[Urinary diversion in old patients (80+ years)]. / Harnableitung beim alten Patienten (80+).

With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.

Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis.

BACKGROUND: Sepsis is one of the leading causes of death. Treatment attempts targeting the immune response regularly fail in clinical trials. As HCMV latency can modulate the immune response and changes the immune cell composition, we hypothesized that HCMV serostatus affects mortality in sepsis patients. METHODS: We determined the HCMV serostatus (i.e., latency) of 410 prospectively enrolled patients of the multicenter SepsisDataNet.NRW study. Patients were recruited according to the SEPSIS-3 criteria and clinical data were recorded in an observational approach. We quantified 13 cytokines at Days 1, 4, and 8 after enrollment. Proteomics data were analyzed from the plasma samples of 171 patients. RESULTS: The 30-day mortality was higher in HCMV-seropositive patients than in seronegative sepsis patients (38% vs. 25%, respectively; p = 0.008; HR, 1.656; 95% CI 1.135-2.417). This effect was observed independent of age (p = 0.010; HR, 1.673; 95% CI 1.131-2.477). The predictive value on the outcome of the increased concentrations of IL-6 was present only in the seropositive cohort (30-day mortality, 63% vs. 24%; HR 3.250; 95% CI 2.075-5.090; p < 0.001) with no significant differences in serum concentrations of IL-6 between the two groups. Procalcitonin and IL-10 exhibited the same behavior and were predictive of the outcome only in HCMV-seropositive patients. CONCLUSION: We suggest that the predictive value of inflammation-associated biomarkers should be re-evaluated with regard to the HCMV serostatus. Targeting HCMV latency might open a new approach to selecting suitable patients for individualized treatment in sepsis.

[Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. / Sicherheit und Effizienz der en bloc vs. konventionellen transurethralen Resektion von Blasentumoren: eine Metaanalyse und systematic Review.

BACKGROUND: En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE: To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES: PubMed. STUDY SELECTION: Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS: The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION: ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.

[Transurethral resection of bladder tumors (TURBT)]. / Transurethrale Resektion von Blasentumoren (TUR-B).

Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.

Knowledge about and attitudes towards medical cannabis among Austrian university students.

BACKGROUND: The relevance of medical cannabis (MC) increases; and, educating those who are at the forefront of patient care is imperative. Yet, research on medical students' expertise and opinions is still scarce. OBJECTIVE: This study set out to evaluate Austrian medical students' knowledge about and attitudes towards MC and compare them with other academic disciplines. Additionally, gender was controlled for. METHODS: An online survey was conducted with N = 404 students enrolled in (1) medical studies, (2) studies with a medical background and (3) studies without a medical background. RESULTS: In contrast to non-medical students, 64 % of medical students said they learnt about MC at the university. Although students were confident about their knowledge, they struggled to differentiate between CBD and THC. Chronic pain, oncological diseases and palliative care were the most frequently cited indications, psychiatric indications, however, were mentioned less often. Medical students were more reserved in their attitudes towards increasing medical usage and legalizing cannabis than the two other groups. Also, they were more skeptical about whether physicians should be allowed to prescribe MC and whether they should be obliged to offer it. Males showed more confidence regarding cannabis knowledge and were more favorable of legalizing and prescribing cannabis; females perceived cannabis as more physically addictive and as a gate-way drug. CONCLUSIONS: Considering that beliefs and attitudes shape behavior, it is expected that future health care professionals will struggle with recommending cannabis for medical treatment. A coordinated approach for medical training is needed to ensure high standard medical care.

[A retrospective comparison of robotic assisted and conventional laparoscopic pyeloplasty in two centres]. / Retrospektiver Vergleich der roboterassistierten und der laparoskopischen Pyeloplastik an zwei Zentren.

PURPOSE: The aim of this retrospective study was to compare our initial experience with robotic assisted laparoscopic pyeloplasty (R-LPP) with the conventional laparoscopic method (C-LPP). MATERIALS AND METHODS: In the defined period from May 2015 to September 2019, a total of 76 renal pelvic surgeries were performed at two different university clinics. In all, 63 patients who received either L­NBP (n = 27) or R­NBP (n = 36) were considered for data analysis. RESULTS: The median follow-up for C­LPP and R­LPP was 22.5 and 12.7 months, respectively. The statistical analysis of the two groups revealed no statistically significant difference regarding age, body mass index, gender or affected side. The operating time was nonsignificantly shorter in the R­LPP group (180 ± 72 vs. 159 ± 54 min, p = 0.194). There were no statistically significant differences in postoperative pain, complications, average length of stay in hospital (7.48 ± 2.86 vs. 6.33 ± 2.04 days) or success rate. CONCLUSION: This study shows no significant reduction in operating time in the R­LPP group with an equal rate of complications. It could be shown that there is no disadvantage for the patients undergoing R­LPP directly after the implementation of a robotic system.

Immune response of healthy horses to DNA constructs formulated with a cationic lipid transfection reagent.

BACKGROUND: Deoxyribonucleic acid (DNA) vaccines are used for experimental immunotherapy of equine melanoma. The injection of complexed linear DNA encoding interleukin (IL)-12/IL-18 induced partial tumour remission in a clinical study including 27 grey horses. To date, the detailed mechanism of the anti-tumour effect of this treatment is unknown. RESULTS: In the present study, the clinical and cellular responses of 24 healthy horses were monitored over 72 h after simultaneous intradermal and intramuscular application of equine IL-12/IL-18 DNA (complexed with a transfection reagent) or comparative substances (transfection reagent only, nonsense DNA, nonsense DNA depleted of CG). Although the strongest effect was observed in horses treated with expressing DNA, horses in all groups treated with DNA showed systemic responses. In these horses treated with DNA, rectal temperatures were elevated after treatment and serum amyloid A increased. Total leukocyte and neutrophil counts increased, while lymphocyte numbers decreased. The secretion of tumour necrosis factor alpha (TNFα) and interferon gamma (IFNγ) from peripheral mononuclear blood cells ex vivo increased after treatments with DNA, while IL-10 secretion decreased. Horses treated with DNA had significantly higher myeloid cell numbers and chemokine (C-X-C motif) ligand (CXCL)-10 expression in skin samples at the intradermal injection sites compared to horses treated with transfection reagent only, suggesting an inflammatory response to DNA treatment. In horses treated with expressing DNA, however, local CXCL-10 expression was highest and immunohistochemistry revealed more intradermal IL-12-positive cells when compared to the other treatment groups. In contrast to non-grey horses, grey horses showed fewer effects of DNA treatments on blood lymphocyte counts, TNFα secretion and myeloid cell infiltration in the dermis. CONCLUSION: Treatment with complexed linear DNA constructs induced an inflammatory response independent of the coding sequence and of CG motif content. Expressing IL-12/IL-18 DNA locally induces expression of the downstream mediator CXCL-10. The grey horses included appeared to display an attenuated immune response to DNA treatment, although grey horses bearing melanoma responded to this treatment with moderate tumour remission in a preceding study. Whether the different immunological reactivity compared to other horses may contributes to the melanoma susceptibility of grey horses remains to be elucidated.

Autovaloración de calidad de vida / Self-assessment of quality

Objetivo: describir la autovaloración de calidad de viday del envejecimiento de tres grupos: adultos portadoresy no portadores de la mutación E280A en el gen de laPresenilina 1 para Enfermedad de Alzheimer FamiliarPrecoz, y adultos mayores, en Antioquia-Colombia,estudio realizado entre enero de 2005 y junio de 2007.Metodología: estudio descriptivo transversal dondeparticiparon 162 personas asintomáticas en riesgo dedesarrollar Enfermedad de Alzheimer como consecuenciagenética o del proceso de envejecimiento, quienesse subdividieron en tres grupos: 27 portadores, 39 noportadores y 96 adultos mayores. Investigación realizadaen el Grupo de Neurociencias de la Universidadde Antioquia (Medellín) y en el Centro GerontológicoAtardecer (Envigado). Se analizaron las característicassociodemográficas, y se aplicaron pruebas para laautovaloración de la calidad de vida global del envejecimiento:World Health Organization Quality of Life y laNürnberg -Self-Evaluation-List respectivamente. Análisisestadístico: Se describieron los grupos y se compararonfrente a las variables de estudio utilizando el análisis devarianza no paramétrico de Kruskall Wallis y la prueba Ude Mann-Whitney. Resultados: las calificaciones mediasde los instrumentos para la autovaloración de calidad devida y global del envejecimiento en los tres grupos departicipantes, fueron superiores a 50 puntos e inferioresa 55 puntos respectivamente. Conclusiones: los adultosmayores se autovaloran con menor calidad de vidaque los portadores y los no portadores, especialmenteen el área de salud física, al igual que en la percepcióndel envejecimiento, a pesar de las condiciones de losportadores, aunque, en general, todos los grupos laspuntuaron bien.