A Chance Finding of High Grade Prostate Cancer in a 35-Year-Old Male - A Case Report and Outcomes of Robotic Radical Prostatectomy in Young Men with Prostate Cancer.

Background: Prostate cancer is often considered a disease of older men and this indeed fits with its peak incidence between 65-79 years of age. Reports of prostate cancer in men younger than 40 years of age and the outcomes of this age group following treatment are few in the literature. Here, we present the case of an unusual diagnosis of high grade prostate cancer in a very young man and outline early outcomes following treatment with robotic-assisted radical prostatectomy. Case Presentation: A 35-year-old male, intermittently taking finasteride for hair loss, was found to have an elevated prostate-specific antigen (PSA) of 12.5ng/mL leading to an incidental diagnosis of high grade prostate cancer. Targeted trans-perineal prostate biopsy found Gleason 4+5=9 acinar adenocarcinoma, without cribriform architecture but with features suspicious for extracapsular extension. Robotic radical prostatectomy with bilateral pelvic lymph node dissection was performed and found Gleason 4+5=9 adenocarcinoma with focal cribriform architecture, extra prostatic extension and clear margins, stage pT3a N0 M0. PSA was undetectable at 12 months, continence was immediate, and the patient reported strong erections soon after surgery. Family history of prostate cancer and genetic testing were both negative. Conclusion: This case highlights that not all clinically significant cancers will be identified by following PSA screening guidelines starting at 50 years of age (or 40 years of age for men with a family history of prostate cancer). While high grade prostate cancer in a man less than 40 years of age is uncommon, the literature suggests the incidence is increasing. Our case alongside series in the literature indicate that these men have better functional outcomes and equal oncological outcomes with early surgical intervention for localized disease when compared to the older population.

Segmental testicular infarction secondary to protein C deficiency.

Protein C deficiency is a rare blood disorder that increases the risk of thromboembolism, resulting in deep vein thrombosis, pulmonary embolisms and strokes. Segmental testicular infarction is also a rare condition with unclear aetiology. This case presents a man in his 50s with protein C deficiency who developed a segmental testicular infarction. The patient was managed conservatively, without surgical intervention. He was monitored with serial ultrasound, which demonstrated progression from normal testis to segmental infarction and eventually resolution. The case highlights that protein C deficiency can cause testicular infarction, and a multidisciplinary approach can help avoid unnecessary surgery with excellent outcomes. Segmental infarction should be considered in patients with pre-existing thrombophilias after excluding malignancy and infection. Conservative management with repeat ultrasonography and follow-up can be appropriate in such cases.

Urology case report - Emergency penectomy for the transfeminine patient.

Management of gender dysphoria and healthcare for transgender and non-binary patients is a growing field in Australia and abroad. Currently, gender-affirming surgery is not offered under Australia's national public health insurance. We present an unusual case of emergency penectomy required for a 57-year-old woman assigned-male-at-birth from rural Australia after a self-inflicted chemical burn. This case report outlines the surgical challenges of partial penectomy and neo meatus formation to allow for future gender-affirming surgery and highlights the lack of infrastructure within the public healthcare system for management of gender dysphoria both in rural and metropolitan settings.

A survival nomogram model constructed with common clinical characteristics to assist clinical decisions for diffuse low-grade gliomas: A population analysis based on SEER database.

Background: The prognosis of diffuse low-grade gliomas (DLGGs, WHO grade 2) is highly variable, making it difficult to evaluate individual patient outcomes. In this study, we used common clinical characteristics to construct a predictive model with multiple indicators. Methods: We identified 2459 patients diagnosed with astrocytoma and oligodendroglioma from 2000 to 2018 in the SEER database. After removing invalid information, we randomly divided the cleaned patient data into training and validation groups. We performed univariate and multivariate Cox regression analyses and constructed a nomogram. Receiver operating characteristic (ROC) curve, c-index, calibration curve, and subgroup analyses were used to assess the accuracy of the nomogram by internal and external validation. Results: After univariate and multivariate Cox regression analyses, we identified seven independent prognostic factors, namely, age (P<0.001), sex (P<0.05), histological type (P<0.001), surgery (P<0.01), radiotherapy (P<0.001), chemotherapy (P<0.05) and tumor size (P<0.001). The ROC curve, c-index, calibration curve, and subgroup analyses of the training group and the validation group showed that the model had good predictive value. The nomogram for DLGGs predicted patients' 3-, 5- and 10-year survival rates based on these seven variables. Conclusions: The nomogram constructed with common clinical characteristics has good prognostic value for patients with DLGGs and can help physicians make clinical decisions.

Computational identification of immune-related lncRNA signature for predicting the prognosis and immune landscape of human glioblastoma multiforme.

Emerging evidence shows immune-related long noncoding RNAs (ir-lncRNAs) perform critical roles in tumor progression and prognosis assessment. However, the identification of ir-lncRNAs and their clinical significance in human glioblastoma multiforme (GBM) remain largely unexplored. Here, a designed computational frame based on immune score was used to identify differentially expressed ir-lncRNAs (DEir-lncRNAs) from The Cancer Genome Atlas (TCGA) GBM program. The immune-related lncRNA signature (IRLncSig) composed of prognosis-related DEir-lncRNAs selected by Cox regression analysis and its clinical predictive values were verified, which was further validated by another dataset from the Gene Expression Omnibus database (GEO). Subsequently, the association between IRLncSig and immune cell infiltration, immune checkpoint inhibitor (ICI) biomarkers, O6-methylguanine-DNA methyltransferase (MGMT) gene expression, and biological function were also analyzed. After calculation, five prognosis-related ir-lncRNAs were included in the establishment of IRLncSig. The risk assessment based on IRLncSig indicated that the high-IRLncSig-score group was significantly associated with poor prognosis (p < 0.001), significant aggregation of macrophages (p < 0.05), higher ICI biomarker expression, and MGMT gene expression (p < 0.05). Signature-related lncRNAs may be involved in immune activities in the tumorigenesis and progression of GBM. In summary, the novel IRLncSig shows a promising clinical value in predicting the prognosis and immune landscape of GBM.

Chromobox Homolog 8 (CBX8) in Human Tumor Carcinogenesis and Prognosis: A Pancancer Analysis Using Multiple Databases.

Some emerging studies have suggested that chromobox homolog 8 (CBX8) may play a critical role in carcinogenesis and prognosis in human cancer. Based on The Cancer Genome Atlas (TCGA)'s available data and the Gene Expression Omnibus (GEO) database, we conducted a systematic analysis of the carcinogenic effects of the CBX8 gene. We used TIMER2, GEPIA2, UALCAN, cBioPortal, Kaplan-Meier plotter, OncoLnc, STRING, HPA, and Oncomine data analysis websites and R data analysis software to analyze available data. The results show that the level of expression of CBX8 was significantly different among 27 different types of tumors and adjacent normal tissues. Moreover, we found that CBX8 expression had a close relationship with prognosis in some kinds of cancers. The phosphorylation level of some protein sites (such as S256) was significantly increased in tumors. CD8 + T-cell, B-cell and cancer-associated fibroblast infiltration levels were associated with CBX8 expression. The results of enrichment analysis indicated that the main biological activities of CBX8 are connected to gene transcription and repair of DNA damage. In conclusion, the level of expression of CBX8 was closely related to carcinogenesis and prognosis of some kinds of tumors, which needs further experimental verification.

Successful management of severe refractory haemorrhagic cystitis secondary to cyclophosphamide and BK virus with cystotomy and alum infusion.

A 36-year-old male patient is referred for urology review for haematuria following cyclophosphamide and mesna administration for allogeneic stem cell transplant for treatment of acute lymphoblastic leukaemia. Severe haematuria continued despite multiple interventions including continuous bladder irrigation and cystoscopic fulguration, with formation of consolidated clot in the bladder. A successful cystotomy for removal of clot and initiation of alum was performed, leading to resolution of haematuria.

Identification of rare PTCH1 nonsense variant causing orofacial cleft in a Chinese family and an up-to-date genotype-phenotype analysis.

The Patched 1 (PTCH1) gene encodes a membrane receptor involved in the Hedgehog (Hh) signaling pathway, an abnormal state of which may result in congenital defects or human tumors. In this study, we conducted whole-exome sequencing on a three-generation Chinese family characterized with variable penetrance of orofacial clefts. A rare heterozygous variant in the PTCH1 gene (c.2833C > T p.R945X) was identified as a disease-associated mutation. Structural modeling revealed a truncation starting from the middle of the second extracellular domain of PTCH1 protein. This may damage its ligand recognition and sterol transportation abilities, thereby affecting the Hh signaling pathway. Biochemical assays indicated that the R945X protein had reduced stability compared to the wild-type in vitro. In addition, we reviewed the locations and mutation types of PTCH1 variants in individuals with clefting phenotypes, and analyzed the associations between clefts and locations or types of variants within PTCH1. Our findings provide further evidence that PTCH1 variants result in orofacial clefts, and contributed to genetic counseling and clinical surveillance in this family.

Diabetes increases the risk of meningioma: A systematic review and meta-analysis of observational studies.

BACKGROUND: Increasing epidemiological evidence suggests that diabetes may be associated with meningioma risk, but the evidence supporting this association is still inconclusive. Therefore, we performed a meta-analysis of all eligible observational studies to evaluate the potential association of diabetes with meningioma risk. METHODS: A comprehensive literature search was performed in the PubMed, Web of Science and Cochrane Library databases up to November 30, 2020. A random-effects model was applied to calculate the pooled effect size (ES) and its 95 % confidence interval (CI). RESULTS: Eight studies were included in this study. In a random-effects pooled analysis, the results showed that DM (diabetes mellitus) increased the risk of meningioma (ES 1.17, 95 % CI: 1.02-1.35, P = 0.027). In subgroup analyses, DM increased the risk of meningioma in women (ES: 1.19, 95 % CI: 1.02-1.40, P = 0.027) and men (ES: 1.53, 95 % CI: 1.25-1.88, P = 0.000). This effect was not observed in the postmenopausal group (ES: 1.18, 95 % CI: 0.64-2.18, P = 0.597). CONCLUSION: Our meta-analysis showed that DM increases the risk of meningioma, but the association was only present in some subgroups. This conclusion should be further confirmed.

Integrin-α9ß1 as a Novel Therapeutic Target for Refractory Diseases: Recent Progress and Insights.

Integrins refer to heterodimers consisting of subunits α and ß. They serve as receptors on cell membranes and interact with extracellular ligands to mediate intracellular molecular signals. One of the least-studied members of the integrin family is integrin-α9ß1, which is widely distributed in various human tissues and organs. Integrin-α9ß1 regulates the physiological state of cells through a variety of complex signaling pathways to participate in the specific pathological processes of some intractable diseases. In recent years, an increasing amount of research has focused on the role of α9ß1 in the molecular mechanisms of different refractory diseases and its promising potential as a therapeutic target. Accordingly, this review introduces and summarizes recent research related to integrin-α9ß1, describes the synergistic functions of α9ß1 and its corresponding ligands in cancer, autoimmune diseases, nerve injury and thrombosis and, more importantly, highlights the potential of α9ß1 as a distinctive target for the treatment of these intractable diseases.

The protective impact of Trans-Cinnamaldehyde (TCA) against the IL-1b induced inflammation in in vitro osteoarthritis model by regulating PI3K/AKT pathways.

INTRODUCTION: Osteoarthritis (OA) is a severe joint degeneration disease in elderly people described by the advanced degradation of articular cartilage, which ultimately leads to chronic pain. Trans-cinnamaldehyde (TCA) exerted its anti-inflammatory function in numerous disease syndromes; however, its role in the pathogenesis of OA remains unknown. The current research aimed to explore the potential protective impact of TCA in the progression of osteoarthritis in vitro. MATERIAL AND METHODS: Human knee articular chondrocytes were treated with 10 ng/ml IL-1b alone for 24 h or in a combination in a pretreatment with TCA at different concentrations (2, 5, 10 µg/mL, 24 h). The viability and cell apoptosis were determined by CCK-8 assay and flow cytometry methods. The protein levels of IL-8, PGE2, and TNF-a and the levels of phosphorylated AKT and PI3K were evaluated using ELISA assay. Moreover, RT-qPCR was used to measure the relative mRNA expression of MMP-13, iNOS, COX-2, and ADAMTS-5 in IL-1b-induced chondrocytes. RESULTS: Our results revealed that the treatment with TCA had no effect on chondrocytes' proliferation and apoptosis. Moreover, the protein levels of IL-8, TNF-a, and PGE2 were considerably reduced in IL-1b-induced chondrocytes treated with different concentrations of TCA. Furthermore, the mRNA expression of MMP-13, iNOS, COX-2, and ADAMTS-5 and the phosphorylation of AKT and PI3K were markedly reduced in IL-1b-induced chondrocytes with the increase in the concentration of TCA. CONCLUSIONS: Trans-cinnamaldehyde inhibited the inflammation induced by IL-1b in chondrocytes through the PI3K/AKT pathway, which suggests that TCA might serve as a potential therapeutic agent for osteoarthritis treatment.

A Systematic Review and Meta-Analysis of Pelvic Drain Insertion After Robot-Assisted Radical Prostatectomy.

Purpose: To perform a systematic review and meta-analysis and to assess the clinical benefit of prophylactic pelvic drain (PD) placement after robot-assisted laparoscopic prostatectomy (RALP) with pelvic lymph node dissection (PLND) in patients with localized prostate cancer. Materials and Methods: An electronic search of databases, including Scopus, Medline, and EMbase, was conducted for articles that considered postoperative outcomes with PD placement and without PD (no drain) placement after RALP. The primary outcome was rate of symptomatic lymphocele (requiring intervention) and secondary outcomes were complications as described by the Clavien-Dindo classification system. Quality assessment was performed using the Modified Cochrane Risk of Bias Tool for Quality Assessment. Results: Six relevant articles comprising 1783 patients (PD = 1253; ND = 530) were included. Use of PD conferred no difference in symptomatic lymphocoele rate (risk difference 0.01; 95% confidence interval [CI] -0.007 to 0.027), with an overall incidence of 2.2% (95% CI 0.013-0.032). No difference in low-grade (I-II; risk difference 0.035, 95% CI -0.065 to 0.148) or high-grade (III-V; risk difference -0.003, 95% CI -0.05 to 0.044) complications was observed between PD and ND groups. Low-grade (I-II) complications were 11.8% (95% CI 0-0.42) and 7.3% (95% CI 0-0.26), with similar rates of high-grade (III-V) complications, being 4.1% (95% CI 0.008-0.084) and 4.3% (95% CI 0.007-0.067) for PD and ND groups, respectively. Conclusion: PD insertion after RALP with extended PLND did not confer significant benefits in prevention of symptomatic lymphocoele or postoperative complications. Based on these results, PD insertion may be safely omitted in uncomplicated cases after consideration of clinical factors.

A Rare Case of Ureteral IgG4 Disease Masquerading as Urothelial Carcinoma.

The present paper described a rare case of ureteral IgG4-related disease (IgG4-RD) that mimicked urothelial carcinoma. An otherwise healthy patient presented with computed tomography, ureteroscopic, and biopsy findings that were suspicious of urothelial carcinoma. The patient received a right nephroureterectomy. Histopathology showed ureteral IgG4-RD, without evidence of urothelial carcinoma. Accurate diagnosis of this rare entity should be based on clinical, biochemical, and histopathological findings.

A standardized analysis of the current surgical and non-surgical treatment selection process for men with localized prostate cancer.

Robot-assisted radical prostatectomy to treat localized prostate cancer has increased in popularity, although other options exist, including radiotherapy and active surveillance. The decision about choosing the right treatment has become pertinent for many patients. This literature review aimed to assess the current state-of-the-art regarding decisional aids and the associated decisional outcomes for the purpose of designing a method for both patients and doctors to use to make the best treatment decision for the patient. A literature search was conducted via MEDLINE, Embase, and Web of Science databases using the keywords "prostate" and "cancer" and "impact" and "decisio*" and "treatment." Articles were included that focused on treatment outcomes, decision-making processes, and the use of decisional aids for localized prostate cancer. Articles that investigated prostate cancer in general or prostate cancer screening were excluded, as were articles that were not written in English. Altogether, 13 articles were finally critically reviewed for this study. Results were conflicting regarding the relations between patient factors, use of decisional aids, and decisional outcomes. There was a large gap in the literature regarding the optimal decision-making process for men with localized prostate cancer. The role of currently available decisional aids is limited to helping patients make the right decisions. There is a need to develop a novel decisional aid in which patient-physician discussion-involving evaluation of a spectrum of patient-, doctor-, and treatment-related factors-is included.

Systematic Review of Decision Aids for the Management of Men With Localized Prostate Cancer.

A broader range of decisional tools should be investigated. This paper will update the decisional outcome data and assess the features of decisional tool. Literature search strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles that cited Lin et al and Violette et al were searched. Features of decisional tools were analyzed using the International Patient Decision Aid Standards Instrument criteria. The scores of the 31 decisional tools ranged from 6 to 15, which did not correlate proportionally with the positive decisional outcomes. Personal importance appeared to be a significant component. Multidisciplinary clinics are superior in improving decisional outcomes as they promote more at shared decision making.

A Case Report of Priapism With Unusual Presentation and Clinical Course.

This is a case report on a patient with an unusual presentation and clinical course of priapism. It further discusses treatment options with reflection on current literatures and guidelines. 48 year old patient presented with a history of more than 50 episodes of priapism, each lasting for five minutes. Patient had history of brain tumor that was resected and had since been in remission. On examination and further biochemistry assessment revealed conflicting clinical findings, making it difficult to ascertain the type of priapism in this case. The patient, however, recovered from the acute attacks of priapism after 24 hours of conservative management and no obvious cause had been identified on post-discharge follow-up. Priapism, despite being rare, is a medical emergency. This case report reflected upon the limitations of treatment guidelines and the lack of level one evidence to support treatment decisions.

Utilization and Surgical Skill Transferability of the Simulator Robot to the Clinical Robot for Urology Surgery.

INTRODUCTION: Virtual reality is an increasingly popular surgical training tool in Australia, following the introduction of Australia's first virtual reality simulation machine at Liverpool Hospital, Sydney. This literature review aims at identifying gaps in previous studies, and in providing a comprehensive review of future studies to be further developed in Australia. METHOD: A multi-field research was performed combining the key terms 'uro*' and 'virtua*' and 'simula*' and 'robo*'. Academic search engines used in this literature review included 'Medline', 'Scopus', and 'Sciencedirect'. Studies with laparoscopic skills as a focused investigation but not robotic skills were excluded. Critical appraisal of each of the article was conducted with a discussion of key topic involving urologists with expert skills on robotic surgery. RESULT: A thorough literature review discovered 3 main types of studies in this area. These are: (1) validity studies; (2) studies specific for urology procedures; (3) studies on skill transfer, in general. Cohort study and randomized control trial are the 2 dominant forms of research designs. CONCLUSION: Future studies need to focus more around the investigation of operation-specific training, in conjunction with skills-based teaching. Also, it is important that these studies incorporate teamwork, decision-making, and communication skills.

A cadaveric study of surgical landmarks for retrograde parotidectomy.

PURPOSE: Retrograde parotidectomy is employed in situations where tumors or scar tissue obscure the facial nerve trunk, making anterograde parotidectomy hazardous. Hence, the reliability of anatomical landmarks in retrograde parotidectomy is of equal practical importance. METHODS: Distances from soft tissue and osseous landmarks to the corresponding peripheral branches of the facial nerve were measured in 41 half-head specimens. The distances were from: i) the zygomatic arch (Z) to the buccal branch (B); ii) the retromandibular vein (RMV) to the marginal mandibular branch (MM); and iii) the angle of the mandible (A) to MM. These distances were compared in left vs, right sides, male vs. female groups, occlusal vs. nonocclusal sides. RESULTS: No statistically significant differences were found in any of the three distances between all groups compared, amongst which, the mean distances from A to MM were the shortest and least variable (Male = 8.9 ± 3.0 mm vs. Female = 6.8 ± 3.5 mm; Left = 7.3 ± 2.8 mm vs. Right = 8.8 ± 3.9 mm; Occlusal = 8.6 ± 3.5 mm vs. Nonocclusal = 7.8 ± 3.4 mm). CONCLUSION: The findings indicate that all three landmarks are useful for surgeons to locate the facial nerve branches during retrograde parotidectomy. Since all three landmarks were consistent indicators for the corresponding facial nerve branches, the surgeon has more than one option should one landmark be obscured by tumors. The optimal landmark is the distance from A to MM because it is shortest and most reliable, followed by RMV to MM, and Z to B.