bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuing evolution of statistical tests in medical research
Authors: Totaro Angelo , Volpe Andrea , Sacco Emilio , Pinto Francesco , Palma Monica , Bassi Pierfrancesco 
Published: June 2018

The role of statistics in medical research starts at the planning stage of a clinical trial or laboratory experiment to establish the design and size of an experiment that will ensure a good prospect of detecting effects of clinical or scientific interest. Statistics is again used during data analysis (sample data) to make inferences valid in a wider population. In simple situations, computation of simple quantities such as P-values, confidence intervals, standard deviations, standard errors or application of some standard parametric or nonparametric tests may suffice. Moreover, despite the wide use of statistics in medical research, simple notions are sometimes misunderstood or misinterpreted by medical research workers, who have only a limited knowledge of statistics. This article, written for non-statisticians, is to explain what are the most common statistical tests used today in the field of medical research, tracing the evolution of statistical tests over time, in particular the introduction of nonparametric methods and, more recently, the NonParametric Combination (NPC) methodology. At the same time, this work seeks to identify some of the errors associated with their use, that often lead to an incorrect assessment and interpretation of results of medical research.
Nefropessi Retroperitoneoscopica
Authors: Buffardi A. , Ceruti C. , Destetan P. , Ruffino M.A. , Bosio A. , Bisconti A. , De Maria C. , Negro C. , Carchedi M. , Fontana D. 
Published: June 2018

Introduction Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position, that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy. Methods We present the case of a 25–years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle. Results NO blood loss nor perioperative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index. Conclusions Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the “true” cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.
I nuovi Materiali Nella Chirurgia del Prolasso e Dell'incontinenza
Authors: Tuffu G. , Fioretti F , Frumenzio E. , Bruno R. , Costantini E. 
Published: June 2018

In line with the results of general surgeons, who revolutionised the surgical approach and the success rate of ventral hernia repair using synthetic mesh, urologists and gynaecologists recently moved towards the use of prosthesis to augment the native tissues. The rationale was based on the relatively high failure rates of the traditional anterior vaginal compartment repair and the recognition that the native tissue may no longer assume the position, strength or functionality by simple re-approximation. Actually the plethora of mesh or graft material, ranging from absorbable (synthetic and biological) to non-absorbable materials, indicates how uncertain we are about the best management. The surgical results are variable on the basis of 1) the material used (synthetic or biological, absorbable or not absorbable); 2) the position of the mesh (incorporated in the suture, overlay the suture, below or under the fascia); 3) the tension adopted. Major problems concern the complications related to the use of the meshes in urogynaecological surgery and the final message is that surgeons may want to consider adopting use of graft techniques to improve surgical results with care given to carefully monitor complications.
Carcinoma dei Dotti Collettori del Bellini: Case Report con Metastasi Cutanea Come Iniziale Manifestazione Clinica
Authors: Grande M. , Facchini F. , La Rosa M. , Pozzoli G.L. , Leone M. , Piana S. , Monica B. 
Published: June 2018

Introduction Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp. Materials and Methods All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data. Results After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis. Conclusions Most of Bellini's carcinoma are already metastatic at presentation. Analiyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.
The Role of Non-Invasive Urodynamics in Bladder Outlet Obstruction Diagnosis in Male Patients
Authors: Palazzetti A. , Tosco L , Crìvellaro S. , Guaitoli P. , Abbinante M. , Frea B. 
Published: June 2018

Purpose Many Methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity. Materials and Methods A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article. Results There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction. Conclusions Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.
Endometriosis: Necessary and Sequential Therapeutic Procedures and Guidelines
Authors: Jasonni Valerio M. 
Published: June 2018

Objectives TO define the actual guidelines about the therapy of endometriosis. Methods. A brief review of the literature for the correct diagnosis of endometriosis and the medical and surgical approach. Results It is well accepted that the gold standard of endometriosis diagnosis is the direct vision of the disease with laparoscopy or the presence of endometriosis implants in vagina or cervix. Staging must be performed along with the distribution, and depth and bowel involvement must be noted. Symptoms intensity is not related to the degree of endometriosis. Therapy, medical or surgical, should be chosen in relation to symptoms and the disease degree, keeping in mind that surgery is the approach that may offer better results. Conclusions The direct vision of the disease is the only method to obtain the correct diagnosis and an accurate staging. However, ultrasound can be helpful in cases of pelvic localization and in the follow-up of the disease. Moreover, MRI can be employed, especially in cases with particular endometriosis implant, e.g. gluteus muscle. Surgery offers the best results but some medical therapy, especially hormonal therapy, is often employed for the relief of pains.
Indications and Limits to Endourologic Procedures for Endometriosis of the Urinary Tract
Authors: Marino G. , Piras D. , Pedalino M. , Di Primio O.G. , Velia R. , Vercesi E. 
Published: June 2018

Introduction The incidence of Urinary tract endometriosis (UTE) ranges from 1% to 3%; bladder is the most affected organ (85% of UTE), followed by ureter (12–14% of UTE), for which we distinguish an intrinsic very rare form and an extrinsic variety most frequently occurring in advanced pelvic endometriosis. Materials and Methods. From 1997 to 2010, 33 surgical procedures for urologic endometriosis were performed, involving the urinary tract, in 28 patients with mean age of 31 years (25–43). The localization of endometriosis were: 7 cases in the bladder, 2 cases in the vesicoureteral tract, and 19 cases of ureteral tract only. Of these, two cases were diagnosed with an intrinsic localization. Results Overall, we performed 3 TURB, 5 partial cystectomies (2 with open surgical approach and 3 by laparoscopy procedure), 12 laparoscopic ureterolysis and simultaneous protection of the upper urinary tract with stent, 9 cases of ureterocystoneostomy (UCNS) according to Lich-Gregoire procedure, and 3 according to Boari–Kuess procedure. Of the 12 patients who underwent ureterolysis with laparoscopic and stenting procedure, five cases required a UCNS according to Lich-Gregoire technique for persistent ureteral obstruction. Conclusions The limits of endoscopic procedures in endometriosis of the urinary tract are correlated both to the degree of extension and the localization of the disease. It is mandatory to achieve an interdisciplinary consensus in order to ensure the disease removal and the simultaneous functional results of the upper urinary tract.
Long-Term Results of Laparoscopic Retroperitoneal Lymph Node Dissection (RPLND) in Low-Stage Nonseminomatous Germ-Cell Testicular Tumors (NSGCTT) Performed by a Senior Surgeon: 1999–2003
Authors: Pizzocaro G. , Schiavo M. , Solima S. , Vitellaro M. , Blasoni D. , Nicolai N. 
Published: June 2018

Background Laparoscopic RPLND for low-stages NSGCTT is controversial: it is performed and recommended by excellent laparoscopic surgeons, but it is not widely used. The aim of this paper is to evaluate the results achieved by a senior surgeon, expert in open RPLND, who was introduced to laparoscopic surgery by excellent laparoscopists (LN, CU, GJ). Patients and Methods of the 48 operated patients, 36 had primary RPLND for clinical stage I disease (22 TINO, 7 TxNO, 5 T2–3 NO and 2 TIS1 NO) and 12 had post-chemotherapy surgery for IIA and IIB retroperitoneal nodes with normalized AFP and HCG. L-RPLND was performed with 4 ports and the en bloc removal of unilateral retroperitoneal nodes with the spermatic vessels. No post-operative adjuvant chemotherapy was planned for patients with documented nodal metastases as for open RPLND since 1985. Results Average operative time was 3.30'for the 36 clinical stage I patients and 4 hours for post-chemotherapy surgery. Blood loss was minimal in all cases, because of early conversion to open surgery in all patients with no immediate hemostasis at L-RPLND. Metastases were found in 6 (17%) out of the 36 clinical stage I patients: none in the 22 pTI, 1 in the 7 Tx, 3 in the 5 pT2–3 and in 2 of the 2 pT1S1 patients. Residual teratoma was found in 6 of the 12 patients who received neo-adjuvant chemotherapy for clinical stage IIA or IIB disease. The other 6 had fibrosis-necrosis. Further metastases developed in 2 of the 30 patients with negative nodes: 1 in the lung in a pT1, and 1 in a pT2 patient with increasing markers. Surprisingly, the first two pT2–3 patients with positive nodes developed liver metastases in a few months after L-RPLND. Consequently, all following patients with active metastases at L-RPLND received 2 courses of adjuvant PEB. All 4 patients who relapsed were cured, are alive and disease-free. Conclusions L-RPLND is a very demanding operation, which appears to be more a staging procedure than a curative operation. It is ideal for pT1 clinical stage I and for post-chemotherapy stages IIA& B with residual teratoma and normalized markers, but wait & see in good risk and open RPLND in high risk patients are very competing. Only few reports compared laparoscopic versus open RPLND, but not in a randomized study.
Multiple application of three-dimensional soft kidney models with localized kidney cancer: A pilot study
Authors: Glybochko Peter Vitalevich , Rapoport Leonid Mikhailovich , Alyaev Yuri Gennadevich , Sirota Eugene Sergeevich , Bezrukov Eugene Alexeevich , Fiev Dmitry Nikolaevich , Byadretdinov Ildar Shamilevich , Bukatov Mikhail Dmitrievich , Letunovskiy Alexander Vasilevich , Korolev Dmitry Olegovich 
Published: June 2018

Aim: To evaluate the effectiveness of three-dimensional printing application in urology for localized renal cancer treatment using three-dimensional printed soft models. Materials and methods: The study included five patients with kidney tumors. The patients were treated in the Urology Clinic of I.M. Sechenov First Moscow State Medical University from February 2016 to June 2017. Personalized three-dimensional printed models based on computed tomographic images were created. Five surgeons took part in a survey in which the utility of computed tomographic images versus three-dimensional printed models for presurgical planning was compared. A laparoscopic partial nephrectomy training using the developed three-dimensional printed models was performed by the same surgeons in a surgical training box. Results: The patients underwent endoscopic surgery using laparoscopic access. The average time of surgery was 187 min. All the operations were performed with complete renal artery clamping. The average warm ischemia time was 19.5 min and the average blood loss was 170 mL. No conversions to open surgery or radical nephrectomy, and no postoperative complications and deaths were observed. All the surgical margins were negative. The tumors were morphologically identified as renal cell carcinoma in four cases and as oncocytoma in one case. Conclusion: The developed three-dimensional printed models allow one to evaluate the pathological anatomy of tumors more effectively. High similarity between three-dimensional models and native kidneys contribute to improvement of surgical skills necessary for partial nephrectomy. Training on the three-dimensional models also allows surgeons to facilitate selection of an optimal surgical tactics for each patient.
Persistent Mullerian duct syndrome: Report of two cases with phenotypical immunohistochemical profiling
Authors: Ambrosi Francesca , Fiorentino Michelangelo , Chessa Francesco , Brunocilla Eugenio , D’Errico Antonietta , Bertuzzo Rosa Valentina , Giunchi Francesca 
Published: June 2018

Introduction: Persistent Mullerian duct syndrome is a rare disorder of male organ development characterized by internal male pseudohermaphroditism. Persistent Mullerian duct syndrome is usually an incidental finding in patients presenting cryptorchidism, inguinal hernia, or a previous story of undescended testes. Case description: We report on two cases of persistent Mullerian duct syndrome: an adult fertile male with uterus and ectopic prostate occurring as pelvic mass and a 75-year-old organ donor with uterus and two fallopian tubes, discovered in course of organ recruitment. We performed routine histological analysis and immunohistochemical profiling of the different tissue components. Examined tissues were all benign, and the living patient is well after surgery. Conclusion: In order to prevent further complications such as infertility and potential malignant change, surgeons and surgical pathologists must be aware of this condition and should consider excision of the Mullerian remnant where possible.
Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia
Authors: Grechenkov Anton , Sukhanov Roman , Bezrukov Eugene , Butnaru Denis , Barbagli Guido , Vasyutin Igor , Tivtikyan Alexander , Rapoport Leonid , Alyaev Yury , Glybochko Peter 
Published: June 2018

Objective: To identify risk factors for urethral stricture and/or bladder neck contracture after transurethral resection of benign prostatic hyperplasia. Materials and methods: We performed a retrospective analysis of 402 patients, which underwent a monopolar transurethral resection of the prostate in the urology clinic of Sechenov First Moscow State Medical University for prostatic hyperplasia during the period 2011–2014. Urethral stricture and (or) bladder neck contracture in the postoperative period were diagnosed in 61 (15.27%) patients; 34 patients (8.6%) had urethral stricture, 20 (4.97%) bladder neck contracture, and 7 (1.7%) had a combination of urethral stricture and bladder neck contracture. In 341 of cases (84.73%), no late postoperative complications were observed. A total of 106 of the 341 patients met the inclusion criteria, hence, containing all the information necessary for analysis such as the volume of the prostate, the duration of the surgery, the size of the endoscope, data on concomitant diseases, analysis prostatic secretion, and so on. Thus, two groups were formed. Group 1 (106 patients) is the control group in which urethral strictures and/or bladder neck contractures did not occur in the long-term postoperative period and group 2 (61 patients), in which was observed the formation of these complications. To calculate the statistical significance of the differences for categorical data, Fisher criterion was used. For quantitative variables, in the case of normal data distribution, an unpaired t-test or one-way analysis of variance was used; for data having a distribution different from normal, a Mann–Whitney rank test was used. Results: Regression analysis established the significance of the influence of four factors on the development of scar-sclerotic changes of urethra and bladder neck: the tool diameter 27 Fr ( p < 0.0001), presence of prostatitis in past medical history ( p < 0.0001), prostate volume ( p = 0.003), and redraining of the bladder ( p = 0.0162). Conclusion: The relationship between the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, and repeated drainage of the bladder using the urethral catheter with the risk of developing scar-sclerotic changes in the urethra and/or bladder neck are statistically reliable and confirmed as a result of regression analysis.
A potent tetravalent T-cell–engaging bispecific antibody against CD33 in acute myeloid leukemia
Authors: Hoseini Sayed Shahabuddin , Guo Hongfen , Wu Zhihao , Hatano Miho Nakajima , Cheung Nai-Kong V. 
Published: June 2018

Key PointsA tetravalent BsAb against CD33 treated AML human xenografts despite CD33 internalization. BsAb with bivalent versus monolavent binding to CD33 and CD3 had more than 10-fold greater potency against leukemia.
Severe Paediatric Asthma Collaborative in Europe (SPACE): protocol for a European registry
Authors: Liu Norrice M. , van Aalderen Wim , Carlsen Karin C.L. , Coleman Courtney , Chalmers James D. , Cunningham Steve , Fernandes Ricardo M. , Fleming Louise J. , Gappa Monika , Karadag Bülent , Midulla Fabio , Pijnenburg Marielle W.H. , Rutjes Niels W. , Rusconi Franca , Grigg Jonathan 
Published: June 2018

The development of new asthma biologics and receptor blockers for the treatment of paediatric severe asthma raises challenges. It is unclear whether there are sufficient children in Europe to recruit into randomised placebo-controlled trials to establish efficacy and safety in this age group.In February 2016, the European Respiratory Society funded a clinical research collaboration entitled “Severe Paediatric Asthma Collaborative in Europe” (SPACE). We now report the SPACE protocol for a prospective pan-European observational study of paediatric severe asthma. Inclusion criteria are: 1) age 6–17 years, 2) severe asthma managed at a specialised centre for ≥6 months, 3)clinical and spirometry evidence of asthma, and 4) reaching a pre-defined treatment threshold. The exclusion criterion is the presence of conditions which mimic asthma symptoms. Eligible children will be prospectively recruited into a registry, recording demographics, comorbidities, quality of life, family history, neonatal history, smoking history, asthma background, investigations, and treatment. Follow-up will provide longitudinal data on asthma control and treatment changes.The SPACE registry, by identifying well-phenotyped children eligible for clinical trials, and the amount of overlap in eligibility criteria, will inform the design of European trials in paediatric severe asthma, and facilitate observational research where data from single centres are limited.
Molecular Iodine Catalysed One Pot Synthesis of Spirooxindoles by Tandem Knoevenagel Cyclisation
Authors: Anitha Varghese Aatika Nizam 
Published: June 2018

Spirooxindoles are heterocycles found in various natural and synthetic products with potent bio-, physio-, and pharmaceutical activities. Heterocyclic fused phthalazines possess antimicrobial, antifungal, anticancer, anti- inflammatory, and cardiotonic activities. Hence, an efficient multi-component method has been developed for the synthesis of pyrazolophthalazinyl spirooxindoles through tandem Knoevenagel cyclisation from isatin, malononitrile and various phthalhydrazides in presence of readily available molecular iodine as a catalyst in ethanol solvent under ultrasonic condition to afford the products in very good yield within 15 mins. The method is simple, efficient, uses readily available commercial starting materials and gives good yield of product in short reaction time.