Diabetes mellitus is associated to high-risk late gadolinium enhancement and worse outcomes in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: Diabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM). METHODS: This is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes. RESULTS: We studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003). CONCLUSION: DM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.

Anogenital Distance, a Biomarker of Prenatal Androgen Exposure Is Associated With Prostate Cancer Severity.

BACKGROUND: Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity. MATERIALS: We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP ). We compared differences in groups to evaluate the association between AGD measurements and severity of the preoperative biopsy and clinical scores. RESULTS: Longer AGDAS was significantly associated with the highest Gleason score (P = 0.015) and D'Amico nomogram (P = 0.048). In contrast, no statistical differences were found in the AGDAP and severity of the preoperative biopsy. CONCLUSIONS: These findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.

Contractility of isolated colonic smooth muscle strips from rats treated with cancer chemotherapy: differential effects of cisplatin and vincristine.

Background: Certain antineoplastic drugs cause gastrointestinal disorders even after the end of treatment. Enteric neuropathy has been associated with some of these alterations. Our goal was to assess the impact of repeated treatment with cisplatin and vincristine on the contractility of circular and longitudinal muscle strips isolated from the rat colon. Methods: Two cohorts of male rats were used: in cohort 1, rats received one intraperitoneal (ip) injection of saline or cisplatin (2 mg kg-1 week-1) on the first day of weeks 1-5; in cohort 2, rats received two cycles of five daily ip injections (Monday to Friday, weeks 1-2) of saline or vincristine (0.1 mg kg-1 day-1). Body weight and food and water intake were monitored throughout the study. One week after treatment, responses of colonic smooth muscle strips to acetylcholine (10-9-10-5 M) and electrical field stimulation (EFS, 0.1-20 Hz), before and after atropine (10-6 M), were evaluated in an organ bath. Results: Both drugs decreased body weight gain. Compared to saline, cisplatin significantly decreased responses of both longitudinal and circular smooth muscle strips to EFS, whereas vincristine tended to increase them, although in a non-significant manner. No differences were observed in the muscle response to acetylcholine. Atropine abolished the contractile responses induced by acetylcholine, although those induced by EFS were only partially reduced in the presence of atropine. Conclusion: The findings suggest that although both drugs cause the development of enteric neuropathy, this seems to have a functional impact only in cisplatin-treated animals. Understanding the effects of chemotherapy on gastrointestinal motor function is vital for enhancing the quality of life of cancer patients.

Direct association between pharyngeal viral secretion and host cytokine response in severe pandemic influenza.

BACKGROUND: Severe disease caused by 2009 pandemic influenza A/H1N1virus is characterized by the presence of hypercytokinemia. The origin of the exacerbated cytokine response is unclear. As observed previously, uncontrolled influenza virus replication could strongly influence cytokine production. The objective of the present study was to evaluate the relationship between host cytokine responses and viral levels in pandemic influenza critically ill patients. METHODS: Twenty three patients admitted to the ICU with primary viral pneumonia were included in this study. A quantitative PCR based method targeting the M1 influenza gene was developed to quantify pharyngeal viral load. In addition, by using a multiplex based assay, we systematically evaluated host cytokine responses to the viral infection at admission to the ICU. Correlation studies between cytokine levels and viral load were done by calculating the Spearman correlation coefficient. RESULTS: Fifteen patients needed of intubation and ventilation, while eight did not need of mechanical ventilation during ICU hospitalization. Viral load in pharyngeal swabs was 300 fold higher in the group of patients with the worst respiratory condition at admission to the ICU. Pharyngeal viral load directly correlated with plasma levels of the pro-inflammatory cytokines IL-6, IL-12p70, IFN-γ, the chemotactic factors MIP-1ß, GM-CSF, the angiogenic mediator VEGF and also of the immuno-modulatory cytokine IL-1ra (p < 0.05). Correlation studies demonstrated also the existence of a significant positive association between the levels of these mediators, evidencing that they are simultaneously regulated in response to the virus. CONCLUSIONS: Severe respiratory disease caused by the 2009 pandemic influenza virus is characterized by the existence of a direct association between viral replication and host cytokine response, revealing a potential pathogenic link with the severe disease caused by other influenza subtypes such as H5N1.

Laparoscopic simple prostatectomy: a large single-center prospective cohort study.

BACKROUND: The aim of our study was to analyze outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high-volume center. METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80 cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favorable outcome which was defined as a combination of the following items: 1) no perioperative complications; 2) postoperative IPSS <8; 3) postoperative Qmax >15 mL/s. Complications were evaluated according to the modified Clavien classification system. Univariate and multivariate binary logistic regression was performed to identify predictors of a positive trifecta outcome. RESULTS: Overall 272 patients were enrolled. At three months after surgery median IPSS total score was 4 (IQR: 3-7), median IPSS QoL was 1 (IQR:1-2), median prostate-specific antigen was 0.53 (IQR: 0.33-1.00) ng/ml and median Qmax was 23 (IQR: 17-30) mL/s. All these parameters improved statistically when compared to baseline (P<0.001). The overall complication rate was 21% however most of the complications were low grade complications according to modified Clavien-Dindo classification (grade ≤2). Overall, 68% of the patients presented a positive trifecta outcome. On multivariate analysis only preoperative hemoglobin and hospital stay were confirmed predictors of positive trifecta outcome. CONCLUSIONS: LSP represents a safe and effective procedure in the treatment of large adenomas. Although RCTs are needed before reaching definitive conclusions, LSP is a promising technique for patients with LUTS and large prostates.

Myocardial strain in nonischemic dilated cardiomyopathy with feature tracking. Feasibility and prognostic implications.

INTRODUCTION AND OBJECTIVES: Myocardial strain analysis could provide additional information to left ventricular ejection fraction (LVEF) in nonischemic dilated cardiomyopathy (NIDC). Our aim was to analyze the feasibility of left ventricular strain evaluation using cardiac magnetic resonance feature tracking (FT) in NIDC, and to determine its clinical and prognostic impact. METHODS: We retrospectively included consecutive patients with NIDC who underwent cardiac magnetic resonance. Left ventricular global longitudinal, circumferential and radial strain were obtained from standard cine sequences using FT analysis software. We evaluated their association with a composite endpoint (heart failure, implantable cardioverter-defibrillator in secondary prevention, or death). RESULTS: FT analysis could be performed in all of the 98 patients (mean age 68±13 years, 72% men). Intra- and interobserver concordance was good for global longitudinal and circumferential strain but was worse for radial strain. Global circumferential strain was independently associated (OR, 1.16; P=.045) with LVEF normalization during follow-up and was the only morphological parameter independently associated with the composite endpoint (OR, 1.15; P=.038). A cutoff value <-8.2% was able to predict the incidence of this event during follow-up (log-rank 4.6; P=.032). CONCLUSIONS: Left ventricular strain analysis with FT is feasible and reproducible in NIDC. Global circumferential strain was able to predict LVEF recovery and the appearance of major cardiovascular events during follow-up.

Successful Conservative Treatment of a Large Infected Saphenous Graft Aneurysm: Usefulness of PET/CT.

We report a case of a 75-year-old man with a medical history of coronary artery bypass graft surgery and a recent graft angioplasty, who presented to our emergency department with fever. An 18F-fluorodeoxyglucose positron emission tomography demonstrated a saphenous graft infected aneurysm, which was successfully treated conservatively with antibiotic therapy. (Level of Difficulty: Beginner.).

[Study of anogenital distance as a diagnostic tool for prostate cancer]. / Análisis de la distancia anogenital como herramienta diagnóstica del cáncer de próstata.

INTRODUCTION AND OBJECTIVE: The distance from the genitals to the anus (anogenital distance [AGD]) reflects androgen concentration during prenatal development in mammals. At the present time, there is only one study suggesting the relationship between AGD and risk of prostate cancer (CaP). The goal of this study was to assess the performance and clinical utility of AGD, as a biomarker of prenatal androgenic milieu, and risk of CaP in a larger population, in CaP diagnosis. MATERIAL AND METHODS: A case-control study was conducted on 260 men seen in a hospital outpatient clinic where underwent a physical and andrological examination and completed a brief questionnaire. CaP patients were confirmed by biopsy of the tumor. Controls were men without CaP seen in the urology outpatient clinic for routine examinations. Two variants of AGD (from the anus to the posterior base of the scrotum [AGDAS] and to the cephalad insertion of the penis [AGDAP]) were measured. Parametric and non-parametric tests and receiver operating characteristic (COR) analyses were used to determine relationships between AGD and presence of CaP. RESULTS: The highest area under the curve (0.69; 95% CI 0.60 to 0.78 and 0.69; 95% CI 0.61 to 0.77) was obtained for the Gleason=7 subgroup with the AGDAS and AGDAP measurement, with a sensitivity and specificity of 83% and 55%, and 91% and 41%, the predictive positive value of 39% and 35% and negative value of 90% and 93% respectively. CONCLUSION: AGD may be a useful clinical tool for the CaP diagnosis.

[Prostate cancer is associated with the anogenital distance, a biomarker of prenatal androgen milieu.] / El cáncer de próstata está asociado con la distancia anogenital, un biomarcador del ambiente androgénico prenatal.

OBJECTIVE: To evaluate the associationbetween anogenital distance (AGD), as a biomarker ofprenatal androgen milieu, and risk of prostate cancer(PCa). METHODS: A case-control study was conducted on260 men attending a university hospital where theyunderwent physical and andrological examination andcompleted a brief questionnaire. PCa patients were confirmedby biopsy of the tumor. Controls were men withoutPCa attending the urology outpatient clinic for routineexaminations. Two variants of AGD [from the anus to theposterior base of the scrotum (AGDAS) and to the cephaladinsertion of the penis (AGDAP)] were measured.Unconditional multiple logistic regression was used toestimate the association between AGD measurementsand presence of PCa, and Odds Ratios and 95% confidenceintervals (CI) were calculated. RESULTS: Cases showed significantly shorter AGDAPand AGDAS than controls. Subjects with AGDAP andAGDAS in the lowest compared to the upper tertile were2.6 times (95% CI 1.2-5.6) and 3.2 times (95% CI 1.5-6.9) more likely to have PCa, respectively. CONCLUSIONS: We found that shorter measurementsof both distances (AGDAS and AGDAP) were associatedwith higher risk of PCa. A previous study reportedsimilar results, showing that longer AGDAP was associatedwith lower risk of PCa, but this relationship was notfound for AGDAS, as it was in our study with a largersample size.

OBJETIVO: Evaluar la asociación entre la distancia anogenital (AGD) como biomarcador de la ventana androgénica prenatal y el riesgo de padecer cáncer de próstata (PCa).MATERIAL Y MÉTODO: Estudio de casos y controles realizado en 260 pacientes. Todos los pacientes fueron sometidos a examen físico y andrológico y completaron un breve cuestionario. Los pacientes con PCa tenían diagnóstico histológico por biopsia prostática. Los controles fueron varones sin sospecha de PCa que acudieron a la consulta externa de Urología para exámenes rutinarios. Se midieron dos variantes de AGD [del ano a la base posterior del escroto (AGDAS) y del ano a la inserción dorsal del pene (AGDAP)]. Se utilizóanálisis de regresión logística múltiple para estimar la asociación entre las medidas de AGD y la presencia de PCa. Se calcularon Odds Ratios (ORs) e intervalos de confianza (IC) 95%. RESULTADOS: Los casos mostraron unas AGDAP y AGDAS  significativamente más cortas que los controles.Los pacientes con AGDAP y AGDAS en el tercil inferior comparado con los pacientes del tercil superior mostraron 2,6 (IC 95% 1,2-5,6) y 3,2 veces (IC 95% 1,5-6,9) más riesgo, respectivamente, de padecer PCa. CONCLUSIONES: Encontramos que las medidas acortadas de ambas AGDs se asociaron con un mayor riesgo de padecer PCa. Un estudio previo obtuvo resultados similares, mostrando que una AGDAP alargada se asoció con un menor riesgo de padecer PCa, pero noobservó ninguna relación con respecto a la AGDAS, como sí objetivamos en este estudio con un mayor tamaño muestral.

[Relationship between anogenital distance and prognosis of prostate cancer.] / Relación entre distancia anogenital y pronóstico del cáncer de próstata.

OBJECTIVE: Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Several experimental studies have demonstrated that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The objective of this study was to assess the relationship between AGD (as an indirect marker of prenatal hormonal environment) and severity of the surgical specimen and prostate cancer (PCa) prognosis. METHODS: We conducted a cross-sectional study with a total of 119 PCa patients with confirmed biopsy of the tumour. Every participant underwent a physical examination where two variants of the AGD were assessed, a) from the anus to the cephalad insertion of the penis (AGDAP) and b) to the posterior base of the scrotum (AGDAS). To assess the association between both AGD and severity and PCa prognosis multiple logistic regression analysis was used. RESULTS: Longer AGDAS was significantly associated with biochemical recurrence and affected margins of the surgical specimen (OR: 2.5; IC 95%:1.2-5.5, and 2.8; IC 95%: 1.1-7.5, respectively). CONCLUSIONS: Our findings suggest that a higher prenatal androgen exposure, resulting in a longer AGD, is associated with worse prognosis of PCa.

Unexpected hosts: imaging parasitic diseases.

Radiologists seldom encounter parasitic diseases in their daily practice in most of Europe, although the incidence of these diseases is increasing due to migration and tourism from/to endemic areas. Moreover, some parasitic diseases are still endemic in certain European regions, and immunocompromised individuals also pose a higher risk of developing these conditions. This article reviews and summarises the imaging findings of some of the most important and frequent human parasitic diseases, including information about the parasite's life cycle, pathophysiology, clinical findings, diagnosis, and treatment. We include malaria, amoebiasis, toxoplasmosis, trypanosomiasis, leishmaniasis, echinococcosis, cysticercosis, clonorchiasis, schistosomiasis, fascioliasis, ascariasis, anisakiasis, dracunculiasis, and strongyloidiasis. The aim of this review is to help radiologists when dealing with these diseases or in cases where they are suspected. Teaching Points • Incidence of parasitic diseases is increasing due to migratory movements and travelling. • Some parasitic diseases are still endemic in certain regions in Europe. • Parasitic diseases can have complex life cycles often involving different hosts. • Prompt diagnosis and treatment is essential for patient management in parasitic diseases. • Radiologists should be able to recognise and suspect the most relevant parasitic diseases.

Deformación miocárdica en miocardiopatía dilatada no isquémica mediante feature tracking. Factibilidad e implicaciones pronósticas / Myocardial strain in nonischemic dilated cardiomyopathy with feature tracking. Feasibility and prognostic implications

Introducción y objetivos El análisis de la deformación miocárdica puede aportar información adicional a la fracción de eyección del ventrículo izquierdo (FEVI) en la miocardiopatía dilatada no isquémica (MDNI). El objetivo es analizar la factibilidad del estudio del strain del ventrículo izquierdo mediante feature tracking (FT) de cardiorresonancia magnética en la MDNI y determinar su relevancia clínica y pronóstica. Métodos Se incluyó retrospectivamente a los pacientes consecutivos con MDNI sometidos a cardiorresonancia magnética. Se obtuvieron el strain global longitudinal, circunferencial y radial del ventrículo izquierdo de secuencias convencionales de cine mediante un software de análisis de FT. Se evaluó su asociación con el evento combinado (insuficiencia cardiaca, implante de desfibrilador en prevención secundaria y muerte). Resultados Se pudo realizar el FT en los 98 pacientes evaluados (edad, 68± 13 años; el 72% varones). La concordancia intraobservador e interobservadores fue buena para el strain global longitudinal y circunferencial, y más limitada para el radial. El strain global circunferencial se asoció de manera independiente (OR=1,16; p=0,045) con la normalización de la FEVI en el seguimiento y fue el único parámetro morfológico con asociación independiente (OR=1,15; p=0,038) con el evento combinado. Un valor <–8,2% fue capaz de predecir la aparición de este evento en el seguimiento (Log-ranktest, 4,6; p=0,032) Conclusiones El análisis del strain del ventrículo izquierdo mediante FT es factible y reproducible en MDNI. El strain global circunferencial fue capaz de predecir la recuperación de la FEVI y la aparición de eventos cardiovasculares mayores en el seguimiento. (AU)

Introduction and objectives Myocardial strain analysis could provide additional information to left ventricular ejection fraction (LVEF) in nonischemic dilated cardiomyopathy (NIDC). Our aim was to analyze the feasibility of left ventricular strain evaluation using cardiac magnetic resonance feature tracking (FT) in NIDC, and to determine its clinical and prognostic impact. Methods We retrospectively included consecutive patients with NIDC who underwent cardiac magnetic resonance. Left ventricular global longitudinal, circumferential and radial strain were obtained from standard cine sequences using FT analysis software. We evaluated their association with a composite endpoint (heart failure, implantable cardioverter-defibrillator in secondary prevention, or death). Results FT analysis could be performed in all of the 98 patients (mean age 68±13 years, 72% men). Intra- and interobserver concordance was good for global longitudinal and circumferential strain but was worse for radial strain. Global circumferential strain was independently associated (OR, 1.16; P=.045) with LVEF normalization during follow-up and was the only morphological parameter independently associated with the composite endpoint (OR, 1.15; P=.038). A cutoff value <−8.2% was able to predict the incidence of this event during follow-up (log-rank 4.6; P=.032). Conclusions Left ventricular strain analysis with FT is feasible and reproducible in NIDC. Global circumferential strain was able to predict LVEF recovery and the appearance of major cardiovascular events during follow-up. (AU)

Asociación entre el cociente del segundo y cuarto dedo y el riesgo de cáncer de próstata: Un estudio de casos y controles en población mediterránea / Second to Fourth Digit Ratio and Prostate Cancer Risk: A Case-control Study in Mediterranean Population

Objetivo Evaluar la asociación entre el cociente de los dedos segundo y cuarto (2D:4D), como un biomarcador de la exposición prenatal a andrógenos, y la presencia de cáncer de próstata (CaP). Métodos Estudio de casos y controles con 260 hombres que consultaron en el Servicio de Urología del Hospital General Universitario Reina Sofía (Murcia, España). Los casos (n = 125) fueron pacientes diagnosticados de CaP por anatomía patológica a los que se les realizó una prostatectomía radical. Los controles (n = 135) fueron pacientes que consultaron en Urología por otro motivo y que no mostraron signos ni síntomas de patología prostática. La longitud del 2D y 4D de la mano derecha fue medida mediante un pie de rey digital y se calculó el cociente entre ambos (2D:4D). Para los análisis estadísticos se utilizaron modelos de regresión logística obteniendo Odds ratios (OR) crudas y ajustadas e intervalos de confianza al 95%. Resultados Los casos presentaron un cociente 2D:4D significativamente menor que los controles. El cociente 2D:4D se relacionó significativamente con la presencia de CaP. Tras el ajuste multivariante, se observó que los varones que se encontraban en el primer tercil de distribución del cociente 2D:4D, presentaban casi el doble de riesgo de padecer CaP (OR 1,9: IC 95% 1,1­4,0; P-valor = 0,040) en comparación con los varones que se encontraban en el segundo y tercer tercil. Conclusiones Una mayor exposición prenatal a andrógenos, reflejada por un cociente 2D:4D menor, podría estar asociado con riesgo aumentado de padecer CaP, pero más estudios son necesarios para corroborar esos hallazgos.

Objective To evaluate the association between second to fourth digit (2D:4D) ratio, as a biomarker of prenatal androgen exposure, and the presence of prostate cancer (PCa). Methods This was a case-control study of 260 men attending a Department of Urology in a Murcia Region hospital (Spain). Cases (n = 125) were patients who underwent radical prostatectomy due to PCa and were diagnosed by specimen's histopathology. Controls (n = 135) were patients who showed no signs or symptoms of prostate disease. The length of 2D and 4D of the right hand was measured two times using a digital caliper, and the ratio calculated (2D:4D). Unconditional multiple logistic regressions [crude and adjusted Odds ratios (OR) and 95% confidence intervals (CI)] were performed to evaluate associations between the 2D:4D ratio and presence of PCa. Results Cases showed significantly lower 2D:4D ratios than controls. 2D:4D ratios were significantly associated with the presence of PCa. After controlling for important covariates, men in the first tertile of the 2D:4D ratio distribution, compared with the second and third tertile, were almost two-times [OR 1.9 (95% CI 1.1­4.0; P-value = 0.040] more likely to have PCa. Conclusions A higher prenatal androgen exposure, indicated by lower 2D:4D ratios, might be associated with higher PCa risk, but further research is needed to confirm these findings in other male populations.

Relación entre ratio digital 2D: 4D y severidad preoperatoria del cáncer de próstata / Relationship between Digit Ratio (2D:4D) and Preoperative Severity of Prostate Cancer

El cociente entre la longitud del segundo y cuarto dedo (2D:4D) de la mano es un rasgo de dimorfismo sexual, presentando los hombres una ratio menor que las mujeres.1 Varios estudios de cohortes2,3 y un metaanálisis,4 han mostrado que la diferencia de género en la ratio de los dedos se asocia con la exposición de andrógenos prenatales. El cociente 2D:4D está inversamente relacionado a la exposición intrauterina de testosterona (T) y directamente relacionado a la de estradiol.2 Existe evidencia que afirma que la ratio 2D:4D podría ser un marcador válido para los niveles hormonales del adulto (T y estrógeno),3 aunque ese dato es controvertido.4Por esa razón, el cociente 2D:4D seha utilizado como un biomarcador no invasivo y retrospectivo para la exposición prenatal de andrógenos, y se ha correlacionado con una amplia gama de enfermedades como el autismo,5 así como la cognición visoespacial y la orientación sexual.6

The quotient between the length of the second and fourth finger (2D:4D) hand is a trait of sexual dimorphism, featuring the men a lower ratio than women.1 Several studies of the cohorts2,3 and a meta-analysis,4 have shown that the difference between The gender ratio of the fingers is associated with the exposure of prenatal androgens. The quotient 2D:4D is inversely related to intrauterine testosterone (T) exposure and directly related to that of estradiol.2 There is evidence which states that the 2D:4D ratio could be a valid marker for adult hormone levels (T and estrogen),3 although that data is controversial.4 For that reason, the 2D:4D quotient has been used as a noninvasive and retrospective biomarker for prenatal exposure to androgens, and it has been correlated with a wide range of diseases such as autism,5 as well as such as visuospatial cognition and sexual orientation.6

El cáncer de próstata está asociado con la distancia anogenital, un biomarcador del ambiente androgénico prenatal / No disponible

Objetivo: Evaluar la asociación entre la distancia anogenital (AGD) como biomarcador de la ventana androgénica prenatal y el riesgo de padecer cáncer de próstata (PCa). Material y método: Estudio de casos y controles realizado en 260 pacientes. Todos los pacientes fueron sometidos a examen físico y andrológico y completaron un breve cuestionario. Los pacientes con PCa tenían diagnóstico histológico por biopsia prostática. Los controles fueron varones sin sospecha de PCa que acudieron a la consulta externa de Urología para exámenes rutinarios. Se midieron dos variantes de AGD [del ano a la base posterior del escroto (AGDAS) y del ano a la inserción dorsal del pene (AGDAP)]. Se utilizó análisis de regresión logística múltiple para estimar la asociación entre las medidas de AGD y la presencia de PCa. Se calcularon Odds Ratios (ORs) e intervalos de confianza (IC) 95%. Resultados: Los casos mostraron unas AGDAP y AGDAS significativamente más cortas que los controles. Los pacientes con AGDAP y AGDAS en el tercil inferior comparado con los pacientes del tercil superior mostraron 2,6 (IC 95% 1,2-5,6) y 3,2 veces (IC 95% 1,5-6,9) más riesgo, respectivamente, de padecer PCa. Conclusiones: Encontramos que las medidas acortadas de ambas AGDs se asociaron con un mayor riesgo de padecer PCa. Un estudio previo obtuvo resultados similares, mostrando que una AGDAP alargada se asoció con un menor riesgo de padecer PCa, pero no observó ninguna relación con respecto a la AGDAS, como sí objetivamos en este estudio con un mayor tamaño muestral

Objective: To evaluate the association between anogenital distance (AGD), as a biomarker of prenatal androgen milieu, and risk of prostate cancer (PCa). Methods: A case-control study was conducted on 260 men attending a university hospital where they underwent physical and andrological examination and completed a brief questionnaire. PCa patients were confirmed by biopsy of the tumor. Controls were men without PCa attending the urology outpatient clinic for routine examinations. Two variants of AGD [from the anus to the posterior base of the scrotum (AGDAS) and to the cephalad insertion of the penis (AGDAP)] were measured. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of PCa, and Odds Ratios and 95% confidence intervals (CI) were calculated. Results: Cases showed significantly shorter AGDAP and AGDAS than controls. Subjects with AGDAP and AGDAS in the lowest compared to the upper tertile were 2.6 times (95% CI 1.2-5.6) and 3.2 times (95% CI 1.5-6.9) more likely to have PCa, respectively. Conclusions: We found that shorter measurements of both distances (AGDAS and AGDAP) were associated with higher risk of PCa. A previous study reported similar results, showing that longer AGDAP was associated with lower risk of PCa, but this relationship was not found for AGDAS, as it was in our study with a larger sample size

Análisis de la distancia anogenital como herramienta diagnóstica del cáncer de próstata / Study of anogenital distance as a diagnostic tool for prostate cáncer

Introducción y objetivo: La distancia entre los genitales y el ano (distancia anogenital [AGD]) es un reflejo de la concentración de andrógenos durante el desarrollo prenatal en mamíferos. En la actualidad solo existe un estudio que indique la relación entre AGD y riesgo de presentar cáncer de próstata (CaP). El objetivo de este estudio fue evaluar la utilidad clínica de la AGD, como biomarcador del ambiente androgénico prenatal y el riesgo de presentar CaP en una amplia población. Material y método: Se realizó un estudio de casos y controles sobre 260 pacientes, atendidos en la consulta externa de Urología, a los que se sometió a examen físico y andrológico, y cumplimentaron cuestionarios. En los pacientes con CaP (n = 125) hubo confirmación histológica de la enfermedad y se dividió a los pacientes según la puntuación de Gleason acorde con los grupos de riesgo de d'Amico. Los controles (n = 135) fueron hombres sin signos, ni síntomas de CaP que fueron atendidos en la consulta externa de Urología para un examen rutinario. Se midieron 2variantes de AGD (del ano a la base posterior del escroto [AGDAS] y del ano a la inserción cefálica del pene [AGDAP]). Se utilizaron pruebas paramétricas y no paramétricas y curvas ROC para determinar la relación entre la AGD y la presencia de CaP. Resultados: La mayor área bajo la curva se obtuvo para el subgrupo de Gleason = 7 con las mediciones AGDAS y AGDAP (0,69; IC del 95%: 0,60-0,78 y 0,69; IC del 95%: 0,61-0,77, respectivamente), con una sensibilidad y especificidad del 83 y el55%, y el 91 y el 41%, un valor predictivo positivo del 39 y el 35%, y predictivo negativo del 90 y el 93%, respectivamente. Conclusión: Nuestros resultados sugieren que la AGD podría ser una herramienta clínica útil para el diagnóstico del CaP

Introduction and objective: The distance from the genitals to the anus (anogenital distance [AGD]) reflects androgen concentration during prenatal development in mammals. At the present time, there is only one study suggesting the relationship between AGD and risk of prostate cancer (CaP). The goal of this study was to assess the performance and clinical utility of AGD, as a biomarker of prenatal androgenic milieu, and risk of CaP in a larger population, in CaP diagnosis. Material and methods: A case-control study was conducted on 260 men seen in a hospital outpatient clinic where underwent a physical and andrological examination and completed a brief questionnaire. CaP patients were confirmed by biopsy of the tumor. Controls were men without CaP seen in the urology outpatient clinic for routine examinations. Two variants of AGD (from the anus to the posterior base of the scrotum [AGDAS] and to the cephalad insertion of the penis [AGDAP]) were measured. Parametric and non-parametric tests and receiver operating characteristic (COR) analyses were used to determine relationships between AGD and presence of CaP. Results: The highest area under the curve (0.69; 95% CI 0.60 to 0.78 and 0.69; 95% CI 0.61 to 0.77) was obtained for the Gleason = 7 subgroup with the AGDAS and AGDAP measurement, with a sensitivity and specificity of 83% and 55%, and 91% and 41%, the predictive positive value of 39% and 35% and negative value of 90% and 93% respectively. Conclusion: AGD may be a useful clinical tool for the CaP diagnosis

Relación entre distancia anogenital y pronóstico del cáncer de próstata / Relationship between anogenital distance and prognosis of prostate cancer

OBJETIVO: La distancia anogenital (DAG) es un marcador de desarrollo genital que presenta un dimorfismo sexual en mamíferos. Diversos estudios experimentales han demostrado que la DAG al nacimiento refleja la exposición androgénica a la que el feto ha estado expuesto durante su desarrollo intrauterino. El objetivo de nuestro estudio fue analizar la asociación entre la DAG (como marcador indirecto del ambiente hormonal intrauterino) y la severidad en la pieza quirúrgica y el pronóstico del cáncer de próstata (CaP). MÉTODOS: Se trata de un estudio transversal que incluyó 119 pacientes intervenidos de CaP y con confirmación histológica por biopsia. A cada paciente se le realizó una exploración física y se midieron dos variantes de DAG; a) medida desde la inserción posterior del pene en el abdomen bajo al borde superior del ano (DAGAP) y b) medida desde la base posterior del escroto al borde superior del ano (DAGAS). La asociación entre ambas DAG y los indicadores de severidad y pronóstico postquirúrgicos de CaP se realizaron mediante análisis de regresión logística múltiple. RESULTADOS: La DAGAS se asoció significativamente con la recidiva bioquímica y márgenes afectados en la pieza quirúrgica (OR: 2,5; IC 95%: 1,2-5,5, y 2,8; IC 95%: 1,1-7,5, respectivamente). CONCLUSIÓN: Nuestros resultados sugieren que una mayor exposición androgénica prenatal, reflejado en una DAG alargada, estaría asociada con un peor pronóstico del CaP

OBJECTIVE: Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Several experimental studies have demonstrated that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The objective of this study was to assess the relationship between AGD (as an indirect marker of prenatal hormonal environment) and severity of the surgical specimen and prostate cancer (PCa) prognosis. METHODS: We conducted a cross-sectional study with a total of 119 PCa patients with confirmed biopsy of the tumour. Every participant underwent a physical examination where two variants of the AGD were assessed, a) from the anus to the cephalad insertion of the penis (AGDAP) and b) to the posterior base of the scrotum (AGDAS). To assess the association between both AGD and severity and PCa prognosis multiple logistic regression analysis was used. RESULTS: Longer AGDAS was significantly associated with biochemical recurrence and affected margins of the surgical specimen (OR: 2.5; IC 95%:1.2-5.5, and 2.8; IC 95%: 1.1-7.5, respectively). CONCLUSIONS: Our findings suggest that a higher prenatal androgen exposure, resulting in a longer AGD, is associated with worse prognosis of PCa