Cutaneous metastasis as the first sign of renal cell carcinoma - crossroad between literature analysis and own observations.

Introduction: Metastatic disease can be observed in nearly 25% of all renal cell carcinoma cases (RCC). This can present in the skin as a late symptom of the disease or as a manifestation of an undetected, asymptomatic RCC. Aim: To review the literature and present a case study of cutaneous metastasis in primary genitourinary malignancy, especially RCC in order to broaden the related knowledge. Material and methods: The first stage of our work was focused on presenting the results of the literature review about cutaneous metastasis in the patients with renal cell carcinoma. Next, taking into account that this type of metastasis associated with RCC is relatively rare, we have decided to present a patient aged 68 with incidentally detected skin metastases of RCC located on the scalp. Results: It was diagnosed as a primary manifestation of advanced disease. Computed tomography scans showed a solid mass in the left kidney. Following surgical excision of the skin lesion, a left-side nephrectomy was performed. Conclusions: Cutaneous metastases of RCC present an unfavourable prognosis, however, remission is possible subsequent to early diagnosis and appropriate surgical excision.

Characterisation of Selected Materials in Medical Applications.

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide-hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Management of Incidental Finding of Triorchidism Diagnosed During Routine Hernia Repair.

Polyorchidism is a rare congenital anomaly which refers to the presence of more than two intra- or extrascrotal testicles. Triorchidism, the presence of one extra testicle is the most common type. This report describes the case of a 29-year-old male who was found to have a right supernumerary undescended testis encountered incidentally during hernia repair. With this in mind, the current knowledge of management of supernumerary testis was analysed, including potential scenarios, to delineate what a urologist should do when a supernumerary testis is found during routine surgical procedures such as orchidopexy or hernia repair.

The Dual Role of Glutamatergic Neurotransmission in Alzheimer's Disease: From Pathophysiology to Pharmacotherapy.

Alzheimer's disease (AD) is an age-related dementia and neurodegenerative disorder, characterized by Aß and tau protein deposition impairing learning, memory and suppressing synaptic plasticity of neurons. Increasing evidence suggests that there is a link between the glucose and glutamate alterations with age that down-regulates glucose utilization reducing glutamate levels in AD patients. Deviations in brain energy metabolism reinforce the development of AD by hampering glutamate levels in the brain. Glutamate is a nonessential amino acid and the major excitatory neurotransmitter synthesized from glucose. Alterations in cerebral glucose and glutamate levels precede the deposition of Aß plaques. In the brain, over 40% of neuronal synapses are glutamatergic and disturbances in glutamatergic function have been implicated in pathophysiology of AD. Nevertheless, targeting the glutamatergic system seems to be a promising strategy to develop novel, improved therapeutics for AD. Here, we review data supporting the involvement of the glutamatergic system in AD pathophysiology as well as the efficacy of glutamatergic agents in this neurodegenerative disorder. We also discuss exciting new prospects for the development of improved therapeutics for this devastating disorder.

The Glucose Metabolic Pathway as A Potential Target for Therapeutics: Crucial Role of Glycosylation in Alzheimer's Disease.

Glucose uptake in the brain decreases because of normal aging but this decline is accelerated in Alzheimer's disease (AD) patients. In fact, positron emission tomography (PET) studies have shown that metabolic reductions in AD patients occur decades before the onset of symptoms, suggesting that metabolic deficits may be an upstream event in at least some late-onset cases. A decrease in availability of glucose content induces a considerable impairment/downregulation of glycosylation, which is an important post-translational modification. Glycosylation is an important and highly regulated mechanism of secondary protein processing within cells and it plays a crucial role in modulating stability of proteins, as carbohydrates are important in achieving the proper three-dimensional conformation of glycoproteins. Moreover, glycosylation acts as a metabolic sensor that links glucose metabolism to normal neuronal functioning. All the proteins involved in ß-amyloid (Aß) precursor protein metabolism have been identified as candidates of glycosylation highlighting the possibility that Aß metabolism could be regulated by their glycosylation. Within this framework, the present review aims to summarize the current understanding on the role of glycosylation in the etiopathology of AD, emphasizing the idea that glucose metabolic pathway may represent an alternative therapeutic option for targeting AD. From this perspective, the pharmacological modulation of glycosylation levels may represent a 'sweet approach' to treat AD targeting new mechanisms independent of the amyloid cascade and with comparable impacts in familial and sporadic AD.

From Cannabis sativa to Cannabidiol: Promising Therapeutic Candidate for the Treatment of Neurodegenerative Diseases.

Cannabis sativa, commonly known as marijuana, contains a pool of secondary plant metabolites with therapeutic effects. Besides Δ9-tetrahydrocannabinol that is the principal psychoactive constituent of Cannabis, cannabidiol (CBD) is the most abundant nonpsychoactive phytocannabinoid and may represent a prototype for anti-inflammatory drug development for human pathologies where both the inflammation and oxidative stress (OS) play an important role to their etiology and progression. To this regard, Alzheimer's disease (AD), Parkinson's disease (PD), the most common neurodegenerative disorders, are characterized by extensive oxidative damage to different biological substrates that can cause cell death by different pathways. Most cases of neurodegenerative diseases have a complex etiology with a variety of factors contributing to the progression of the neurodegenerative processes; therefore, promising treatment strategies should simultaneously target multiple substrates in order to stop and/or slow down the neurodegeneration. In this context, CBD, which interacts with the eCB system, but has also cannabinoid receptor-independent mechanism, might be a good candidate as a prototype for anti-oxidant drug development for the major neurodegenerative disorders, such as PD and AD. This review summarizes the multiple molecular pathways that underlie the positive effects of CBD, which may have a considerable impact on the progression of the major neurodegenerative disorders.

The impact of selected modifiable lifestyle factors on male fertility in the modern world.

INTRODUCTION: The modern man during his reproductive period is exposed to the negative influence of widespread lifestyle-related habits. The available studies show a significant decline in the quality of young men's sperm, which results in male and female infertility factors being given equal consideration. The progressive decline of sperm quality has lowered the spermiogram parameters proposed by the World Health Organization. MATERIAL AND METHODS: We performed a review of the literature on the most common unhealthy habits in the modern world, such as obesity, mobile phone usage, smoking and alcohol intake, and their reported effects on male fertility. Several papers including original, review and meta-analysis were searched using the ScienceDirect and Web of Science databases. RESULTS: All the factors under analysis contribute to a significant deterioration of sperm quality, mainly through decreased sperm concentration, vitality, motility and morphology. CONCLUSIONS: Lifestyle-related factors are a significant cause of male infertility in the world today. Studies have shown that sperm quality is essentially determined by: obesity, nicotine addiction, heavy exposure to electromagnetic compatibility radiation-emitting devices and alcohol consumption. Weight loss and cessation or limitation of unhealthy lifestyle-related factors might represent the best course of action for any couple trying to achieve pregnancy.

Pharmacological Treatment of Depression in Alzheimer's Disease: A Challenging Task.

Besides the memory impairment, Alzheimer's disease (AD) is often complicated by neuropsychiatric symptoms also known as behavioral and psychological symptoms of dementia, which occur in one-third of patients at an early stage of the disease. Although the relationship between depressive disorders and AD is debated, the question if depression is a prodromal symptom preceding cognitive deficits or an independent risk factor for AD is still unclear. Moreover, there is growing evidence reporting that conventional antidepressants are not effective in depression associated with AD and, therefore, there is an urgent need to understand the neurobiological mechanism underlying the resistance to the antidepressants. Another important question that remains to be addressed is whether the antidepressant treatment is able to modulate the levels of amyloid-ß peptide (Aß), which is a key pathological hallmark in AD. The present review summarizes the present knowledge on the link between depression and AD with a focus on the resistance of antidepressant therapies in AD patients. Finally, we have briefly outlined the preclinical and clinical evidences behind the possible mechanisms by which antidepressants modulate Aß pathology. To our opinion, understanding the cellular processes that regulate Aß levels may provide greater insight into the disease pathogenesis and might be helpful in designing novel selective and effective therapy against depression in AD.

Anatomical and clinical aspects of horseshoe kidney: a review of the current literature / Aspectos anatómicos y clínicos del riñón en herradura: una revisión de la literatura actual

SUMMARY: Horseshoe kidney (HSK) is the most common kidney malformation. This review analyses the literature surrounding the etiology, morphology and clinical anatomy of these kidney fusion anomalies. A systematic literature search was carried out using the Science Direct and Scopus applications. HSK is characterized by three anatomic abnormalities: ectopia, malrotation and vascular changes. The study put emphasis especially on blood supply and upper urinary tract changes in HSK's patients. Arterial blood supply was analysed not only basing on Graves pattern, but also a new model of supply created on horseshoe kidneys computed tomography was taken into account. In addition, study presents clinical aspects of especially significant pathology of HSK, like hydronephrosis, stones and urinary tract infection. This study focuses also on congenital anomalies associated with horseshoe kidney.

RESUMEN: El riñón en herradura (RH) es la malformación renal más común reportada en la literatura. Esta revisión analiza la literatura que rodea la etiología, morfología y anatomía clínica de esta anomalía de fusión renal. Se realizó una búsqueda sistemática de la literatura utilizando las aplicaciones Science Direct y Scopus. El riñón en herradura se caracteriza por tres anomalías anatómicas: ectopía, malrotación y cambios vasculares. El estudio puso énfasis especialmente en el suministro de sangre y los cambios del tracto urinario superior en los pacientes con RH. El suministro de sangre arterial se analizó no solo basándose en el patrón de Graves, sino que también se tuvo en cuenta un nuevo modelo de suministro creado en los riñones en herradura. Además, el estudio presenta aspectos clínicos de patología especialmente significativa de RH, como hidronefrosis, cálculos e infección del tracto urinario. Este estudio se centró también en las anomalías congénitas asociadas con el riñón en herradura.

Testicular microlithiasis: what urologists should know. A review of the current literature.

INTRODUCTION: Testicular microlithiasis is a finding incidental to the ultrasound examination of the scrotum. This article presents some new data regarding the etiopathology of testicular microliths. As there is a growing body of literature available, which associates testicular microlithiasis with a testicular germ cell tumor or male infertility, our review focuses on these relations (based on a new meta-analysis and retrospective follow-up programs). The purpose of this review is to summarize the knowledge about testicular microlithiasis and discuss the latest recommendations. MATERIAL AND METHODS: A comprehensive literature review was performed using Science Direct and Scopus with MeSH terms and keywords 'testicular microlithiasis', testicular tumor', male infertility'. RESULTS: The clinical consequences of testicular microlithiasis depend on the co-occurrence of specific risk factors. The presence of testicular microlithiasis alone in the absence of risk factors is not an indication for further investigation. CONCLUSIONS: A link between testicular microlithiasis and testicular cancer as well as male infertility has been analyzed. Follow-up is only recommended where risk factors of testicular cancer other than testicular microlithiasis are present.

Morphological study of the ureterovesical junction in children.

Morphological and morphometric assessment of the elements of the ureterovesical junction in children was performed in the present study in different age groups ranging from 24 weeks of gestation to 16 years old. We tried to answer the question whether, in human ontogenesis, there is a period of anatomical predisposition to primary vesicoureteral reflux. The study included 210 urinary bladders with juxtavesical parts of the ureters that had been obtained from routine autopsies. As a result of the study, we showed that provided the pregnancy is uncomplicated there is no inherited susceptibility that would account for reducing or disturbing the development of ureterovesical junction elements. Based on the analysis of our results concerning the anatomy and morphological changes taking place in the elements of the ureterovesical junction in different age groups, one could put forward a hypothesis that anatomical predisposition to primary vesicoureteral reflux occurs in age group II, i.e. between 28 and 37 weeks of gestation. The parameters that define interrelations between elements of the ureterovesical junction and that are considered essential for normal functioning of antireflux mechanism were still observed in age group VI in our study. This suggests that these relations are not unambiguous in children with normally structured and functionally competent vesicoureteral junction.

Evaluation of selected Doppler parameters of renal blood flow in patients undergoing extracorporeal shock wave lithotripsy.

INTRODUCTION: Despite the risk of complications, which does not exceed several percent, extracorporeal shock wave lithotripsy (ESWL) causes morphological and functional changes in kidneys as a result of the effect of the generated shock wave energy on the renal parenchyma structure. MATERIAL AND METHODS: Forty-two patients were included in the study. The mean age in the studied group was 50.9 years (SD ±13.7). Extracorporeal lithotripsy treatments were carried out during the period from January 2014 to April 2014 using an electromagnetic shock wave generator. The spectrum of blood flow of the interlobar arteries of both the treated and the opposite kidney was investigated. On the basis of these spectrums, parameters such as: resistive index (RI), pulsatility index (PI) and acceleration time (AT) were calculated. RESULTS: The ESWL treatment causes a statistically significant increase of the RI parameter in the ipsilateral kidney (p <0.0001) as well as in the opposite kidney (p <0.0001). The RI value decreases after 92 hours after the treatment, reaching statistical significance in both kidneys (p <0.005). The PI parameter substantially increases after treatment in both kidneys (p <0.0001), and decreases after 92 hours (p <0.0001). Statistically significant correlations are shown between RI as well as the PI parameters and the patient's age. CONCLUSIONS: Extracorporeal shock wave lithotripsy (ESWL) of renal stones causes temporary impairment of the renal perfusion in both ipsilateral and contralateral kidneys. The main factor that determines the value of the RI and PI parameters is the patient's age.

Triiodothyronine modulates initiation of spermatogenesis in rats depending on treatment timing and blood level of the hormone.

Triiodothyronine (T3) stimulates spermatogenic onset but the influence of T3 on spermatogonia development is unknown. The aim of the study was to investigate the role of T3 for both processes simultaneously. Male rats were given daily injections of 100 µg T3/kg body weight or vehicle from birth until postnatal day (pnd) 5 and euthanized on pnd 6 (short T3-sT3). Other rats, euthanized on pnd 16, were treated either transiently with T3 (tT3) during the initial 5 days or continuously until pnd 15 (cT3). sT3 was found to increase gonocyte differentiation, spermatogonia number, cell degeneration and proliferation. tT3 increased serum T3 level and spermatogonial development to adult values precociously, but cell degeneration or proliferation were not affected. cT3 increased serum T3 together with cell degeneration and proliferation, but cell number was not affected. In conclusion, T3 may modulate spermatogonial development quantitatively depending on treatment timing and blood level of the hormone.