Factores para predecir los resultados de la litotricia por ondas de choque en pacientes pediátricos y validación externa de un nomograma / Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram

OBJETIVO: Evaluar la exactitud del nomograma de Dogan para predecir la tasa libre de cálculos (LC) tras una única sesión de litotricia extracorpórea por ondas de choque (LEOCH) y evaluar factores predictivos de los resultados de LEOCH en niños. PACIENTES Y MÉTODOS: En el estudio participaron 68 pacientes menores de 18 años que habían sido tratados con LEOCH en nuestro centro terciario desde enero de 2010 hasta diciembre de 2016, por cálculos radiopacos del tracto urinario superior. La media de edad fue de 50 meses (6-207) y la media del período de seguimiento, de 9 meses (4-50). Se excluyeron los pacientes con litiasis cistínica, anomalía renal, derivación urinaria y litiasis múltiples localizadas en diferentes cálices, igual que en el estudio del nomograma original. El estatus LC se evaluó mediante la realización de radiografía simple de abdomen y ecografía urinaria 2 semanas después de cada sesión de LEOCH. Los pacientes que estaban completamente libres de cálculos fueron considerados LC. Se realizaron análisis de regresión logística múltiple para determinar las variables que afectan el estado de LC. El método bootstrap con 1.000 repeticiones se utilizó para la validación externa del nomograma desarrollado por Dogan. RESULTADOS: Las tasas de LC para cada sesión de LEOCH fueron de 54,4% (37/68) para la primera sesión, de 33,3% (7/21) para la segunda y de 55,6% (5/9) para la tercera. En total, la tasa de LC fue del 72,1% (49/68). El análisis de regresión logística múltiple mostró correlaciones positivas y significativas entre la edad y el tamaño del cálculo, y el riesgo de fracaso al tratamiento con LEOCH. El gráfico de calibración externa mostró una validación aceptable respecto al nomograma de Dogan para predecir el fracaso de LEOCH en la primera sesión. CONCLUSIÓN: Nuestro estudio demostró que el nomograma de Dogan se puede utilizar para predecir el estado LC tras una sesión de LEOCH en pacientes pediátricos

OBJECTIVE: To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS: The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS: SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION: Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients

Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram. / Factores para predecir los resultados de la litotricia por ondas de choque en pacientes pediátricos y validación externa de un nomograma.

OBJECTIVE: To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS: The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS: SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION: Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients.

The realm of microRNAs in cancers.

MicroRNAs (miRNAs) are members of the non-protein coding RNA family. miRNAs, which can regulate genes on transcriptomic level through either degrading the target messenger RNA (mRNA) or suppressing the protein synthesis, also take part in a number of biological functions that involve development, differentiation, proliferation and apoptosis. The mutations and polymorphisms in the expression levels of miRNA genes or alterations in their epigenetic mechanisms may play their roles in the formation of malignancies. Increasing evidence shows that aberrant miRNA expression profiles are present in a variety of cancers. Therefore, it has been suggested that these profiles could be useful for diagnosis and classification of different tumor types and that these small RNAs might provide significant opportunities for the development of future miRNA-based therapies. In this review, we aimed to look into the realm of miRNAs, which is a recent area of research, appraise their biological activities on molecular level and their probable benefits on clinical practice.

FDG-PET in patients with fever of unknown origin: the importance of diagnosing large vessel vasculitis.

This review analyzes the impact of 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) in the diagnostic work-up of classic fever of unknown origin (FUO) according to the criteria first proposed by Petersorf in 1961 and later modified by Durack et al. in 1991. Algorithms currently used in this diagnostic process are not strictly evidence based up to now. FDG accumulates in malignant tissues, but also in inflammatory cells by the overexpression of facultative glucose transporter-isotypes (mainly GLUT-1 and GLUT-3) and by an overproduction of glycolytic enzymes. Therefore, this technique covers a broad spectrum of possible etiologies for FUO. Once imaged, these lesions can be further investigated by other (e.g. invasive) and more specific methods. Until now, four prospective studies using FDG-PET in patients with classic FUO, encompassing 167 patients in total are published. Three retrospective studies with 125 patients are also available. These studies are discussed and weighted according to the control of selection-bias that was performed. An interstudy-bias may also be present resulting from a considerable variability in causes of FUO. A low number of diagnostic scans in a study may sometimes be related to a high rate of fevers caused by miscellaneous disorders or to a high rate of undiagnosed patients. In these disease categories, focal pathologies that can be imaged with FDG-PET, are rare. A high number of diagnostic scans is always related to a high prevalence of patients with medium- and large-vessel vasculitis. Available data indicate that FDG-PET has the potential to play an important role as a second line procedure in the management of about 1/3 of patients with classic FUO. It is expected that hybrid imaging (PET/computed tomography [CT]; PET/magnetic resonance imaging [MRI]) will improve the diagnostic impact of FDG-PET further, but prospective data about the value of this methods are currently not available. The question as to how these new techniques can be implemented into an evidence based diagnostic algorithm, can only be resolved within a multidisciplinary setting, avoiding both selection- and interstudy-bias whenever possible.