Effect of muscle density in patients with metastatic prostate cancer administered androgen deprivation therapy. / Efecto de la densidad muscular en pacientes con cáncer de próstata metastásico tratados con terapia de privación androgénica.

INTRODUCTION: Sarcopenia is a syndrome characterized by the loss of muscle mass and strength. The study objective was to determine the association between muscle density and overall survival (OS) in patients with metastatic onset prostate cancer (MPCa). MATERIALS AND METHODS: This was a retrospective study of patients diagnosed with MPCa between 2009 and 2015 who received androgen deprivation therapy alone as initial treatment. Muscle density was calculated using the Hounsfield Unit Average Calculation (HUAC) in both psoas muscles in the computed tomography (CT) scan performed for diagnosis. RESULTS: A total of 59 patients diagnosed with MPCa, with a mean age of 57.5±72.47 years, were found. Median prostate-specific antigen (PSA) level at diagnosis was 68.25 ng/dL (IQR 37.26-290). Gleason scores≥8 were recorded in 90.75% of the patients, bone metastases in 88.13%, and visceral metastases in 10.16%. Median HUAC was 20.32 HU (IQR 15.46-22.83). In a univariate analysis, the number of bone metastases, the presence of visceral metastases, and testosterone levels≥50 ng/dL at follow-up were associated with poorer OS, while high HUAC levels were associated with better OS. In a multivariate analysis, the number of bone metastases [hazard ratio (HR)=1.573, 95% confidence interval (CI)=1.103-2.243, p=0.012], the presence of visceral metastases (HR=7.404, CI=2.233-24.549, p=0.001), and the Gleason score (HR=2.001, CI=1.02-3.923, p=0.044) were associated with greater overall mortality, and HUAC (HR=0.902, CI=0.835-0.973, p=0.008) was associated with better OS. CONCLUSIONS: In our series, increased HUAC values in the psoas muscles, as a reflection of muscle density, when MPCa was diagnosed had a protective effect on OS in these patients.

Quality of life in female patients with bladder exstrophy-epispadias complex: Long-term follow-up.

INTRODUCTION: Bladder exstrophy-epispadias complex (BEEC) is a congenital malformation that requires multiple surgeries during childhood and life-long follow-up. It often presents with conditions that have the potential to impact quality-of-life (QoL) and psychosocial functioning of affected patients, such as incontinence and sexual dysfunction. The aim of this study is to examine the QoL, urinary continence, sexual function, and overall health in a long-term series of female patients with BEEC. METHOD: A retrospective review was performed of female patients with BEEC born between 1964 and 1996. Thirty-three patients were asked to complete four validated questionnaires to evaluate their QoL regarding urinary continence and sexual activity (ICIQ, Potenziani-14, and PISQ-12 questionnaires). Nineteen patients completed and returned the questionnaires. The overall QoL was assessed with the SF-36 questionnaire, and demographics were evaluated. Statistical analysis was performed to compare the general QoL with that of the general population. RESULTS: The median age of the patients was 26 years (range 18-50) (Table). A low to moderate impact of urinary incontinence on QoL was reported by 30% of patients in the ICIQ. Also as a result of urinary incontinence, 84% of patients reported a moderate to severe impact on their sexual lives. Twelve patients got married with eight gestations and five births. SF-36 reported general QoL comparable with that of the general population in five out of eight items. Differences were seen in the mental health, emotional role, and physical functioning items (p < 0.001). The main factors for the differences were poor body image, anxiety, and urinary incontinence. A satisfactory social life was reported by 70% of patients. CONCLUSION: Questionnaire studies on BEEC consistently report a high rate of patients not answering, 43% in the present study. The rarity of the disease determines a small sample size, which diminishes statistical power and could potentially conceal small differences with controls. Despite these limitations, the present findings are consistent with previous studies on BEEC with validated QoL questionnaires: adult women with BEEC suffer psychosocial impact mainly from incontinence, and also from gynecological complications, but their resilience and coping mechanisms allow them to achieve a quasi-normal QoL. Female patients with BEEC reported a normal QoL in five of eight items in the SF-36 questionnaire. Urinary incontinence was the main factor for the moderately decreased QoL according to specific questionnaires.

Mini-percutaneous nephrolithotomy with high-power holmium YAG laser in pediatric patients with staghorn and complex calculi.

INTRODUCTION: Shock wave lithotripsy (SWL) is the treatment of choice for most cases of renal lithiasis in children. Some cases, however, are refractory to SWL and may be associated with anatomic and metabolic changes or a large stone burden. In these circumstances, mini-percutaneous nephrolithotomy (mini-PCNL) is an option. OBJECTIVE: The aim was to assess the safety and efficacy of high-power holmium YAG (Ho:YAG) laser in mini-PCNL for staghorn calculi. PATIENTS AND METHODS: The clinical records relating to 35 mini-PCNLs (Table) performed between January 2008 and December 2012 in 33 patients (27 boys and 6 girls; mean age 7 years, range 2-18 years) were retrospectively reviewed. Twenty-two (66.7%) of the patients had undergone a previous SWL (28.6% three sessions). The mini-PCNL puncture technique used involved fluoroscopic guidance with the C arm at 0-90° in the supine position. An 18F tract was used. Stone fragmentation was performed with a high-power Ho:YAG laser (Lumenis 100 W). RESULTS: Ten of the mini-PCNLs (28.6%) were right sided, and 25 were left sided (71.4%). Stones were located in the lower calyceal group in 64% of patients and in the renal pelvis in 50%. The mean stone size was 4.46 cm(2) (range 3-13.20 cm(2)). The number of stones varied between one and 20, and 83.3% were radiopaque. The laser was set at 70 W (range 50-100 W) (3.5 J/pulse with a frequency of 20 pulses/s). The mean surgical time was 150 min. In 78% of patients, complete stone clearance was achieved, and the overall stone-free rate rose to 85% when residual stones were treated with either SWL or retrograde intrarenal surgery. No perioperative complications were seen. DISCUSSION: There are few reports in the literature concerning the use of a high-power laser for treatment of complex stones and the few that do exist relate to adults have similar results, showing it to be highly effective and safe, with low morbidity. Some limitations of the present study must be acknowledged. It was retrospective and a relatively small number of patients were included. However, randomized prospective studies are required to confirm our findings and conclusions. CONCLUSION: In the pediatric population, mini-PCNL with high-power Ho:YAG laser is feasible and safe and represents the technique of choice for complex renal stones.

Information and communication technologies for informal carers and paid assistants: benefits from micro-, meso-, and macro-levels.

The aim of this study was to explore the benefits of information and communication technologies (ICT)-based services for informal carers and paid assistants of older people living in the community. We cross-case analysed the effects of twelve initiatives in the EU, the USA and Canada, based on their individual analysis documented through interviews with promoters and a literature review. We carried out the cross-case analysis following a variables-oriented strategy on seven dimensions of impact at micro-, meso- and macro-levels: the quality of life of informal carers and paid assistants, quality of life of care recipients, quality of care, care efficiency and sustainability, acceptability, and infrastructure and accessibility. ICT-based services for informal carers and paid assistants improve the quality of life of older people and their carers and access to qualified care. They also generate savings which contribute to the sustainability of the care systems. These findings constitute a first look at the benefits of the use of ICT-based services for informal carers and paid assistants. Nevertheless, more research using experimental methods is needed to demonstrate the impact of these ICT-based services at meso- and macro-levels. This would help to support policy-makers to deploy these technologies for long-term care delivery.