in a broad sample (N=6102, mean age 50 years, 56% women). Using age‐ and sex‐specific criteria,
DD
was present in ≈25% to 30% of individuals across age groups, and it was directly associated with a number of modifiable risk factors. In contrast, with single cut point criteria, age was the primary determinant of
DD
. During follow‐up (mean 7.9±2.2 years), incident cardiovascular disease occurred in 213 of 5770 individuals. Using age‐ and sex‐specific criteria, mild and moderate‐severe
DD
were associated with 50% (95% confidence interval, 1.09–2.05) and 65% (95% confidence interval, 1.14–2.38) higher incidences of cardiovascular disease, respectively, in age‐ and sex‐adjusted analyses. With single cut point criteria, moderate‐severe
DD
(hazard ratio, 1.66; 95% confidence interval, 1.05–2.61), but not mild
DD
(hazard ratio, 0.94; 95% confidence interval, 0.63–1.40), was associated with incident cardiovascular disease.

Conclusions

Age‐ and sex‐specific reference limits may result in
DD
assessments that are less dependent on age, more robustly related to modifiable risk factors, and are more closely associated with incident cardiovascular disease.
Stroke in Adults With Coarctation of the Aorta: A National Population‐Based Study
Authors: Pickard Sarah S. , Gauvreau Kimberlee , Gurvitz Michelle , Gagne Joshua J. , Opotowsky Alexander R. , Jenkins Kathy J. , Prakash Ashwin
Published: June 2018

Background

Adults with repaired coarctation of the aorta (CoA) have reduced long‐term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era.

Methods and Results

This was a cross‐sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population. To test this hypothesis, we compared the age at stroke in patients with and without a diagnosis of CoA using simple and multivariable weighted linear regression. Among 4 894 582 stroke discharges, 207 had a diagnosis of CoA. Patients with CoA had strokes at significantly younger age compared with patients without CoA: 18.9 years younger for all‐cause stroke (
P
<0.001), 15.9 years younger for ischemic stroke (
P
<0.001), and 28.5 years younger for hemorrhagic stroke (
P
<0.001), after adjusting for potential confounders. There was no significant difference in the proportion of ischemic strokes between those with and without CoA (79.2% versus 83.0%,
P
=0.50). However, CoA patients had a higher proportion of subarachnoid hemorrhage (11.8% versus 4.8%,
P
=0.039) than those without CoA. Among patients who had a hemorrhagic stroke, the prevalence of unruptured intracranial aneurysms was higher in patients with CoA compared with those without CoA (23.3% versus 2.5%,
P
=0.002).

Conclusions

Patients with CoA have both ischemic and hemorrhagic strokes at significantly younger ages compared with the general population.
Aryl Hydrocarbon Receptor Nuclear Translocator in Vascular Smooth Muscle Cells Is Required for Optimal Peripheral Perfusion Recovery
Authors: Borton Anna Henry , Benson Bryan L. , Neilson Lee E. , Saunders Ashley , Alaiti M. Amer , Huang Alex Y. , Jain Mukesh K. , Proweller Aaron , Ramirez‐Bergeron Diana L.
Published: June 2018

Background

Limb ischemia resulting from peripheral vascular disease is a common cause of morbidity. Vessel occlusion limits blood flow, creating a hypoxic environment that damages distal tissue, requiring therapeutic revascularization. Hypoxia‐inducible factors (
HIF
s) are key transcriptional regulators of hypoxic vascular responses, including angiogenesis and arteriogenesis. Despite vascular smooth muscle cells’ (
VSMC
s’) importance in vessel integrity, little is known about their functional responses to hypoxia in peripheral vascular disease. This study investigated the role of
VSMC HIF
in mediating peripheral ischemic responses.

Methods and Results

We used
Arnt

SMKO

mice with smooth muscle–specific deletion of aryl hydrocarbon receptor nuclear translocator (ARNT,
HIF
‐1β), required for
HIF
transcriptional activity, in a femoral artery ligation model of peripheral vascular disease.
Arnt

SMKO

mice exhibit impaired perfusion recovery despite normal collateral vessel dilation and angiogenic capillary responses. Decreased blood flow manifests in extensive tissue damage and hypoxia in ligated limbs of
Arnt

SMKO

mice. Furthermore, loss of aryl hydrocarbon receptor nuclear translocator changes the proliferation, migration, and transcriptional profile of cultured
VSMC
s.
Arnt

SMKO

mice display disrupted
VSMC
morphologic features and wrapping around arterioles and increased vascular permeability linked to decreased local blood flow.

Conclusions

Our data demonstrate that traditional vascular remodeling responses are insufficient to provide robust peripheral tissue reperfusion in
Arnt

SMKO

mice. In all, this study highlights
HIF
responses to hypoxia in arteriole
VSMC
s critical for the phenotypic and functional stability of vessels that aid in the recovery of blood flow in ischemic peripheral tissues.
Disentangling the Effects of the School Year from the School Day: Evidence from the TIMSS Assessments
Authors: Wu Derek
Published: June 2018

Schools often have to decide between extending the length of the school year or the school day. This paper examines the effects of changes in the distribution of instructional time on eighth-grade student achievement through a methodological framework that disaggregates total yearly instructional time into separate inputs for days per year and hours per day. This study's dataset brings together nearly 900,000 student observations across eighty countries and four quadrennial testing cycles of the Trends in International Mathematics and Science Study (TIMSS) Assessments (1995–2007). I find that the positive effects of instructional time on student achievement are driven largely by the length of the school day and not by the length of the school year, with diminishing marginal returns to the former. Socioeconomically underprivileged students are most likely to realize gains from a longer school day. Furthermore, isolating the amount of instructional time spent on TIMSS-tested subjects from the rest of the school day reveals spillover effects from time spent in non-tested subjects that are especially meaningful for underprivileged students. In contrast, the effects of time spent in tested subjects are more homogeneous across student groups.
Between Myth-Making and Shiite Exegesis: Nasnās and Qurʾān 2:30
Authors: Vilozny Roy
Published: June 2018

This paper explores the role that the myth of the Nasnās, a pre-Adamic humanlike creature, plays in the Shiite exegesis of Qurʾān 2:30. It aims to shed light on the blurry line between myth-making, fiction and Quranic commentary. Of a cosmological nature, this verse has long provoked speculation by Muslim exegetes about universal history. Nevertheless, the Shiite evocation of the Nasnās in this context is unique and reflects a somewhat different cosmological perception. Whether this perception is the result of commentators’ endeavors to tackle some of the theological difficulties posed by this verse or a mere reflection of their heretofore existing cosmological notions, is an additional tension to be addressed.
The identity of Clematis zhejiangensis (Ranunculaceae) from China
Authors: YUAN QIONG , YANG QIN-ER
Published: June 2018

We demonstrate that Clematis zhejiangensis (Ranunculaceae) is conspecific with C. uncinata, a species widespread in subtropical regions in China and the neighboring countries. We therefore reduce C. zhejiangensis to the synonymy of C. uncinata. The varietal division of C. uncinata is briefly reviewed, and the type information of C. leiocarpa, which has been reduced to the synonymy of C. uncinata var. uncinata or C. uncinata var. coriacea, is also discussed. Furthermore, the likelihood of confusion between C. zhejiangensis and C. chekiangensis is mentioned.
The identity of Senecio obtusatus (Asteraceae, Senecioneae) and a previous misapplication of the name
Authors: TONG TIAN-JING , REN CHEN , YANG QIN-ER
Published: June 2018

We demonstrate that the name Senecio obtusatus (Asteraceae, Senecioneae) has been misapplied. This name should be synonymized under Jacobaea nudicaulis, whereas those specimens previously misidentified as S. obtusatus should be referred to S. boluangensis.
Anti-Immigration Discourses in Hungary during the ‘Crisis’ Year: The Orbán Government’s ‘National Consultation’ Campaign of 2015
Authors: Bocskor Ákos
Published: June 2018

This article conducts a critical discourse analysis of the Hungarian government’s National Consultation campaign on ‘immigration and terrorism’ in early 2015. The analysis draws on a discourse-historical approach to illuminate how the language and contents of the consultation draw on the discursive and political repertoires of the post-2010 Orbán governments and how, at the same time, they are underpinned by particular elements in the history of migration and diversity in Hungary. The consultation framed immigration as both an economic and security threat and conflated asylum seekers, economic migrants and terrorists, as well as regular and irregular migration. Nevertheless, these discourses would later feed into the government’s response to the large number of asylum seekers who entered the country in the summer of 2015 and would be used to legitimize the actions subsequently taken to tackle what would internationally come to be defined as a ‘crisis’.
Resilience for family carers of advanced cancer patients—how can health care providers contribute? A qualitative interview study with carers
Authors: Røen Ingebrigt , Stifoss-Hanssen Hans , Grande Gunn , Brenne Anne-Tove , Kaasa Stein , Sand Kari , Knudsen Anne Kari
Published: June 2018

Background:

Caring for advanced cancer patients affects carers’ psychological and physical health. Resilience has been defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat.”

Aim:

The aim of this study was to explore factors promoting carer resilience, based on carers’ experiences with and preferences for health care provider support.

Design:

Qualitative, semi-structured, individual interviews with family carers of advanced cancer patients were performed until data saturation. The interviews were recorded, transcribed, and analyzed using systematic text condensation.

Setting/participants:

Carers ( n = 14) of advanced cancer patients, not receiving curative treatment, admitted to an integrated curative and palliative care cancer outpatient clinic or to a university hospital cancer clinic, were included.

Results:

14 carers of advanced cancer patients were included; 7 men, 7 women, and mean age of 59 years; 3 were bereaved; 12 were partners; 5 had young and teenage children. Four main resilience factors were identified: (1) being seen and known by health care providers—a personal relation; (2) availability of palliative care; (3) information and communication about illness, prognosis, and death; and (4) facilitating a good carer–patient relation.

Conclusion:

Health care providers may enhance carers’ resilience by a series of simple interventions. Education should address carers’ support needs and resilience. Systematic assessment of carers’ support needs is recommended. Further investigation is needed into how health care providers can help carers and patients communicate about death.
ESWL a Legnano: La Nostra Esperienza
Authors: Paccaduscio A. , Berti G.L. , Giola V. , Longoni E. , Raimoldi A. , Russo R. , Confalonieri S. , Bacchioni A.M.
Published: June 2018

ESWL is today the gold standard in the treatment of most cases of urolithiasis. The new generation lithotriptors let an easier patient management, reduce hospitalisation time, optimize therapeutical and economic outcomes. We show our experience first with Storz Modulith SLX from 1996 to 1999 then with Sonolith 4000+ form 1999 until today.
Bcl-2 and Bax: Prognostic Factors in the Interstitial Brachytherapy of Prostatic Adenocarcinoma
Authors: Casetta G. , Vaccino D. , DE Libero A. , Zitella A. , Greco A. , Bernardi D. , Tizzani A.
Published: June 2018

We examined the potential use as predictive factor for therapeutical response to interstitial brachytherapy of bcl-2 and bax histochemical staining in prostatic biopsy of patients with organ-confined prostatic adenocarcinoma.

Materials and Methods

We evaluated the results on 24 patients treated in our Department with transperineal and transrectal ultrasound-guided permanent implantation of I-125 radioactive seeds. The average follow-up was 15.2 ± 5.6 months (range: 10–24) and we considered the biochemical control of the disease as primary end-point. We performed immunohistochemical analysis on tissue samples of prostatic biopsy using specific monoclonal antibodies anti-human bcl-2 and bax proteins.

Results

5 patients (20.8%) were classified as non-responders and 19 as responders. Bcl-2 positive patients (26.1%) showed a superior rate of biochemical recurrence (50%) than negative ones (11.76%). Nevertheless this correlation was not statistically significant. Moreover immunohistochemical analysis of bax was not evaluable in all the examined samples because for technical reason.

Conclusions

So far on the basis of our results bcl-2 and bax immunohistochemical staining of prostatic biopsy samples cannot be used on a routine basis as prognostic factors in patients with localized prostatic adenocarcinoma treated with interstitial brachytherapy.
Five Year Results after Radical Prostatectomy in Patients with pT3a Patological Stage and Positive Surgical Margins
Authors: Parma P. , Dall'Oglio B. , Schiavon L. , Luciano M. , Guatelli S. , Galletta V. , Bondavalli C.
Published: June 2018

Five year results in men with pT3a disease and positive surgical margins after radical retropubic prostatectomy were evaluated.

Materials and Methods

Between 1/90 and 12/98, 250 men underwent radical retropubic prostatectomy for prostate cancer. In 63 cases (25%) we found positive surgical margin. In these group 32 patients presented pathological stage T3a N0 with a Gleason score between 5 and 8. In 21 patients no adiuvant therapy was made while 11 patients underwent an adiuvant therapy (in 2 patients ormonal therapy, in 9 radiotherapy).

Results

The actuarial 5 years post prostatectomy biochemical, local and distant recurrence rates were 9%, 3% e 3 % respectively. For 21 men who didn't receive adiuvant therapy, 17 were biochemical recurrence free, in 3 cases a biochemical recurrence occurred, 1man underwent a radiotherapy of salvatage for a local recurrence. For 9 patients who received adiuvant radiation therapy, 8 are biochemical free while 1 presents metastatic desease at 5 years of follow-up. The 2 patients who received adiuvant hormonal therapy are biochemical recurrence free at 5 years.

Conclusions

The role of positive surgical margins on local recurrence of desease is still under debate. In our experience isolated local recurrence is rare during long term follow up of men with pT3a No stage and positive surgical margins at radica prostatectomy. The adiuvant radiotherapy seems to give a good local desease control at 5 years of follow-up.
Laparoscopic renal tumour ablation by means of the Tissuelink floating-ball radiofrequency device
Authors: Alfano V. , Maganja C. , Tallarigo C.
Published: June 2018

The Tissuelink floating ball, a new radiofrequency monopolar device, allows us to remove small renal parenchimal tumours during a laparoscopic procedure in a safe, simple way. It applies radiofrequency energy with low volume saline irrigation for simultaneous blunt dissection of the renal mass and haemostatic sealing and coagulation of the renal parenchyma without the need of a preventive occlusion of the major renal vessels.

Materials and Methods.

From November 2001 to November 2003, we performed 5 laparoscopic enucleoresections of renal parenchimal tumours using the Tissuelink technology. Four were in the right kidney, 1 was in the left kidney. The patients were male in 3 and female in 2 cases. Mean patient's age was 61.2 years (range 33–71). All the tumors were small in size (range 10–40 mm) and had a peripheral location. None of them was in close proximity to the collecting system. This was the reason why we never inserted a stent in the urinary tract before the laparoscopic procedure. No patients required blood transfusion. The histology revealed a renal clear cell carcinoma in 4 cases (grade 1 in two, grade 2 in two) while the remaining was an old haematoma.

Overall we had 2 complications.

The haematoma broke during the procedure, because of its softness. Another patient suffered of a burning of the skin, just on the place of an ECG electrode.

Conclusions.

The laparoscopic enucleoresection of small, peripheral renal tumours by mean of the Tissuelink floating ball devise seems to be, even in an initial experience, simple and effective, even without the need of the preventive occlusion of the renal artery and vein. No relapse occurred after 12 months follow-up.
ProACT: A New Surgical Therapy for the Male Sui
Authors: Frea B. , Kocjancic E. , Zaramella S. , Crivellaro S. , Gontero P. , Favro M. , Ceratti G. , Sala M. , Monesi G.
Published: June 2018

The incidence of reported male stress urinary incontinence (SUI) status prostate surgery varies widely between 2–40%. While the artificial urinary sphincter (AUS) reports good long-term efficacy, this procedure is associated with a high rate of reoperation. The aim of this study was to assess the results at 1 year of follow up of a new minimally invasive surgical technique called Pro ACT (Adjustable Continence Therapy).

Material & Methods

The ProACT is a new implant for post-prostatectomy incontinence. A balloon, a port and a tube of connection are the components of the Pro ACT. It is percutaneously implanted and is postoperatively adjustable. From September 2000 to December 2003 16 males underwent to the procedure. The mean age was 56.5 years (range 29–83). The SUI was due in 13 cases to radical retropubic prostatectomy, in one case to TURP, in one case to open prostatectomy for benign prostatic hypertrophy and one case to congenital incontinence associated with epispadia. The urodynamic exam revealed SUI due to intrinsic sphincteric deficiency in all patients. Efficacy was assessed by change in use of average number of pads used daily, and overall impression

Results

The average number of adjustments after the surgery was 1.6. The average number of pads used decreased from a mean 5.11 at baseline to 1.62 at 12 months. Overall 42.8% of the patients are now completely dry. 28% are improved and 30% are either not improved or only slightly improved. In three of these patients the adjustments are still on going. The only post-operative complication was a migration of both the balloons into the bladder in one patient, which necessitated the removal of both devices as a minor procedure under local anesthetic.

Conclusions

The ProACT is a new surgical therapy for the male SUI. This technique is easy, quick to learn and associated with a low rate of complications and a satisfactory rate of success. 70% patients were dry or improved at 1-year follow up. The device is well accepted from the patients because it doesn't require any manual skill to operate implanted components. Complications are easily managed because of the possibility to remove the Pro ACTs implants completely, or by simply deflating the balloons via percutaneous injection.
Uterine Preservation or Hysterectomy for the Uterovaginal Prolapse
Authors: Costantini E. , Saccomanni M. , Vianello A. , Ioannidou K. , Del Zingaro M. , Cecchetti G. , Zucchi A.
Published: June 2018

For many years uterine prolapse has been an indication for hysterectomy, quite apart from the presence or the absence of any uterine disease and independently of the patients’ desire. Many studies on pelvic statics showed the central role of uterus on the pelvic static itself. Aim of the study is to prospectively compare sacropexy with and without hysterectomy in patients with uterovaginal prolapse. Surgical techniques, efficacy and overall results are described.

Material and Methods

Fifty-six consecutive patients affected by grade III-IV uterovaginal prolapse underwent colposacropexy: hysterectomy followed by sacropexy (SP) in 29 and hysterocolposacropexy (ISP) in 27. Before surgery all patients provided a detailed case history and replied to a questionnaire on urinary symptoms (Urogenital distress inventory). Patients underwent a clinical urogynaecological examination (HSW), a pelvic ultrasound scan and urodynamic test. Check-ups were scheduled at 3, 6, 12 months and then annually.

Results

No significant differences emerged in demographic and clinical characteristic in the SP and ISP groups. Mean operating times, intraoperative blood loss and hospital stay are significantly less after ISP (p<0.001). No patient required surgery for recurrent prolapse. Urodynamic results showed the pressure/flow parameters improved significantly (p< 0.001). 24/27 patients (88.9%) in the ISP group and 25/29 (86.2%) in the SP are satisfied and would repeat surgery again. 5/7 patients who would not repeat surgery were incontinent.

Conclusions

Sacrocolpopexy provides a secure anchorage restoring an anatomical vaginal axis and a good vaginal length. ISP can be safely offered to women who request uterine preservation. Long-term results in terms of prolapse resolution, urodynamic outcomes, improvements in voiding and sexual dysfunctions are excellent.
Citrate and Urolithiasis
Authors: Saita A. , Bonaccorsi A. , Motta M.
Published: June 2018

Kidney stones are an endemic pathology in mediterranean area. Although urologists have developed a lot of mini-invasive techniques to treat this pathology they usually do not have background to treat the medical aspect of lithiasis. For this reason we underline the necessity to know the lithogenetic mechanism starting from the formation of a simple salt like Ca – Ox and is growing as macrocrysthal. In this work we describe the etiology stone formation, metabolic evaluation and medical treatment of urinary stones. Underlining the role of citrate as a inhibitor of crystallogenesis and his role in medical chemiolisis.
Gefitinib is Able to Sustain Metastatic Progression
Authors: Angelucci A. , Gravina G. L. , Festuccia C. , Muzi P. , Rucci N. , Galatioto G. Paradiso , Costa A.M. , Teti A. , Vicentini C. , Bologna M.
Published: June 2018

The expression of epidermal growth factor receptor (EGFR) is a distinctive marker in the biologic progression of prostatic carcinoma (PCa). Gefitinib (‘Iressa’) is an orally active EGFR tyrosine kinase inhibitor, and in clinical trials has shown important antitumor activity in tumors expressing EGFR. Our aim was to demonstrate that Gefitinib was also effective in inhibiting the cellular capabilities leading to metastasis formation.

Methods

The inhibitory effect of Gefitinib on the invasive phenotype of PCa cells was tested in vivo by injecting PC3 cells subcutaneously (Xenograft) or into the left ventricle of nude mice and by daily administration of various doses of Gefitinib.

Results

The tumoral growth of xenograft was significantly inhibited by 150mg/kg Gefitinib with a reduction of 40% in tumor weight. Moreover mice receiving tumoral cells intracardially showed a significant reduction in bone metastases when treated with Gefitinib.

Conclusions

Our data demonstrate that EGF is able to sustain not only cellular growth, but also metastatic progression. For this reason the use of Gefitinib as a therapeutic agent may also be indicated in the control of tumor spreading in EGF responsive tumor cells.
Primary Carcinoid Tumor in a Horseshoe Kidney
Authors: Cerulli C. , Sciarra A. , Mazzone L. , Autran Gomez AM. , Salciccia S. , Di Silverio F.
Published: June 2018

We report on a rare case of primary carcinoid tumor in a horseshoe kidney. A 56-year-old male was referred at our clinic with a history of urinary tract stones. A CT scan revealed a horseshoe kidney with a large mass in the lower pole of the right kidney. The patient was submitted to a partial right nephrectomy with resection of the lower half of the right kidney and isthmectomy The histological and immunohistochemical findings were compatible with a diagnosis of primary carcinoid tumor. After 24 months the patient is still alive without evidence of recurrence or progression.
Immunotherapy for Urologic Tumors
Authors: Ridolfi R. , Matera L. , Tizzani A.
Published: June 2018

Cancer vaccines are intended to promote a long-lasting memory response against tumors.

Rationale for cancer vaccines is based on two observations: a) many tumors express antigens (TA), which are recognized by specific cytotoxic T lymphocytes; b) these lymphocytes may protect the host against tumor growth in vivo.

So far, cancer vaccines have been developed using soluble TA and, more recently, TA presented by dendritic cells (DC), the most powerful antigen presenting cells (APC). DCs play a key role in the process leading to antigen recognition and lymphocyte activation. Despite a deeper understanding of these processes, clinical efficacy of cancer vaccines is still hampered by the heterogeneity of the studies performed so far, and by the largely unknown mechanisms through which tumors escape immunosurveillance.

Current DC-based cancer vaccines require the preparation of DCs from patient blood monocytes, as well as DC-loading with TA. Both whole tumor and TA peptides are used as source of TA. Similar schedules have been implemented in many clinical trials on melanoma, kidney and prostate cancer, with partial responses ranging from 7% to 30%. The study population was made up of non-respondent patients to any other therapy; the DC vaccination showed an extremely low toxicity.

22 patients with metastatic melanoma received a DC vaccine in Forlì (Italy) since August 2001. Good correlation between immunologic response, clinical response and overall survival was found. A clinical trial on pulsed APC administration to patients with recurring prostate cancer is ready to be started in Torino (Italy), pending the Ministerial approval from a local cell factory.
Quality of Life before and after Andro-Gynoid and Gynoandroid Conversion Surgery
Authors: Trombetta C. , Scati L.
Published: June 2018

Our study intended to assess if surgery could be able to improve transsexuals’ QoL (quality of life); 16 subjects were asked to fill in a test form to verify quality of life before and after andro-gynoid conversion surgery.

Other individuals were studied as follows: 18 MtoF (andro-gynoid) subjects awaiting surgery; 16 MtoF subjects who had been operated on more than one year before; 13 FtoM (gynoandroid) individuals waiting for surgery; 4 FtoM subjects after surgery.

The “Quality of Life Enjoyment and Satisfaction Questionnaire - Q-LES-Q” (Endicott 1993) was drawn up: this is a self-report questionnaire which assesses the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. Outcomes confirmed the assumption of origin.
Cryptococcosis
Authors: Meazza A. , Pachera F. , Oreste P.L. , Marzorati G.
Published: June 2018

A case of cryptococcosis is presented in this review: its prostatic localization is considered to be extremely unusual.

The relevant diagnostic course and therapeutic treatment are discussed, taking into account the fact that this mycotic infectious disease occurs in immunodepressed subjects.
Enterovesical Fistulas Secondary to Crohn's Disease: Medical versus Surgical Therapies
Authors: Fischetti G. , Di CROSTA G.
Published: June 2018

The purpose of this study is to evaluate the efficacy of medical therapies, especially infliximab, to induce remission of enteric fistulas in Crohn's disease (CD). Similarly to CD, chronic transmural inflammation of the bowel, diverticulitis and other pathologies may predispose to the development of fistulas. The risk of fistulization secondary to CD ranges from 17% to 80%. We focused on enterovesical fistulas, which statistically represent 10% of all fistulas secondary to CD.

Material and Methods

In this study we decided to implement a therapeutic program with infliximab 5 mg/kg associated with steroids, which proved to be the most effective method of treatment. From January 2003 to March 2005, we studied 4 patients with CD and enterovesical fistulas. All patients underwent NMR, colonoscopy and cystoscopy combined with fistulography; a therapeutic strategy with cortisone, mesalazine, nutritional therapy and infliximab was established.

Results

No regression was observed; therefore, all the four patients underwent surgery with complete remission of symptoms.

Conclusions

Data reported in literature and the evidence from our experience seem to be contradictory; we concluded therefore that it is mandatory to consider different therapeutic approaches, according to the fistulizing pathways, to such a complex disease, and to formulate some hypothesis that might explain why this treatment was unsuccessful in our patients.
Mesothelial Cyst of the Kidney. A Rare Case Report of this Neoformation on the Left Kidney
Authors: Calabrò G. , Pappalardo S. , Calabrò V. , Pizzarelli M. , Spampinato A.
Published: June 2018

The authors are hereby presenting a rare case of neoformation developing on the left kidney in a 80-year-old patient affected by left lumbar backache. The neoformation appears doubtful in nature, on ultrasonography, CT scan and MRI. The lesion is roundish and contiguous at the kidney convex edge; due to its clinical aspects, it requires a surgical management and is, therefore, easily excised. The histopathologic examination confirms it is a mesothelial cyst. The case is presented for its absolute rarity and for the preoperative diagnostic doubts it may generate.
Therapeutic education in urology: a fundamental resource for the sick and the health carers
Authors: Bassi P.F. , Falabella R. , Bonadiman L. , Marcolongo R.
Published: June 2018

Therapeutic Education (TE) means to build a partnership between doctors and patients comparing knowledge and therapeutic procedures to manage the disease and its treatment. Patients cannot be a mere passive beneficiary of therapeutic services, but they must play an active role, be conscious and participate in charging proper and community health. Patient TE is a pathway characterized by an “educational diagnosis” including identification of patient demands about pathology; an “educational-therapeutic policy” based on assignment of tasks and rules to manage every aspect of pathology; and the “evaluation” of results of patients’ educational process. The aim of TE is to allow the patients to know their pathology, to properly perform therapeutic procedures, to self-manage and prevent complications and to adopt a correct lifestyle. It can be useful to organize theoretical and practical lessons reserved to groups of patients. TE can be applied to urologic pathologies. These pathologies are often chronic diseases and affect elderly patients, who are organically and psychologically fragile. Urologic patients must often manage urostomies, urinary drains, complex follow-up plans. The patients’ learning about procedures and disease management represents a professional duty of the urologic team: bladder and prostate cancer, urinary drains management are fields where we can apply a TE plan to support and safeguard the patients’ health.
Angiomyofibroblastoma-like tumors
Authors: Arancio M. , Delsignore A. , Fontana F. , Landi G. , Marchetti C. , Mina A. , Marcato M. , Muscarà M. , Martinengo C.
Published: June 2018

Angiomyofibroblastomas are rare, benign, slow-growing tumors, that occurring predominantly in vulvar lesions of premenopausal women. In male patients only few cases are reported (angiomyofibroblastoma-like tumors). They occur mostly in scrotal and inguinal regions. We report a case of left scrotal angiomyofibroblastoma-like tumor in a 52-years old man. After a biopsy for histological examination, a complete surgical excision was performed. At 12 months’ follow-up the patient is asymptomatic, and no tumor signs were was found on by abdominal computed tomography.
TVT and TOT: a comparison between these two techniques based on our clinical experience
Authors: Tamai A. , Donazzan A. , Gallo V. , Durante S.
Published: June 2018

Aim of the Study

A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI.

Materials and Methods.

In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines.

Results.

Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).
Early vs Delayed Radical Cystectomy Compared in Highgrade Superficial Bladder Tumors
Authors: Varca V. , Simonato A. , Esposito M. , Curotto A. , Orlandini M. , Rikani E. , Carmignani G.
Published: June 2018

Objectives

The treatment of aggressive superficial TCC of the bladder remains controversial. In fact, although still classified as ‘superficial’, it has been shown that the biological characteristics of T1G3 bladder tumors are the same as those of the muscle-invasive group (T2 and above). Even with close monitoring and intensive intravesical therapy, the reported risk of muscle invasion in these patients is 53% and 1/3 die from this disease in the long-term. The aim of this study is to determine whether the timing of radical cystectomy affects the survival of patients with aggressive superficial bladder tumor.

Methods

We consider 74 patients who underwent radical cystectomy between November 1994 and October 2006 before a diagnosis of T1G3 bladder tumor. These patients were divided in 2 subgroups: group A (n=27, 25 M and 2 F) who underwent immediate radical cystectomy, and group B (n=47, 40 M and 7 F) who underwent other conservative treatments before radical cystectomy.

Results

The two subgroups were similar concerning age (66.29±8.37 yrs vs 66.87±8.6 yrs, respectively, p NS) and the timing of follow-up (respectively 77±45 vs 60±35 mths, p NS). Moreover, the progression-free survival was significantly higher in subgroup A (53.73±48.54 vs 31.94±35.19 mths, log-rank p<0.05) as well as the overall survival (59.73±45.37 vs 36.45±33.96 mths respectively, log-rank p<0.05). Comparing the histological examinations, the two subgroups were significantly different concerning the T stage (superficial tumors 14/27 vs 16/47, respectively, p<0.05; invasive tumors 13/27 vs 31/47, respectively, p<0.00005) and the lymphonodal dissemination (2N+/27 vs 11N+/47, respectively, p<<0.0005).

Conclusions

Delaying radical cystectomy for aggressive superficial bladder tumors leads to a worse progression-free survival; the overall survival is likely to be due also to an early lymphonodal dissemination, which occurs extending the timing between diagnosis and radical treatment.
Solitary Fibrous Tumor of the Kidney. A Propos of a Case
Authors: Marzi M. , D'Alpaos M. , Piras P. , Paiusco A. , Minervini M.S. , Di Zitti P.
Published: June 2018

Solitary Fibrous Tumors (SFT) are rare spindle cell neoplasm that typically originate from the pleura. However, cases of the SFT are described with origin in other organs, including the urinary and genital apparatus. Within the kidney, except from the renal pelvis, only 19 cases of SFT are described and such rarity of localization makes the histogenesis and the prognosis of the tumor rather unknown. We report the case of a 72-year-old lady who attended our Unit for a mass that was clinically palpable at the level of the left hemiabdomen. The tomodensitographic test indicated a 19cm-diameter mass of likely pertinence of the middle bystender of the left kidney. She had undergone left radical nephrectomy. The histological examination highlighted a solitary fibrous tumor (SFT): the presence of hypercellularity, of cellular pleiomorphism and of a high number of mitosis has led to a histological diagnosis of malignancy for the neoplasm analyzed. The SFT are of rare clinical comparison: this does not allow for a deep knowledge of the lesion histogenesis and prognosis; moreover, the clinical behavior should be more precisely defined.
Urethral Stricture: Complex Surgery
Authors: De Luca V.
Published: June 2018

The optimal management strategy for urethral stricture remains controversial. The therapeutic indication and surgery technique are still as much an art as they are a science. It is often unclear which type of urethroplasty to perform under which particular circumstance, but some evidence basis for urethral surgery has been developed in the last 20 years at last.

This article reports the options for urethroplasty at different sites in the urethra and for different types of stricture, indicating which procedure should be used in which circumstances according to best available publications on urethral stricture management.
Analysis of the Results Obtained with a new Phytotherapeutic Association for Benign Prostatic Hyperplasia versus Controls
Authors: Bercovich Eduard , Saccomanni Mauro
Published: June 2018

Introduction

Benign prostatic hypertrophy (BPH) is a common disease whose frequency has risen throughout the world in concomitance with the increase in life expectancy. BPH causes voiding distur-bances known by the acronym LUTS (lower urinary tract symptoms), which heavily influence the quality of life in the elderly. The treatment for LUTS is mainly divided into medical and surgical, the latter usually represented by prostate ablation. Medical therapy includes synthetic molecules that interfere with the hormonal control of BPH or act on the bladder neck tonus, as well as natural remedies based on plant extracts from Serenoa Repens and/or Urtica Dioica.

Material and Methods

TWO groups of patients who were candidates for surgery for BPH-induced LUTS, were randomly recruited in a six-month trial aimed at comparing outcome of treatment with a new combination of plants extracts (Pluvio®), which differs from the previous ones in that it also contains avocado and soya oil, as well as a high dose of Urtica Dioica, with no therapy. Age, IPSS score, maximal uroflow, prostate volume, PSA, free-to-total PSA ratio, post voiding residual urine and number of nocturia episodes were recorded and statistically evaluated using a NCSS 60® program.

Result

A marked benefit in terms of quality of life, measured by IPSS score, uroflow, residual urine and nocturia, was observed in the treated group compared to controls. PSA and prostate volume were not significantly affected. No noteworthy adverse events were observed.

Conclusions

The new phytotherapeutic combination evaluated in the present study would seem to be highly effective for the treatment of LUTS in BPH patients and does not have negative side effects. Its use could therefore be strongly advocated in this setting.