Surrogate indices of insulin resistance using the Matsuda index as reference in adult men-a computational approach.

Background: Overweight and obesity, high blood pressure, hyperglycemia, hyperlipidemia, and insulin resistance (IR) are strongly associated with non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease, stroke, and cancer. Different surrogate indices of IR are derived and validated with the euglycemic-hyperinsulinemic clamp (EHC) test. Thus, using a computational approach to predict IR with Matsuda index as reference, this study aimed to determine the optimal cutoff value and diagnosis accuracy for surrogate indices in non-diabetic young adult men. Methods: A cross-sectional descriptive study was carried out with 93 young men (ages 18-31). Serum levels of glucose and insulin were analyzed in the fasting state and during an oral glucose tolerance test (OGTT). Additionally, clinical, biochemical, hormonal, and anthropometric characteristics and body composition (DEXA) were determined. The computational approach to evaluate the IR diagnostic accuracy and cutoff value using difference parameters was examined, as well as other statistical tools to make the output robust. Results: The highest sensitivity and specificity at the optimal cutoff value, respectively, were established for the Homeostasis model assessment of insulin resistance index (HOMA-IR) (0.91; 0.98; 3.40), the Quantitative insulin sensitivity check index (QUICKI) (0.98; 0.96; 0.33), the triglyceride-glucose (TyG)-waist circumference index (TyG-WC) (1.00; 1.00; 427.77), the TyG-body mass index (TyG-BMI) (1.00; 1.00; 132.44), TyG-waist-to-height ratio (TyG-WHtR) (0.98; 1.00; 2.48), waist-to-height ratio (WHtR) (1.00; 1.00; 0.53), waist circumference (WC) (1.00; 1.00; 92.63), body mass index (BMI) (1.00; 1.00; 28.69), total body fat percentage (TFM) (%) (1.00; 1.00; 31.07), android fat (AF) (%) (1.00; 0.98; 40.33), lipid accumulation product (LAP) (0.84; 1.00; 45.49), leptin (0.91; 1.00; 16.08), leptin/adiponectin ratio (LAR) (0.84; 1.00; 1.17), and fasting insulin (0.91; 0.98; 16.01). Conclusions: The computational approach was used to determine the diagnosis accuracy and the optimal cutoff value for IR to be used in preventive healthcare.

Design of Novel Series of Antimalarial PMX Inhibitors with Increased Half-Life via Molecular Property Optimization.

Plasmepsin X (PMX) has been identified as a multistage antimalarial target. PMX is a malarial aspartyl protease essential for merozoite egress from infected red blood cells and invasion of the host erythrocytes. Previously, we reported the identification of PMX inhibitors by structure-based optimization of a cyclic guanidine core. Preclinical assessment of UCB7362, which displayed both in vitro and in vivo antimalarial activity, revealed a suboptimal dose paradigm (once daily dosing of 50 mg for 7 days for treatment of uncomplicated malaria) relative to current standard of care (three-dose regime). We report here the efforts toward extending the half-life (t1/2) by reducing metabolic clearance and increasing volume of distribution (Vss). Our efforts culminated in the identification of a biaryl series, with an expected longer t1/2 in human than UCB7362 while maintaining a similar in vitro off-target hit rate.

Cloxacillin plus fosfomycin versus cloxacillin alone for methicillin-susceptible Staphylococcus aureus bacteremia: a randomized trial.

Treatment failure occurs in about 25% of patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We assessed whether cloxacillin plus fosfomycin achieves better treatment success than cloxacillin alone in hospitalized adults with MSSA bacteremia. We conducted a multicenter, open-label, phase III-IV superiority randomized clinical trial. We randomly assigned patients (1:1) to receive 2 g of intravenous cloxacillin alone every 4 h or with 3 g of intravenous fosfomycin every 6 h for the initial 7 days. The primary endpoint was treatment success at day 7, a composite endpoint with the following criteria: patient alive, stable or with improved quick Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA, adjudicated by an independent committee blinded to treatment allocation. We randomized 215 patients, of whom 105 received cloxacillin plus fosfomycin and 110 received cloxacillin alone. We analyzed the primary endpoint with the intention-to-treat approach in 214 patients who received at least 1 day of treatment. Treatment success at day 7 after randomization was achieved in 83 (79.8%) of 104 patients receiving combination treatment versus 82 (74.5%) of 110 patients receiving monotherapy (risk difference 5.3%; 95% confidence interval (CI), -5.95-16.48). Secondary endpoints, including mortality and adverse events, were similar in the two groups except for persistent bacteremia at day 3, which was less common in the combination arm. In a prespecified interim analysis, the independent committee recommended stopping recruitment for futility prior to meeting the planned randomization of 366 patients. Cloxacillin plus fosfomycin did not achieve better treatment success at day 7 of therapy than cloxacillin alone in MSSA bacteremia. Further trials should consider the intrinsic heterogeneity of the infection by using a more personalized approach. ClinicalTrials.gov registration: NCT03959345 .

Divergent functional outcomes of NLRP3 blockade downstream of multi-inflammasome activation: therapeutic implications for ALS.

NOD-Like Receptor Family Pyrin Domain Containing 3 (NLRP3) inflammasome modulation has emerged as a potential therapeutic approach targeting inflammation amplified by pyroptotic innate immune cell death. In diseases characterized by non-cell autonomous neurodegeneration including amyotrophic lateral sclerosis (ALS), the activation of several inflammasomes has been reported. Since functional redundancy can exist among inflammasome pathways, here we investigate the effects of NLRP3 inhibition on NLRP3, NLR family CARD Domain Containing 4 (NLRC4) and non-canonical pathways to understand whether NLRP3 blockade alone can mitigate pro-inflammatory cytokine release and pyroptotic cell death in contexts where single or multiple inflammasome pathways independent of NLRP3 are activated. In this study we do not limit our insights into inflammasome biology by solely relying on the THP-1 monocytic line under the LPS/nigericin-mediated NLRP3 pathway activation paradigm. We assess therapeutic potential and limitations of NLRP3 inhibition in multi-inflammasome activation contexts utilizing various human cellular systems including cell lines expressing gain of function (GoF) mutations for several inflammasomes, primary human monocytes, macrophages, healthy and Amyotrophic Lateral Sclerosis (ALS) patient induced pluripotent stem cells (iPSC)-derived microglia (iMGL) stimulated for canonical and non-canonical inflammasome pathways. We demonstrate that NLRP3 inhibition can modulate the NLRC4 and non-canonical inflammasome pathways; however, these effects differ between immortalized, human primary innate immune cells, and iMGL. We extend our investigation in more complex systems characterized by activation of multiple inflammasomes such as the SOD1G93A mouse model. Through deep immune phenotyping by single-cell mass cytometry we demonstrate that acute NLRP3 inhibition does not ameliorate spinal cord inflammation in this model. Taken together, our data suggests that NLRP3 inhibition alone may not be sufficient to address dynamic and complex neuroinflammatory pathobiological mechanisms including dysregulation of multiple inflammasome pathways in neurodegenerative disease such as ALS.

In vivo effects of the alpha-synuclein misfolding inhibitor minzasolmin supports clinical development in Parkinson's disease.

Direct targeting of alpha-synuclein (ASYN) has emerged as a disease-modifying strategy for Parkinson's disease and other synucleinopathies which is being approached using both small molecule compounds and ASYN-targeted biologics. Minzasolmin (UCB0599) is an orally bioavailable and brain-penetrant small molecule ASYN misfolding inhibitor in clinical development as a disease-modifying therapeutic for Parkinson's disease. Herein the results of preclinical evaluations of minzasolmin that formed the basis for subsequent clinical development are described. Pharmacokinetic evaluations of intraperitoneal 1 and 5 mg/kg minzasolmin in wildtype mice revealed parallel and dose-proportional exposures in brain and plasma. Three-month administration studies in the Line 61 transgenic mouse model of PD were conducted to measure ASYN pathology and other PD-relevant endpoints including markers of CNS inflammation, striatal DAT labeling and gait. Reductions in ASYN pathology were correlated with improved aspects of gait and balance, reductions in CNS inflammation marker abundance, and normalized striatal DAT levels. These findings provide support for human dose determinations and have informed the translational strategy for clinical trial design and biomarker selection for the ongoing clinical studies of minzasolmin in patients living with early-stage Parkinson's disease (ClinicalTrials.gov ID: NCT04658186; EudraCT Number 2020-003265).

A longitudinal study of free leptin index in pre-eclamptic pregnancies.

The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.

Resilient Structural Sparsity in the Design of Consensus Networks.

The consensus problem is relevant to different areas ranging from biology, social psychology, and physics to power systems and robotics. Two crucial aspects of the design of a consensus system are the implementation issues that arise in densely connected networks and the presence of malicious agents that try to cause a deviation from a synchronization state. In this article, we introduce a formulation to design the topology of a consensus network to improve its resilience to attacks while remaining sparse and consistent with the a priori structural relations between the agents. Through mathematical analysis and simulations on artificial and real-world cases, we show the benefits and usefulness of using this strategy to design resilient and structurally sparse consensus networks.

Discovery and Characterization of Potent, Efficacious, Orally Available Antimalarial Plasmepsin X Inhibitors and Preclinical Safety Assessment of UCB7362.

Plasmepsin X (PMX) is an essential aspartyl protease controlling malaria parasite egress and invasion of erythrocytes, development of functional liver merozoites (prophylactic activity), and blocking transmission to mosquitoes, making it a potential multistage drug target. We report the optimization of an aspartyl protease binding scaffold and the discovery of potent, orally active PMX inhibitors with in vivo antimalarial efficacy. Incorporation of safety evaluation early in the characterization of PMX inhibitors precluded compounds with a long human half-life (t1/2) to be developed. Optimization focused on improving the off-target safety profile led to the identification of UCB7362 that had an improved in vitro and in vivo safety profile but a shorter predicted human t1/2. UCB7362 is estimated to achieve 9 log 10 unit reduction in asexual blood-stage parasites with once-daily dosing of 50 mg for 7 days. This work demonstrates the potential to deliver PMX inhibitors with in vivo efficacy to treat malaria.

Maternal Serum Angiopoietin-Like 3 Levels in Healthy and Mild Preeclamptic Pregnant Women.

Objective: Angiopoietin-like protein 3(ANGPTL3) is an important regulator of lipoprotein metabolism in the fed state by inhibiting the enzyme lipoprotein lipase in oxidative tissues. However, the possible role of ANGPTL3 throughout gestation and its relationship with hormonal and biochemical variables are still unknown. The aim of this study was to determinate serum ANGPTL3 level in healthy non-pregnant women, during healthy and preeclamptic pregnancy and postpartum. Methods: Serum ANGPTL3 was analyzed by enzyme-linked immunosorbent assay (ELISA), in a prospective cohort of healthy pregnant women (n = 52) and women with mild preeclampsia (n = 21), and women at three months postpartum (n = 20) and healthy non-pregnant women (n = 20). The results obtained were correlated with biochemical, hormonal and anthropometric variables and insulin resistance indices. Results: Levels of ANGPTL3 were not different between the follicular and the luteal phases of the cycle in healthy non-pregnant women. There was a significant reduction in serum ANGPTL3 levels from the first to the third trimester in healthy pregnant women compared with healthy non-pregnant and postpartum women (p <0.01). ANGPTL3 levels do not differ significantly during the three trimesters of pregnancy neither in healthy women nor in preeclamptic women. The serum levels of ANGPTL3 in women who developed preeclampsia are not statistically different from those observed in healthy pregnant women in each trimester of pregnancy. A significant lineal positive correlation was observed between serum ANGPTL3 levels and triglyceride (P =0.0186, r =0.52), very low-density lipoprotein cholesterol (P =0.0224, r =0.50), and total cholesterol levels (P =0.0220, r =0.50) in healthy non-pregnant women (P 0.05). Besides, there were no significant correlations between serum ANGPTL3 and body mass index (BMI), high-density lipoprotein cholesterol, glucose, insulin, leptin, or HOMA-IR (P >0.05). Conclusions: We describe for the first time the profile of ANGPTL3 throughout pregnancy and postpartum as well as and discussed about explore their potential contribution interactions with lipoprotein metabolism throughout pregnancy and postpartum. Thus, low levels of ANGPTL3 during pregnancy might favor lipid uptake in oxidative tissues as the main maternal energy source, while may helping to preserve glucose for use by the fetus and placenta.

Serum angiopoietin-like 3 levels are elevated in obese non diabetic men but are unaffected during an oral glucose tolerance test.

This study aimed to determine ANGPTL3 serum levels in healthy young lean and obese non-diabetic men during an oral glucose tolerance test (OGTT) and correlate them with anthropometric, biochemical and hormonal parameters. A case-control study was carried out and 30 young obese non-diabetic (23.90 ± 3.84 years and BMI 37.92 ± 4.85 kg/m2) and 28 age-matched healthy lean (24.56 ± 3.50 years and BMI of 22.10 ± 1.72 kg/m2) men were included in this study. The primary outcome measures were serum basal ANGPTL3 and ANGPTL3-area under the curve (AUC) levels. The percentage of body fat was measured by dual-energy X-ray absorptiometry and biochemical, hormonal and insulin resistance indices were determined. Basal ANGPTL3 and ANGPTL3-AUC levels were significantly elevated (p < 0.05) in young obese subjects compared with lean subjects and were positively and significantly associated with different anthropometric measurements. Fasting ANGPTL3 serum levels were positively correlated with fasting insulin, leptin, Leptin/Adiponectin index and triglyceride-glucose index. Moreover, ANGPTL3-AUC was negatively correlated with Matsuda index. In this regard, chronically high ANGPTL3 levels in young obese subjects might favor triglyceride-rich lipoprotein clearance to replenish triglyceride stores by white adipose tissue rather than oxidative tissues.

Atrapamiento ureteral por sarcoma uterino / Ureteral entrapment by uterine sarcoma

No disponible

Quiste de uraco / Urachal cyst

No disponible

Uso de desfibriladores implantables y terapia de resincronización cardiaca en ancianos mayores de 70 a 80 años: controversias y evidencia / Use of implantable defibrillators and cardiac resynchronisation therapy in patients more than 70 to 80 years old: arguments and evidence

Resumen Prevenir la muerte súbita y aumentar la supervivencia y la calidad de vida en los pacientes con falla cardiaca son las principales indicaciones para el uso de los desfibriladores implantables y la terapia de resincronización cardiaca respectivamente. Hay certeza de la eficacia clínica de estos dispositivos para la población general; sin embargo, no es tan clara para los pacientes mayores de 70 años dado que esta población no está lo suficientemente representada en los diseños de los estudios clínicos. La evidencia disponible hasta el momento precisa que en este grupo etario existe beneficio de la terapia de resincronización cardiaca, pero es cuestionable el uso de cardiodesfibriladores. Así mismo, es indispensable tener en cuenta no sólo el riesgo de mortalidad de los pacientes sino también su funcionalidad y fragilidad para definir si se benefician o no de estos dispositivos.

Abstract The prevention of sudden death, to increase the survival, and quality of life in patients with heart failure, are the main indications for the use of implantable defibrillators and cardiac resynchronisation therapy, respectively. There is confidence in the clinical efficacy of these devices for the general population, but it is not so clear in patients over 70 years-old, given that this population is not sufficiently represented in clinical study designs. Although the evidence available up until now shows that there is a benefit in this age group for the use cardiac resynchronisation therapy, the use of cardiac defibrillators is questionable. It is also indispensable to not only to take into account the mortality risk in these patients, but also their functionality and frailty in order to determine whether or not they would benefit from these devices.

[Evaluation of our series of first biopsies and rebiopsies by applying a prostate cancer risk calculator.] / Evaluación de nuestra serie de primeras biopsias y rebiopsias mediante la aplicación de calculadora de riesgo de cáncer de próstata.

OBJECTIVES: 1.- To know the risk of detectable Prostate Cancer (PC) and significant PC by applying a Risk Calculator to patients who underwent a prostate biopsy (PB) and to analyze if there are significant differences between the risk of patients who had positive versus negative biopsies. 2.- To compare the risk of those patients with positive results who were detected in the first biopsies vs re-biopsies. 3.- To compare our results with those obtained if we had applied the cut points established in the CP risk calculator. METHODS: Through a retrospective descriptive analytical study, we studied 496 prostate biopsies (PB) performed during 3 years (2014-2016), applying the SWOP risk calculator, analyzing if there are significant differences between those patients who had a positive vs negative result and those submitted to re-biopsies. RESULTS: The mean risk of detectable PC by the calculator for positive PB was 34.98% versus 24.71% of negative PB; in relation to the risk of significant PC, for positive PB it was 19.13% versus 8.8% of the negative PB, with significant differences (p<0.01) in both comparisons. When patients were grouped by first biopsies vs re-biopsies, we observed that patients with the first positive biopsy had an estimated risk by the calculator of 44% compared to 31% of the first negative prostate biopsies, this difference being statistically significant. CONCLUSIONS: The application of a prostate cancer risk calculator in candidates for first biopsy allows optimization of the test, although it loses effectiveness in patients with previous negative PB.

OBJETIVOS: 1.- Conocer el riesgo de Cáncer de Próstata (CP) detectable y el riesgo de CP significativo mediante la aplicación retrospectiva de una Calculadora de Riesgo de los pacientes a los que se les realizó una biopsia de próstata y analizar si existen diferencias significativas entre el riesgo de los pacientes que tuvieron resultado de biopsias positivas vs negativas. 2.- Comparar el riesgo de aquellos pacientes con resultado positivo que fueron detectados en primeras biopsias vs rebiopsias. 3.- Comparar nuestros resultados con los obtenidos si hubiéramos aplicado los puntos de cortes establecidos en la calculadora de riesgo de CP. MÉTODOS: Mediante estudio analítico descriptivo retrospectivo estudiamos las 496 biopsias de próstata (BP) realizadas durante 3 años (2014-2016), aplicando la calculadora de riesgo SWOP analizando si existen diferencias significativas entre aquellos pacientes que tuvieron un resultado positivo vs negativo así como los sometidos a rebiopsias. RESULTADOS: La media de riesgo de CP detectable mediante la calculadora para las BP positivas fue del 34,98% frente al 24,71% de las BP negativas; en cuanto al riesgo de CP significativo las BP positivas tuvieron una cifra de 19,13% frente al 8,8% de las BP negativas, existiendo diferencias significativas (pambas comparaciones. Al agrupar los pacientes por primeras biopsias vs rebiopsias observamos que los pacientes con primera biopsia positiva tenían un riesgo estimado por la calculadora del 44% frente al 31% de las primeras biopsias de próstata negativas siendo esta diferencia estadísticamente significativa. CONCLUSIONES: La aplicación de una calculadora de riesgo de CP en pacientes candidatos a primera biopsia, permite la optimización de la prueba, si bien, parece perder eficacia en pacientes con BP negativas previas.

Evaluación de nuestra serie de primeras biopsias y rebiopsias mediante la aplicación de calculadora de riesgo de cáncer de próstata / Evaluation of our series of first biopsies and rebiopsies by applying a prostate cancer risk calculator

Objetivos: 1.- Conocer el riesgo de Cáncer de Próstata (CP) detectable y el riesgo de CP significativo mediante la aplicación retrospectiva de una Calculadora de Riesgo de los pacientes a los que se les realizó una biopsia de próstata y analizar si existen diferencias significativas entre el riesgo de los pacientes que tuvieron resultado de biopsias positivas vs negativas. 2.- Comparar el riesgo de aquellos pacientes con resultado positivo que fueron detectados en primeras biopsias vs rebiopsias. 3.- Comparar nuestros resultados con los obtenidos si hubiéramos aplicado los puntos de cortes establecidos en la calculadora de riesgo de CP. Métodos: Mediante estudio analítico descriptivo retrospectivo estudiamos las 496 biopsias de próstata (BP) realizadas durante 3 años (2014-2016), aplicando la calculadora de riesgo SWOP analizando si existen diferencias significativas entre aquellos pacientes que tuvieron un resultado positivo vs negativo así como los sometidos a rebiopsias. Resultados: La media de riesgo de CP detectable mediante la calculadora para las BP positivas fue del 34,98% frente al 24,71% de las BP negativas; en cuanto al riesgo de CP significativo las BP positivas tuvieron una cifra de 19,13% frente al 8,8% de las BP negativas, existiendo diferencias significativas (p < 0,001) en ambas comparaciones. Al agrupar los pacientes por primeras biopsias vs rebiopsias observamos que los pacientes con primera biopsia positiva tenían un riesgo estimado por la calculadora del 44% frente al 31% de las primeras biopsias de próstata negativas siendo esta diferencia estadísticamente significativa. Conclusiones: La aplicación de una calculadora de riesgo de CP en pacientes candidatos a primera biopsia, permite la optimización de la prueba, si bien, parece perder eficacia en pacientes con BP negativas previas

Objectives: 1.- To know the risk of detectable Prostate Cancer (PC) and significant PC by applying a Risk Calculator to patients who underwent a prostate biopsy (PB) and to analyze if there are significant differences between the risk of patients who had positive versus negative biopsies. 2.- To compare the risk of those patients with positive results who were detected in the first biopsies vs re-biopsies. 3.- To compare our results with those obtained if we had applied the cut points established in the CP risk calculator. Methods: Through a retrospective descriptive analytical study, we studied 496 prostate biopsies (PB) performed during 3 years (2014-2016), applying the SWOP risk calculator, analyzing if there are significant differences between those patients who had a positive vs negative result and those submitted to rebiopsies. RESULTS: The mean risk of detectable PC by the calculator for positive PB was 34.98% versus 24.71% of negative PB; in relation to the risk of significant PC, for positive PB it was 19.13% versus 8.8% of the negative PB, with significant differences (p < 0.001) in both comparisons. When patients were grouped by first biopsies vs re-biopsies, we observed that patients with the first positive biopsy had an estimated risk by the calculator of 44% compared to 31% of the first negative prostate biopsies, this difference being statistically significant. Conclusions: The application of a prostate cancer risk calculator in candidates for first biopsy allows optimization of the test, although it loses effectiveness in patients with previous negative PB

[First prostate biopsy vs rebiopsy: Analysis of our series.] / Primeras biopsias prostáticas vs rebiopsias: análisis de nuestra serie.

INTRODUCTION: Prostate re-biopsydoes not guarantee detection of prostate cancer(PC), sometimes leading to overdiagnosis of clinicallyinsignificant tumors. The present study shows theincidence of PC in our hospital and analyzes thedistribution of risk groups and prognosis depending inthe diagnosis obtained by first biopsy vs rebiopsy. OBJECTIVES: 1. To know the incidence of ProstateCancer (PC) in patients biopsied in our hospital duringthe years 2014, 2015 and 2016 as well as thedistribution by risk and prognosis groups.2. To know if there are significant differences in thedistribution of risk and prognostic groups among patientsdiagnosed of PC by first biopsy vs rebiopsies in ourhospital in the years 2014, 2015 and 2016. MATERIALS AND METHODS: A longitudinal retrospectivedescriptive and analytical study was performed with496 patients undergoing prostate biopsy (PB) in ourhospital between January 1st 2014 and December31st 2016. We analyze the results of prostate biopsy,Gleason score and distribution by prognosis group toverify if there were significant differences between firstbiopsy vs prostate biopsy. RESULTS: The rate of positive PB in first biopsy was38.3% compared to 26.8% in rebiopsy. There weresignificant differences (p=0.01). In our series wediagnosed in first biopsy 71.8% of significant PC andthe 90% of the of bad or very bad prognosis PC (groups4 and 5 according to the ISUP classification). CONCLUSIONS: There are significant differences inthe diagnosis of prostate cancer between a first biopsyand a rebiopsy. Tumors diagnosed by rebiopsies havea better prognosis than those diagnosed by first biopsy.We must adopt mechanisms to increase the diagnosticyield of re-biopsies.

INTRODUCCIÓN: La rebiopsia no garantiza la detección de cáncer de próstata (CP) conllevando en ocasiones al sobrediagnostico de tumores clínicamente no significativos. El presente trabajo exponela incidencia de CP en nuestro centro y analiza la distribución por grupos de riesgo y pronóstico según hayan sido diagnosticados mediante primera biopsia vs rebiopsias. OBJETIVOS: 1.Conocer la incidencia de Cáncer de Próstata (CP) en los pacientes biopsiados en nuestro hospital durante los años 2014, 2015 y 2016 así como conocer también la distribución por grupos deriesgo y pronóstico. 2.Conocer si existen diferencias significativas en la distribución de grupos de riesgo y pronóstico entre los pacientes diagnosticados de CP mediante primera biopsia vs rebiopsias en nuestro hospital en los años 2014, 2015 y 2016.MÉTODOS: Se realizó un estudio analítico descriptivo retrospectivo longitudinal con 496 pacientes sometidos a biopsia de próstata (BP) en nuestro centro entre el 1 de Enero de 2014 y el 31 de diciembre de 2016. Analizamos los resultados de biopsia prostática, score Gleason y distribución por grupos pronósticos para comprobar si existían diferencias significativas entre los pacientes sometidos a primera biopsia vs rebiopsia. RESULTADOS: La tasa de BP positivas en primera biopsia fue de 38,3% frente a los 26,8% diagnosticados en rebiopsias existiendo diferencias significativas con p=0,01. En nuestra serie el 71,8% de los CP significativos y el 90% de los CP de malo o muy mal pronóstico (Grupo 4 y 5 según la ISUP) son diagnosticados en primera biopsia. CONCLUSIONES: Existen diferencias significativas en el diagnóstico de cáncer de próstata cuando se realiza una primera biopsia en comparación con la realización de rebiopsia. Los tumores diagnosticados mediante rebiopsias son de mejor pronóstico que los diagnosticados mediante primera biopsia. Debemos adoptar mecanismos para aumentar la rentabilidad diagnóstica de las rebiopsias.

Primeras biopsias prostáticas vs rebiopsias: análisis de nuestra serie / First prostate biopsy vs rebiopsy: Analysis of our series

INTRODUCCIÓN: La rebiopsia no garantiza la detección de cáncer de próstata (CP) conllevando en ocasiones al sobrediagnostico de tumores clínicamente no significativos. El presente trabajo expone la incidencia de CP en nuestro centro y analiza la distribución por grupos de riesgo y pronóstico según hayan sido diagnosticados mediante primera biopsia vs rebiopsias. OBJETIVOS: 1.Conocer la incidencia de Cáncer de Próstata (CP) en los pacientes biopsiados en nuestro hospital durante los años 2014, 2015 y 2016 así como conocer también la distribución por grupos de riesgo y pronóstico. 2.Conocer si existen diferencias significativas en la distribución de grupos de riesgo y pronóstico entre los pacientes diagnosticados de CP mediante primera biopsia vs rebiopsias en nuestro hospital en los años 2014, 2015 y 2016. MÉTODOS: Se realizó un estudio analítico descriptivo retrospectivo longitudinal con 496 pacientes sometidos a biopsia de próstata (BP) en nuestro centro entre el 1 de Enero de 2014 y el 31 de diciembre de 2016. Analizamos los resultados de biopsia prostática, score Gleason y distribución por grupos pronósticos para comprobar si existían diferencias significativas entre los pacientes sometidos a primera biopsia vs rebiopsia. RESULTADOS: La tasa de BP positivas en primera biopsia fue de 38,3% frente a los 26,8% diagnosticados en rebiopsias existiendo diferencias significativas con" CONCLUSIONES: Existen diferencias significativas en el diagnóstico de cáncer de próstata cuando se realiza una primera biopsia en comparación con la realización de rebiopsia. Los tumores diagnosticados mediante rebiopsias son de mejor pronóstico que los diagnosticados mediante primera biopsia. Debemos adoptar mecanismos para aumentar la rentabilidad diagnóstica de las rebiopsias

INTRODUCTION: Prostate re-biopsy does not guarantee detection of prostate cancer (PC), sometimes leading to overdiagnosis of clinically insignificant tumors. The present study shows the incidence of PC in our hospital and analyzes the distribution of risk groups and prognosis depending in the diagnosis obtained by first biopsy vs rebiopsy. OBJECTIVES: 1. To know the incidence of Prostate Cancer (PC) in patients biopsied in our hospital during the years 2014, 2015 and 2016 as well as the distribution by risk and prognosis groups. 2. To know if there are significant differences in the distribution of risk and prognostic groups among patients diagnosed of PC by first biopsy vs rebiopsies in our hospital in the years 2014, 2015 and 2016. MATERIALS AND METHODS: A longitudinal retrospective descriptive and analytical study was performed with 496 patients undergoing prostate biopsy (PB) in our hospital between January 1st 2014 and December 31st 2016. We analyze the results of prostate biopsy, Gleason score and distribution by prognosis group to verify if there were significant differences between first biopsy vs prostate biopsy. RESULTS: The rate of positive PB in first biopsy was 38.3% compared to 26.8% in rebiopsy. There were significant differences (p = 0.01). In our series we diagnosed in first biopsy 71.8% of significant PC and the 90% of the of bad or very bad prognosis PC (groups 4 and 5 according to the ISUP classification). CONCLUSIONS: There are significant differences in the diagnosis of prostate cancer between a first biopsy and a rebiopsy. Tumors diagnosed by rebiopsies have a better prognosis than those diagnosed by first biopsy. We must adopt mechanisms to increase the diagnostic yield of re-biopsies