The View Outside of the Box: Reporting Outcomes Following Radical Cystectomy Using Pentafecta From a Multicenter Retrospective Analysis.

We aimed at characterization of the patients undergoing radical cystectomy (RC) using the prognostic model (a modified pentafecta). In the multicenter retrospective study, we enrolled 304 patients with bladder cancer (pTis-4N0-2M0) who underwent RC between 2015 and 2020 in experienced centers. The definition of the pentafecta was as follows: no Clavien-Dindo grade III-V complications at 90 days and no long-term complications related to urinary diversion <12 months, negative surgical margins, ≥10 lymph nodes (LNs) resected, and no recurrence ≤12 months. RC-pentafecta achievement rate was 22% (n = 67), varying from 47% to 88% attainment rate for different pentafecta components, and was the lowest for sufficient LN yield. Both 12-month recurrence-free survival (RFS) and cancer-specific mortality were compromised in pentafecta failers compared with achievers (57.8% vs. 100% and 33.8% vs. 1.5%, respectively). The following were identified as crucial predictors of RC pentafecta achievement: modality of the surgery, type of urinary diversion, histological type of bladder cancer, advanced staging, and elevated preoperative serum creatinine. In conclusion, we found that the pentafecta achievement rate was low even in high-volume centers in patients undergoing cystectomy. The complexity of the procedure directly influenced the attainment rate, which in turn led to an increase in cancer-specific mortality rate among the pentafecta failers.

Human kidney injury molecule-1 as a urine biomarker differentiating urothelial and renal cell carcinoma.

INTRODUCTION: Urine concentration of human kidney injury molecule-1 (KIM-1) is suggested to be increased in patients with renal cell carcinoma (RCC). However, it has never been tested in patients with urothelial tumors, while preoperative differentiation between RCC and upper tract urothelial carcinoma (UTUC) plays an essential role in therapeutic decisions.The aim of the study was to evaluate the role of urinary KIM-1 expression in preoperative differentiation between RCC and urothelial carcinoma (UC). MATERIAL AND METHODS: Sixty-four participants were enrolled in the study, including 30 patients with RCC and 27 with UC (16 with UTUC and 11 with bladder tumor). Preoperative urinary KIM-1 levels were measured using a commercially available ELISA kit and normalized to urinary creatinine levels. RESULTS: The median concentration of urinary KIM-1 normalized to urinary creatinine was lower in patients with RCC compared to UC (1.35 vs 1.86 ng/mg creatinine, p = 0.04). The comparison between RCC and UTUC shows even more significant difference (1.33 vs 2.23 ng/mg creatinine, p = 0.02). Urinary KIM-1 concentration did not correlate with tumor stage nor grade in any of the groups. ROC analysis to identify UC revealed AUC of 0.657 with sensitivity 33.3% and specificity 96.7% at the cut-off value of 3.226 ng/mg creatinine. Among patients with eGFR ≥60 mL/min/1.73 m², ROC analysis to detect UC achieved AUC of 0.727 with sensitivity 69.5% and specificity 70.2%. CONCLUSIONS: Urine KIM-1 can potentially differentiate UC from RCC. However, a wide range of observed results and limited sensitivity and specificity requires caution in making clinical decisions before confirmatory studies.

Urinary Human Kidney Injury Molecule1- (hKIM1-) is not Increased in Patients with Renal Cell Carcinoma.

PURPOSE: Human Kidney Injury Molecule-1 (hKIM-1) was proposed as urinary biomarker of renal cell carcinoma (RCC). The aim of the study was to validate urinary hKIM-1 as a biomarker of RCC. MATERIAL AND METHODS: Forty-six participants were enrolled into the study, including 30 patients with clear-cell or papillary RCC and 16 matched patients in the comparison group. Preoperative urinary hKIM-1 levels were measured using commercially available ELISA kit and normalized to urinary creatinine levels. RESULTS: The concentrations of urinary hKIM-1 normalized to urinary creatinine in patients with RCC and comparison group did not differ significantly (1.35 vs. 1.32 ng/mg creatinine, p=.25). There was also no difference in urinary hKIM-1 concentration regarding stage or grade of renal cancer. Additional analysis of patients without chronic kidney disease (defined as eGFR ≥60mL/min/1.73m²) also did not reveal significant difference in urinary hKIM-1 concentrations between the groups (1.54 vs. 1.37; p=.47). CONCLUSION: Results of our study do not confirm recent suggestions that urinary hKIM-1 may be a biomarker of RCC.

[Holter ECG monitoring during research bronchofiberoscopy in patients with asthma]. / Wplyw bronchofiberoskopii i plukania oskrzelowo- pecherzykowego na czynnosc serca u chorych na astme.

UNLABELLED: Bronchoscopy is a very useful tool in asthma research studies. The study was undertaken to evaluate the effect of bronchoscopy, BAL and bronchial biopsies on heart rate and arrhytmias in patients with asthma. Twenty patients (12 M, 8 F, mean age 39,6+/-16,3 yrs) with asthma (mean FEV, 81+/-19.5% pred.; mean FEV(1)%VC 69+/-12.3%) participated in the study. Holter ECG monitoring was performed twice: before (1 or 2 days) and on the day of bronchoscopy. Heart rate and cardiac arrhythmias were compared to prebronchoscopy recording at four separate time intervals: during bronchoscopy, first postbronchoscopic hour, second postbronchoscopic hour and total 24 hours. There were no significant differences between mean heart rate at the time of bronchoscopy (88.5+/-14.1 min(-1) vs 83.7+/-11.9 min(-1)), first and second postbronchoscopic hour (80.9+/-15.8 min(-1) vs 85.7+/-13.7 min(-1) and 82.6+/-13.6 min(-1) vs 80.6+/-11.6 min(-1)) as well as total 24 hours (76.1+/-11.2 min(-1) vs 75.9+/-9.4 min(-1)) as compared to prebronchoscopic recordings. Max. heart rate during bronchoscopy was higher as compared to the corresponding time of prebronchoscopic recording (134.5+/-11.5 min(-1) vs 122.5+/-19.6 min(-1), p<0,05). No differences in the number and type of ventricular (VA) and supraventricular arrhythmias (SVA) between the pre- and peribronchoscopic monitoring were observed. Positive correlation between the age and the number of VA during bronchoscopy has been found. CONCLUSION: Bronchoscopic procedures in asthma patients do not increase the risk of cardiac arrhythmias. Some factors influencing the heart rate and number of VA during bronchoscopy can be identified.

[The results of treatment patients with hepatorenal syndrome. The analysis of 65 cases]. / Wyniki leczenia zespolu watrobowo-nerkowego. Analiza 65 przypadków.

We analysed medical documentation of 65 patients with alcoholic cirrhosis admitted to the Internal Diseases Department with Dialysis Ward in the hospital in Wolomin between 2002 and 2004 year. Patients were divided into 3 groups according to renal disfunction: patients with HRS-1, patients with HRS-2 and patients with cirrhosis without renal failure. Each diagnosis was established basing on criteria of International Ascites Club. Different factors, which may influence a development of HRS, such as large--volume paracentesis without plasma expansion, bacterial infections, gastrointestinal bleeding and nephrotoxic drugs were analysed. Patients were treated with terlipressin and intravenous albumin infusions, antibiotics, diuretics, dopamine, haemodialysis and paracentesis. 10 patients (3 with HRS-1.5 with HRS-2 and 2 without renal failure) died, which is 15.4% of the all group. The mortality in the group of patients with HRS is high but complex treatment may be effective. Nowadays liver transplantation is the most effective method.