New Molecular Markers for Prostate Cancer Diagnosis.

PURPOSE: Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth leading cause of cancer death among men worldwide. Biomarkers are an important tool in the early detection of PCa. Prostate-specific antigen (PSA) is one of the oldest biomarkers for the early detection of PCa. Digital rectal exam (DRE) is another screening test for PCa detection, which is considered as an irritating experience for patients. Biopsy is still the most reliable method for PCa diagnosis; however, patients are prone to complications. Therefore, developing non-invasive and accurate methods for PCa screening seems urgent to avoid unnecessary biopsies. There has been remarkable development in PCa molecular biomarkers discovery, largely through progress in omics technologies. Due to the many benefits of liquid biopsies, a significant set of PCa diagnostic kits have been developed using urine samples. Despite the unique benefits of these kits, there are still many challenges to their widespread use in clinics. Here, we have reviewed the latest developments of PCa biomarkers in liquid biopsies. METHODS: Literature on biomarkers for diagnosis of PCa was reviewed during the past two decades. RESULTS: PSA, PHI, PCA3, and 4K score are among the commonly used markers for PCa diagnosis which have been used over a long-moderate length of time with multiple studies on their performance. We performed a review of their performance. Newer markers are among RNA and DNA markers. Multiple non-coding RNAs (mi-RNAs) were reviewed and their performance on Pca diagnosis was reviewed. Long noncoding RNAs (Lnc RNAs) including PlncRNA-1, HOTAIR, SchLAP-1, MALAT1, MEG3, and PRCAT17.3 were summarized. mRNA markers including TMPRSS2:ERG, and HOXC6 were presented. DNA-based markers including PTEN, HOXB13, and BRCA2 were reviewed. Finally, the use of CircRNAs was reviewed for PCa diagnosis. CONCLUSION: Many reviewed RNA-based biomarkers have promising results in the diagnosis of PCa.

A systematic review and meta-analysis of complications of artificial urinary sphincters in female patients with urinary incontinence due to internal sphincter insufficiency.

BACKGROUND: Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches. METHODS: Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted. RESULTS: We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years. CONCLUSION: The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications.

The Role of Integrative Educational Intervention Package (Monthly ITE, Mentoring, Mocked OSCE) in Improving Successfulness for Anesthesiology Residents in the National Board Exam.

BACKGROUND: National Board of Anesthesiology (NBA) pass rate is an important and critical step in clinical residency programs. OBJECTIVES: This study was designed to assess the relationship between an integrative educational intervention (IEI) and the relative annual pass rate (RAPR). RAPR is defined as ratio of NBA pass rate of Shahid Beheshti University of Medical Sciences (SBMU) to the NBA pass rate of all the anesthesiology residency programs across Iran. METHODS: In a descriptive-analytic retrospective study from 2012 to 2019, RAPR was calculated. IEI was implanted in the latter 4years period of this time interval includes: (1) individualized mentorship for residents by faculty members; (2) monthly in-training examination (ITE) in written; and (3) periodical mocked OSCE exam. Spearman's correlation coefficient was used to assess correlation between integrative educational intervention and RAPR results. P value less than 0.05 was considered statistically significant. RESULTS: There was a statistically significant relationship between "integrative educational intervention program" and the RAPR results: Spearman's correlation coefficient = 0.655 (P value = 0.039). CONCLUSIONS: The IEI package of Anesthesiology Department, SBMU showed a significant relationship with improvements in successfulness for anesthesiology residents in the National Board Exam (RAPR trend). More prolonged studies could prevail further aspects of these interventions.

Genetic Polymorphism of Mismatch Repair Genes and Susceptibility to Prostate Cancer.

PURPOSE: Mismatch repair (MMR) is one of the DNA repair systems that correct mispaired bases during DNA replication errors. Polymorphisms in genes can increase susceptibility to the development of prostate cancer (PCa). In this study, we investigated mutL homolog 1 (MLH1) -93G>A (rs1800734) and mutS homolog 3 (MSH3) (rs26279) polymorphisms with the risk of PCa. MATERIALS AND METHODS: In this study of Iranian population, 175 histopathologically confirmed (PCa) patients and 230 benign prostate hyperplasia (BPH) as the controls were recruited. The genotypes of MLH1 and MSH3 were determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There was no significant difference of MLH1 (P = 0.4) and MSH3 (P?=?0.5) genotype distributions among PCa cases and controls. And also patients with PCa were not significant differences compared to those without in stage of cancer, grade of tumor, perineural invasion, and vascular invasion. CONCLUSION: Our results did not show adequate evidence for any significant association of MLH1 and MSH3 polymorphisms and PCa .

Two long non-coding RNAs, Prcat17.3 and Prcat38, could efficiently discriminate benign prostate hyperplasia from prostate cancer.

BACKGROUND: Long non-coding RNAs (lncRNAs) have recently appeared as new players in cancer biology. Recently, a number of new prostate cancer-associated lncRNAs has been listed via RNA-seq approach by Mitranscriptome project. By analyzing this data we chose four lncRNAs (Prcat17.3, Prcat38, Prcat47, and Cat2184.4) and evaluated their expressions and their abilities to discriminate prostate tumors from benign prostate hyperplasia (BPH). METHODS: Fresh Prostate tissue samples (30 BPH, and 30 tumor samples) and urine samples (19 BPH, and 19 tumor samples) were collected and their total RNA extracted for cDNA syntheses. The expression of candidate lncRNAs was assessed by the real-time PCR technique. RESULTS: Our data revealed that the expression levels of PRCAT17.3 (P < 0.0001) and PRCAT38 (P < 0.0002) were significantly upregulated in human prostate cancer tissues, compared to BPH ones. Moreover, the altered expression was much higher for PRCAT17.3 (∼2000 folds) than PRCAT38 (∼50 folds). In contrast, the expression of Cat2184.4 showed a significant down-regulation in tumor samples (P < 0.0001), compared to BPH ones. While the expression level of PRCAT47 was increased in cancer samples, the changes were not statistically significant. In discriminating prostate tumors from BPH samples, Prcat17.3 (AUC-ROC, 0.927) demonstrated a better diagnostic efficacy than Prcat38 (AUC-ROC, 0.778). Moreover, real-time RT-PCR analyses on urine samples of prostate cancer patients revealed that prcat17.3 level is significantly elevated, (P < 0.0197; AUC-ROC value of 0.72), compared to that of BPH patients. CONCLUSION: We introduce here two novel lncRNAs with a potential application in diagnosis of prostate cancer.

Evaluation of 4-bp insertion/deletion polymorphism within the 3'UTR of SGSM3 in bladder cancer using mismatch PCR-RFLP method: A preliminary report.

The small G protein signaling modulator 3 (SGSM3) has been shown to be associated with small G-protein-coupled receptor signaling. There is little data regarding the impact of SGSM3 polymorphisms on cancer risk. In the present study, we aimed to evaluate the impact of 4-bp insertion/deletion (rs56228771) polymorphism in the 3'UTR of SGSM3 and susceptibility to bladder cancer in a sample of the Iranian population. This case-control study included 143 pathologically confirmed bladder cancer patients and 144 healthy subjects. The SGSM3 4-bp ins/del (rs56228771) variant was determined by mismatch PCR-RFLP. The findings showed that ins/del genotype and ins allele of SGSM3 4-bp ins/del polymorphism significantly increased the risk of bladder cancer (OR = 3.11, 95%CI = 1.70-5.71, P < 0.0001 and OR = 2.11, 95%CI = 1.27-3.52, P = 0.004, respectively). Our findings support an association between 4-bp ins/del polymorphism in the 3'UTR of SGSM3 and the risk of bladder cancer in an Iranian population. Additional studies with larger sample sizes and diverse ethnicities are warranted to establish if such an association exists in general.

Functional polymorphism at the miR-502-binding site in the 3' untranslated region of the SETD8 gene increased the risk of prostate cancer in a sample of Iranian population.

MicroRNAs (miRNAs), a class of non-coding RNAs, bind to the 3' untranslated regions (3'-UTRs) of target mRNAs and regulate gene expression. Genetic variations in miRNA binding domains influence the susceptibility to several diseases such as cancer. Several studies investigated the impact of single-nucleotide polymorphism (SNP) rs16917496 T>C within the 3'-UTR of SETD8 on cancer susceptibility, but the results were controversial. In addition, no study has been conducted to inspect the impact of this SNP in prostate cancer (PCa). Thus, the present study aimed to find out the possible association between rs16917496 polymorphism at the 3'UTR of SETD8 and PCa risk. This case-control study was done on 169 patients with pathologically confirmed PCa and 182 benign prostatic hyperplasia (BPH). Genotyping was done using PCR-RFLP method. The findings revealed that rs16917496 variant significantly increased the risk of PCa in codominant (OR=2.54, 95%CI=1.50-4.30, p<0.001, TC VS TT and OR=3.03, 95%CI=1.63-5.66, p<0.001, CC vs TT), dominant (OR=2.86, 95%CI=1.62-4.43, p<0.001, p<0.001). The C allele significantly increased the risk of PCa (OR=1.72, 95%CI=1.28-2.33, p<0.001) compared to T allele. In conclusion, the findings indicated that rs16917496 polymorphism may be a risk for predisposition to PCa in an Iranian population. Further studies with larger sample sizes and different ethnicities are required to confirm our findings.

Association between polymorphisms in TP53 and MDM2 genes and susceptibility to prostate cancer.

Tumor protein 53 (TP53), a tumor suppressor gene, is a vital cellular cancer suppressor in multicellular organisms. Murine double minute-2 (MDM2) is an oncoprotein that inhibits TP53 activity. A number of studies have examined the association of TP53 and MDM2 polymorphisms with the risk of common forms of cancer, but the findings remain inconclusive. The present study aimed to evaluate the impact of the 40-bp insertion/deletion (I/D) polymorphism (rs3730485) in the MDM2 promoter region and the 16-bp I/D polymorphism (rs17878362) in TP53 on the susceptibility of prostate cancer (PCa) in a sample of the Iranian population. This case-control study included 103 patients with pathologically confirmed PCa and 142 patients with benign prostatic hyperplasia. The MDM2 40-bp I/D and TP53 16-bp I/D polymorphism was determined using polymerase chain reaction analysis. The results demonstrated that the MDM2 40-bp I/D polymorphism increased the risk of PCa in a co-dominant inheritance model [odds ratio (OR)=1.88; 95% confidence interval (CI)=1.11-3.19; P=0.023, D/D vs. I/I], while this variant marginally increased the risk of PCa in a dominant model (OR=1.69; 95% CI=1.00-2.83; P=0.051, I/D+D/D vs. I/I). No significant association was observed between the TP53 16-bp I/D polymorphism and PCa. In conclusion, the present study demonstrated that the 40-bp I/D polymorphism in the MDM2 promoter increased the risk of PCa in an Iranian population. Further investigations with diverse ethnicities and larger sample sizes are required to verify these results.

Efficacy and safety of percutaneous nephrolithotomy with adult standard size instruments in children under 3 years of age: a 10 years single-center experience.

BACKGROUND: Using percutaneous nephrolitotomy (PCNL) with large adult instruments in treatment of pediatricurolithiasis is still in debate. This study was conducted to evaluate the efficacy and safety of PCNL with adult's instrument in treatment of patients less than 3 years old. METHODS: Data on patient characteristics and outcomes for 261 consecutive children undergoing PCNL at a Labbafinejad University Hospital were collected prospectively from September 2006 to February 2016. Thirty-two children, with 34 renal units, who were treated with PCNL were enrolled in the study. All PCNL procedures were performed via subcostal approach with one access tract in all of them. Postoperative complications were evaluated according to the modified Clavien grading system. RESULTS: The mean age of patients was 19.4 ± 6.2 months. Two patients had bilateral stones; thus, PCNL was performed on 34 kidney units. The mean size of the largest stone diameter was 17.5 ± 7.8 mm. The mean duration of procedures was 121.52 ± 29.05 minutes, ranging from 60 to 180 minutes. The most common complication was fever (n = 9, 26.4%), and hemorrhage that needs transfusion was the second one (n = 4, 11.7%). Seventeen patients with complications were in the first degree of Clavien complication system and five of them were in the second degree. CONCLUSIONS: Due to our experience, utilizing PCNL with adult-sized instruments in management of urolithiasis in less than 3 years old children appeared to be effective and relatively safe.

Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success.

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504 ± 350 mm(2). The mean duration of surgery was 43 ± 21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate.

Association between single nucleotide polymorphism in miR-499, miR-196a2, miR-146a and miR-149 and prostate cancer risk in a sample of Iranian population.

MicroRNAs (miRNAs) play an important role in regulating gene expression at the post-transcriptional level and are involved in numerous physiological processes. Accumulating evidence suggests that single-nucleotide polymorphisms (SNPs) in human miRNA genes may affect miRNA biogenesis pathway and influence the susceptibility to several diseases such as cancer. The present study aimed to evaluate the impact of miR-499 rs3746444, miR-196a2 rs11614913, miR-149 rs2292832, and miR-146a rs2910164 polymorphisms on prostate cancer (PCa) risk in a sample of Iranian population. This case-control study was done on 169 patients with pathologically confirmed PCa and 182 benign prostatic hyperplasia (BPH). The genotyping assays were done using T-ARMS-PCR or PCR-RFLP methods. The findings indicated that CC genotype of miR-499 rs3746444 polymorphism increased the risk of PCa (OR = 1.76, 95% CI = 1.12-2.79, P = 0.019) compared to TT genotype. No statistically significant association was found between miR-196a2 rs11614913, miR-149 rs2292832, and miR-146a rs2910164 polymorphisms and PCa risk. In summary, the findings indicated that miR-499 rs3746444 polymorphism increased the risk of PCa in an Iranian population. Further studies with larger sample sizes and different ethnicities are necessary to verify the findings of the present study.

A Significant Upregulation of miR-886-5p in High Grade and Invasive Bladder Tumors.

PURPOSE: To investigate the expression alteration of miR-886-5p in bladder tumors and evaluating its expression level as a potential biomarker in this type of cancer. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded (FFPE) samples of bladder tumors belonging to 70 patients whom had been referred to the Shahid Labbafi-Nejad medical center were obtained from the archival collection of pathology department. After RNA extraction and cDNA synthesis, expression levels of miR-886-5p were quantified by a real-time reverse transcription polymerase chain reaction (RT-PCR) approach. RESULTS: Our data revealed a significant upregulation (~3 times) of miR-886-5p in high grade bladder tumors, compared to the low grade ones (P < .05). Moreover, its expression level could significantly discriminate noninvasive (Ta, T1) from invasive (T-2T4) tumor stages. CONCLUSION: Our data suggests a potential role for miR-886-5p in progression of bladder cancer.

In Vitro Evaluation of Gd(3+)-Anionic Linear Globular Dendrimer-Monoclonal Antibody: Potential Magnetic Resonance Imaging Contrast Agents for Prostate Cancer Cell Imaging.

PURPOSE: Early stage prostate cancer diagnosis is of high global interest. Magnetic resonance imaging (MRI) is a non-invasive modality for early cancer diagnosis, in particular for prostate cancer detection. The research aim is to synthesize a nanodendrimer and its conjugate with C595 monoclonal antibody (mAb C595), against prostate cancer, followed by its chelating with Gd(3+). PROCEDURES: Anti-MUC-1 mAb C595 was conjugated to an anionic linear globular dendrimer (ALGDG2). The polyethylene glycol core and citric acid shell were synthesized followed by loading with Gd(3+) to make novel contrast agents for functional MRI. The in vitro behavior and MRI parameters of the nanoconjugate were investigated performing several studies such as cell toxicity and TNF-alpha evaluations. The investigation of magnetic resonance imaging parameters indicated how well nanoconjugate performs in (1)H-NMR and (17)O-NMR in vitro. RESULTS: Results showed a potential specific MRI activity by improving the swelling responses cell binding. The MTT (2-(4,5-dimethyl-2-thiazolyl)-3,5-diphenyl-2H-tetrazolium bromide) assay demonstrated that this contrast agent had significant cytotoxicity on prostate cancer cells. CONCLUSIONS: These results showed that Gd(3+)-ALGDG2-C595 is a potential prostate molecular imaging agent and could be considered as an ideal functional nanoprobe. Additionally, further investigations by clinical trials are in the pipeline.

Major vascular injury in laparoscopic urology.

BACKGROUND AND OBJECTIVES: Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures. METHODS: All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries. RESULTS: The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel. CONCLUSIONS: Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field.

Growth trends in medical specialists education in Iran; 1979 - 2013.

Over the past 35 years Iran had significant quantitative progress in postgraduate medical education; and growth in specialist's physician workforce supply. Health and medical education policy makers have struggled with many issues related to physician supply, such as determining the sufficient number of physicians workforce and the appropriate number to train; establishing new medical schools; the diversity of specialty programs; efforts to increase the supply of physicians in specialty level in remote and rural areas; and the growing number of female physicians and its impact on health services. After establishment of Ministry of Health and Medical Education (MoHME) in Iran, expansion of medical specialty education was a priority. Since then, great advances have been made in training of new specialty programs. Despite of these brilliant advances during the last decades in Iran, there has been no integrated and comprehensive documentation of previous and current growth trend, yet. To understand where Iranian physician supply and specialty training is headed, we examined the Iranian medical specialist's trends from 1979 to 2013 in a national study by support of Iranian academy of medicine. This paper documents the growth trend of medical specialist's workforce over the past 35 years. Examining the health manpower growth trends allow health and medical education policy makers to plan innovative strategies for the purposeful development of postgraduate medical education to ensure that in future there would be sufficient physicians supply, with the right skills, in the right places in response to population demands.

Achievements in postgraduate urologic education in Iran: a quantitative study.

PURPOSE: The study focus is on the quantitative achievements in urology education and growth trends in urologic surgical workforce and fellowships by gender since 1979. MATERIALS AND METHODS: This comprehensive national quantitative study was performed in Iranian Academy of medical science. The first hand data gathered from The Iran Specialty Training Council of and also from Medical Council of Iran. RESULTS: Over the period 1979 to 2012, the numbers of resident's admission in urology/ fellowships have increased from 5 to 51 and from 0 to 24 respectively, and graduated urologists of national programs has grown from 5 (14%) in 1979 to 47 (100%) in 2012. Iranian urologists workforce haves increased from 315 in 1979 to 1637 in 2012. In 1979, there was 1 urologist for every 117,460 population, while in 2012 there was 1 urologist for every 46120 population. Iran Urologists to population rate is 1:46120. These statistics represents significant improvement from 34 years ago. Number of female urologists has progressively increased from 1 in 1979 (0%) to 110 (7%) in 2012. Urology fellowships are offered in 6 fields since 1994 in Iran. The number of trained fellowships grew sharply and reached to 221 in 2012. CONCLUSION: The current urology training is successful to improve urology health care. Along with expansion of urology and fellowship training, the number of Iranian female urologists significantly increased. To our knowledge Iran had the greatest growth rate of female urologist training in the Middle East, and is comparable with those in the most progressed countries in the world.

Delayed postpercutaneous nephrolithotomy hemorrhage: prevalence, predictive factors and management.

OBJECTIVE: The aim of this study was to assess the prevalence, potential risk factors and management of delayed post-percutaneous nephrolithotomy (PCNL) bleeding. MATERIAL AND METHODS: Records of 2512 patients who had undergone PCNL from April 2008 to April 2011 were reviewed retrospectively. The prevalence of delayed post-PCNL hemorrhage and correlation of different variables such as age, body mass index, stone location and burden, surgical approach, type and number of access ports, type of drainage, comorbidities and previous history of stone surgery with postoperative bleeding were assessed. The efficacy of conservative management and need for angioembolization were analyzed. RESULTS: In total, 2304 patients [1562 men (67.8%) and 742 women (32.2%)], with a mean age of 46.4 ± 13.6 years (range 17-86 years), were enrolled in the study. The prevalence of delayed hemorrhage was 2.6% (61 patients) and the mean time to the onset of hemorrhage after PCNL was 5.8 days (range 3-11 days). Of 61 patients presenting with delayed hemorrhage, only 16 patients received a blood transfusion. Eight patients underwent angiography because of uncontrolled bleeding and only three underwent embolization. No significant association was found between other variables and post-PCNL hemorrhage, except for type of drainage, in that tubeless surgery increased the rate of postoperative bleeding. CONCLUSION: Delayed hemorrhage is an uncommon complication following PCNL that can be successfully managed with conservative management; only a few patients will require angiography and then embolization. Tubeless PCNL significantly predicted the occurrence of severe postoperative bleeding.

Co-regulated expression of TGF-ß Variants and miR-21 in bladder cancer.

PURPOSE: To investigate a potential alteration in the expression levels of transforming growth factor ß (TGF-ß) and miR-21 in bladder cancer tissues. MATERIAL AND METHODS: Using real-time polymerase chain reaction (PCR) method, we examined a potential correlated expression of miR-21 and TGF-ß variants in 30 bladder tumors and their marginal/non-tumor biopsy specimens obtained from the same patients. RESULTS: Our data revealed a significant down-regulation of TGF-ß variants (P = .03) along with a non-significant alteration in the expression of miR-21 in tumor vs. non-tumor samples. However, in contrast to low-grade tumors, the expression of miR-21 was upregulated in high-grade ones, and the expression level can efficiently discriminate low-grade tumors from high-grade ones (P = .03). CONCLUSION: In accordance to the observed similarity between TGF-ß variants and miR-21 gene expression alterations in bladder tumors, treating 5637 bladder cancer cell line with TGF-ß recombinant protein caused a significant upregulation of miR-21. The later finding further confirmed a correlated expression of TGF-ß and miR-21 in bladder tumors.

Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial.

PURPOSE: To evaluate the safety and efficacy of spinal anesthesia compared with general anesthesia in patients who underwent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: One hundred patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia. Spinal anesthesia was performed using an injection of 0.25 mg/kg bupivacaine 0.5% in the intrathecal space; no opium (fentanyl) agent was used. All procedures were performed with the patient in the prone position. Stone access was made by using fluoroscopic guidance, and the tract was dilated using a single-stage technique. All patients received a solution including 1 mg/kg morphine in every 100 mL physiologic saline through the volumetric pump during the 3-hour post-PCNL period in the recovery room. Afterward, morphine (0.05 mg/kg) was injected only according to the verbal rating scale greater than 3 after discharge from the recovery room until 24 hours after surgery. RESULTS: The two groups were matched by mean age, distribution of stone location, and stone burden. Mean operative time, hospital stay, stone-free rate and mean hemoglobin drop were comparable between the two groups. The rate of complications according to the Clavien grading system was nearly similar in both groups. Mean analgesic requirement during 24 hours after PCNL was 6.8 mg in the spinal group and 13.2 mg in the general group (P<0.001). CONCLUSION: It seems that using spinal anesthesia by intrathecal injection of local anesthetic solutions vs general anesthesia has comparable surgical outcomes and reduces the requirement for analgesia after PCNL in the early postoperative period.