Biometric and corneal characteristics in marfan syndrome with ectopia lentis.

PURPOSE: To describe the biometric and corneal characteristics of patients with Marfan Syndrome (MFS) and ectopia lentis. STUDY DESIGN: Observational, descriptive, prospective study. Subjects Individuals with MFS with ectopia lentis (EL). METHODS: Fourty-four eyes of 23 patients underwent Scheimpflug analysis using the Pentacam (Oculus, Wetzlar, Germany), axial length (AL) using the IOL master 700 (Carl Zeiss AG, Oberkochen, Germany), endothelial cell count (ECC) using the CEM-350 (NIDEK, Maihama, Japan) and corneal biomechanics evaluation with the Ocular Response Analyzer: ORA (Reichert Ophthalmic Instruments, Buffalo, New York, USA) and Corvis (Oculus, Wetzlar, Germany). Statistical analysis was performed using IBM SPSS Statistics 25.0. RESULTS: The direction of lens subluxation was most frequently supero-nasal 40.9% (18/44). Mean keratometry (Km) was 40.22±1.76 Diopters (D); mean corneal astigmatism was 1.68±0.83 D; total corneal aberrometric root mean square (RMS) was 2.237±0.795µm; higher-order aberrations (HOAs) RMS were 0.576±0.272µm; mean AL was 25.63±3.65mm; mean ECC was 3315±459cell/mm2; mean CBI was 0.13±0.24, mean TBI was 0.31±0.25, mean posterior elevation was 4.3±4.5µm; mean total corneal densitometry was 16.0±2.14 grayscale units (GSU). CONCLUSION: Increased axial length, flatter and thicker corneas with higher regular astigmatism, normal densitometry, normal corneal biomechanical indices and normal posterior elevation were observed in Marfan patients with EL.

Smoking-related interstitial lung disease.

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Utilidad de la tomografía de emisión de positrones / tomografía computarizada con 18F-colina en el manejo terapéutico de pacientes con recidiva bioquímica de adenocarcinoma de próstata tratados con braquiterapia / Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy

OBJETIVO: El objetivo del trabajo fue valorar la utilidad de la PET/TC con 18F-colina en pacientes con cáncer de próstata tratados con braquiterapia en recidiva bioquímica, así como valorar los cambios en el manejo terapéutico derivados de su resultado. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se incluyeron 20 pacientes entre 51 y 78 años, con antecedente de adenocarcinoma de próstata que habían sido tratados con braquiterapia, que presentaban recidiva bioquímica (PSA 3,1-12ng/ml) y estudio de extensión (TC y gammagrafía ósea) sin alteraciones. Los hallazgos visualizados en la PET/TC con 18F-colina fueron correlacionados con la histopatología y/o la evolución del PSA tras la terapia. RESULTADOS: En 15 pacientes la PET/TC con 18F-colina detectó únicamente recidiva local. En 4 pacientes recidiva local y linfática y en un1 paciente afectación local y ósea. La recidiva local detectada en la PET se confirmó anatomopatológicamente en el 85% de los casos. En un paciente los hallazgos visualizados en la PET resultaron ser una prostatitis y en otro paciente no se pudo confirmar. De los pacientes con recidiva local y linfática se confirmó histológicamente la recidiva local en 3 de 4. En el 25% de los pacientes la PET/TC con 18F-colina cambió el manejo terapéutico, desestimando la cirugía de rescate inicialmente prevista en 3 casos, en uno radioterapia y en otro la braquiterapia. CONCLUSIÓN: La PET/TC con 18F-colina podría ser una técnica útil en el grupo de pacientes tratados con braquiterapia con recidiva bioquímica, permitiendo localizar la afectación locorregional y a distancia no detectada con imágenes convencionales, determinando así un manejo terapéutico más adecuado

OBJECTIVE: The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS: Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS: 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management

Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy. / Utilidad de la tomografía de emisión de positrones / tomografía computarizada con 18F-colina en el manejo terapéutico de pacientes con recidiva bioquímica de adenocarcinoma de próstata tratados con braquiterapia.

OBJECTIVE: The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS: Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS: 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management.

Mecanismos patogénicos en la fibrosis pulmonar idiopática. Implicación de los canales de aquoporina 1 (aqp1) / Pathogenic mechanisms in idiopathic pulmonary fibrosis. Involvement of aquoporin 1 (AQP1) channels

La fibrosis pulmonar idiopática (FPI) es una enfermedad pulmonar intersticial difusa (EPID) y progresiva. La FPI resulta de la alteración en la reepitelización tras la lesión de las células epiteliales alveolares. Se produce un aumento en la apoptosis epitelial y en la síntesis de mediadores profibróticos, con la consiguiente proliferación de fibroblastos, transformación a miofibrobastos y el depósito incontrolado de matriz extracelular. La aquoporina 1 (AQP1), es una proteína que facilita el movimiento de agua entre el espacio aéreo pulmonar y el parénquima y se ha demostrado que se regula al alza en animales expuestos a hipoxia. La AQP1 se expresa en células endoteliales, pero no en el epitelio alveolar pulmonar. Más recientemente se ha asociado a la AQP1 en los mecanismos implicados en la proliferación celular. Nuestro objetivo principal ha sido evaluar la participación de las Aquoporinas (AQPs) pulmonares en la patogenia de la FPI. Hemos analizado la expresión de AQP1 en biopsias de pacientes diagnosticados con FPI según los criterios de la ATS/ERS/ALAT de 2011 y en otras patologías pulmonares tales como la neumonitis por hipersensibilidad, sarcoidosis y biopsias de controles sanos. Los resultado de la inmunohistoquímica revelaron una intensa expresión de AQP1 en neumocitos tipo II hiperplásicos solo en las muestras obtenidas de pacientes con FPI. Además hay una inducción de la expresión de AQP1 (mRNA y proteína) tras la estimulación con TGF-ß lo que acompaña a los cambios típicos del proceso de transición epitelio mesenquimal. Por lo tanto, la aparición de AQP1 en las células hiperplásicas tipo II y su regulación podrían estar implicadas en la patogénesis de la FPI

Idiopathic pulmonary fibrosis (IPF) is a diffuse interstitial lung disease (ILD) that is progressive. IPF results from altered re-epithelialization after injury to alveolar epithelial cells. There is an increase in epithelial apoptosis and synthesis of pro-fibrotic mediators, with consequent proliferation of fibroblasts, transformation into myofibroblasts and uncontrolled deposition of extracellular matrix. Aquoporin 1 (AQP1) is a protein that facilitates the movement of water between the pulmonary airspace and the parenchyma and has been shown to be upregulated in animals exposed to hypoxia. AQP1 is expressed in endothelial cells, but not in the pulmonary alveolar epithelium. More recently, AQP1 has been associated in the mechanisms involved in cell proliferation. Our primary objective has been to assess the participation of lung aquoporins (AQPs) in the pathogenesis of IPF. We have analyzed the expression of AQP1 in biopsies of patients diagnosed with IPF according to the ATS/ERS/ALAT 2011 criteria and in other lung diseases such as hypersensitivity pneumonitis, sarcoidosis and biopsies of healthy controls. Immunohistochemistry results revealed an intense expression of AQP1 in Type II pneumocyte hyperplasia only in samples obtained from patients with IPF. Additionally, AQP1 (mRNA and protein) expression is induced after stimulation with TGFß, which accompanies typical changes in the mesenchymalepithelial transition process. Therefore, the appearance of AQP1 in Type II cell hyperplasia and its regulation could be involved in the pathogenesis of IPF

Hepatitis C subtype distribution in chronically infected patients with mild liver fibrosis in France: the GEMHEP study.

Treatment options for Hepatitis C infection have greatly improved with direct-acting antiviral (DAA) combinations achieving high cure rates. Nevertheless, the cost of this treatment is still high and access to treatment in many countries has been preferentially reserved for patients with more severe fibrosis (F3 and F4). In this French nationwide study, we investigated the epidemiological characteristics and genotype distribution of hepatitis C virus (HCV) in treatment-naive patients with METAVIR fibrosis stages between F0 and F2 in order to identify patient profiles that became eligible for unrestricted treatment in a second period. Between 2015 and 2016 we collected data from nine French university hospitals on a total of 584 HCV positive patients with absent, mild or moderate liver fibrosis. The most represented genotypes were genotype 1b (159/584; 27.2%), followed by genotype 1a (150/584; 25.7%); genotype 3 (87/584: 14.9%); genotype 4 (80/584; 13.7%). Among genotype 4: 4a was predominantly encountered with 22 patients (27.5% of genotype 4). Genotypes 1b and 1a are currently the most frequent virus types present in treatment-naive patients with mild fibrosis in France. They can be readily cured using the available DAA. Nevertheless, non-a/non-d genotype 4 is also frequent in this population and clinical data on the efficacy of DAA on these subtypes is missing. The GEMHEP is the French group for study and evaluation of viral hepatitis on a national scale. Data collection on epidemiological and molecular aspects of viral hepatitis is performed on a regular basis in all main French teaching hospitals and serves as a basis for surveillance of these infections. Analysis and trends are regularly published on behalf of the GEMHEP group. Data collection was performed retrospectively over the 2015-2016 period, covering nine main university hospitals in France. A total of 584 hepatitis C positive patients were included in this study. Genotyping of the circulating viruses showed a high prevalence of genotypes 1b and 1a in our population. The epidemiology of hepatitis C is slowly changing in France, particularly as a consequence of the rise of 'non-a non-d' genotype 4 viruses mainly originating from African populations. More data concerning treatment efficacy of these genotypes is needed in order to guide clinical care.

Postoperative adjuvant and very early salvage radiotherapy after prostatectomy in high-risk prostate cancer patients can improve specific and overall survival.

PURPOSE: Adjuvant radiotherapy (ART) for biochemical relapse (BR) after radical prostatectomy (RP) showed increased disease-free survival (DFS) in three previous randomized trials. Retrospective phase II trials evaluated if early salvage RT (ESRT) is equivalent to ART. Our study aims to compare ART and ESRT to salvage RT. MATERIALS AND METHODS: We compared RP plus ART and ESRT versus SRT. Indication for RT was made by PSA determination after RP: ART when PSA ≤ 0.2 ng/ml, ESRT when PSA ≤ 0.3 after PSA rise from 0.0 to SRT PSA ≥ 0.3. The cause of death of each patients was analyzed, DFS, cause-specific survival (CSS) overall survival (OS) and metastasis-free survival (MFS) in relation to RT intention. RESULTS: Between 1993 and 2008, 204 patients with a median age of 65 years (44-75) were treated. The median follow-up was 160 months (28.1-273.3). At diagnosis, 89.7% had localized clinical stages and 90.2% had Gleason (G) ≤ 7. The median PSA was 10 (range 4-101). The postoperative G was ≥ 7 in 66.2%; 56.4% had ≥ 2 positive margins; 29.4% received ART, 20% ESRT and 59.3% SRT. The DFS for ART, ESRT and SRT was 74, 56 and 39% with significant differences between the three groups (p < 0.001). ART + ESRT were combined versus SRT; for the DFS, the significant differences (p < 0.001) remained 67% versus 39%. Positive margins, pT3 and pre-RT PSA were significant factors on multivariate analysis. The CSS in the ART + ESRT group was 92 vs. 78% in the SRT group (p < 0.05). OS was 69% in ART + ESRT vs. 57% in SRT (p < 0.05). MFS was 82.7% in ART + ESRT vs. 67.4% in SRT. CONCLUSIONS: In this study the ART + ESRT presented benefits versus SRT in DFS, CSS, OS and MFS.

Reconstrucción de la vía aérea principal mediante el uso de prótesis sintéticas integrables / Reconstruction of the main airway through the use of integrable synthetic prosthesis

Uno de los principales problemas que plantea el tratamiento quirúrgico de las lesiones traqueales es la limitación existente en la longitud del segmento que es posible resecar. Actualmente, se puede extirpar con seguridad el 50% de la tráquea como máximo. Lesiones más extensas no se pueden beneficiar de este tratamiento y es necesario utilizar técnicas alternativas, en la mayoría de los casos paliativas. Una posible solución a este problema es la interposición de algún elemento que sustituya el segmento traqueal resecado. Se ha realizado un estudio experimental en animales, sustituyendo segmentos traqueales de distinta longitud por prótesis cilíndricas de politetrafluoroetileno. Posteriormente, se ha realizado un seguimiento y sacrificio de los animales estudiando los cambios histológicos. Los resultados obtenidos muestran la posibilidad técnica de la sustitución de la vía aérea por segmentos de material protésico. En el seguimiento evolutivo de los animales, parece existir una relación directa entre la longitud del implante y la aparición de estenosis traqueal a dicho nivel, tanto en los estudios morfológicos macroscópicos como en los estudios realizados con microscopía óptica. Sin embargo, por el momento, la mortalidad perioperatoria es elevada y, si bien se puede atribuir a la curva de aprendizaje, la traslación de los resultados a una posible práctica clínica no es recomendable

One of the main problems arising from the surgical treatment of tracheal lesions is the existing limitation in the length of segment that can be resected. Currently, a maximum of 50% of the trachea can be safely removed. More extensive lesions cannot benefit from this treatment and alternative techniques must be used, which are palliative in most cases. The interposition of an element which substitutes the segment of resected trachea is a possible solution for this problem. An experimental animal study has been conducted, substituting tracheal segments varying in length with cylindrical polytetrafluoroethylene prostheses. Later, a follow-up was done and the animals were sacrificed to study histological changes. The results show the technical possibility of substituting the airway with segments of prosthetic material. In the monitoring of the animals, there seems to be a direct relationship between the length of the implant and the appearance of tracheal stenosis at the implant site, both in the macroscopic morphological studies and the studies completed with optical microscopy. However, for the time being, perioperative mortality is high and, although it can be attributed to the learning curve, applying the results to possible clinical practice is not recommended

Tratamiento antifibrótico en la fibrosis pulmonar idiopática. Nuestra experiencia en la vida real / Anti-fibrotic treatment in idiopathic pulmonary fibrosis; Our real-life experience

La fibrosis pulmonar idiopática (FPI) es la forma más común de las neumonías intersticiales idiopáticas. Es una neumonía fibrosante, crónica y progresiva, limitada al pulmón, de causa desconocida, con mal pronóstico y, hasta el momento, sin tratamiento curativo. Se caracteriza por un patrón radiológico e histológico de Neumonía Intersticial Usual (NIU).Afecta sobre todo a adultos mayores de 50 años. Su evolución es impredecible en el momento del diagnóstico, condicionando una disminución progresiva de la función pulmonar. Actualmente, existen tratamientos antifibróticos que han demostrado eficacia en frenar la progresión de la enfermedad y, por tanto, mejorando el pronóstico1 . Existe poca información con respecto al uso de estos tratamientos en la vida real, fuera del ámbito de los ensayos clínicos. Presentamos los resultados del seguimiento de 27 pacientes diagnosticados de fibrosis pulmonar idiopática, según los criterios de la ATS/ERS 20112 , 8 de ellos en tratamiento con pirfenidona y 19 en tratamiento con nintedanib. Ambos tratamientos han sido bien tolerados, siendo sus efectos adversos más comunes los síntomas digestivos y la fotosensibilidad, de carácter leve

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonias, It is a fibrosing, chronic and progressive pneumonia, limited to the lung, cause unknown, with malicious prognosis, without curative treatment in this moment. Is characterized for a radiological and histological pattern of Usual Interstitial Pneumonia (UIP). Especially affects over 50 years old. Its evolution is unpredictable at the time of diagnosis conditioning a progressive decrease in lung function. Currently, there are antifibrotic treatments that have proven effective in Progression of the disease and, therefore, improving the prognosis Regarding the use of these treatments in real life, outside the clinical trials. Objective: We present the results of the follow-up of 27 patients diagnosed with idiopathic pulmonary fibrosis, according to ATS / ERS 2011 criteria, 8 of them being treated with pirfenidone and 19 on treatment with nintedanib. Both treatments have been well tolerated, its adverse events have been digestive symptoms and photosensibility

A new promising phylogenetic marker to study the diversity of fungal communities: The Glycoside Hydrolase 63 gene.

In molecular ecology, the development of efficient molecular markers for fungi remains an important research domain. Nuclear ribosomal internal transcribed spacer (ITS) region was proposed as universal DNA barcode marker for fungi, but this marker was criticized for Indel-induced alignment problems and its potential lack of phylogenetic resolution. Our main aim was to develop a new phylogenetic gene and a putative functional marker, from single-copy gene, to describe fungal diversity. Thus, we developed a series of primers to amplify a polymorphic region of the Glycoside Hydrolase GH63 gene, encoding exo-acting α-glucosidases, in basidiomycetes. These primers were validated on 125 different fungal genomic DNAs, and GH63 amplification yield was compared with that of already published functional markers targeting genes coding for laccases, N-acetylhexosaminidases, cellobiohydrolases and class II peroxidases. Specific amplicons were recovered for 95% of the fungal species tested, and GH63 amplification success was strikingly higher than rates obtained with other functional genes. We downloaded the GH63 sequences from 483 fungal genomes publicly available at the JGI mycocosm database. GH63 was present in 461 fungal genomes belonging to all phyla, except Microsporidia and Neocallimastigomycota divisions. Moreover, the phylogenetic trees built with both GH63 and Rpb1 protein sequences revealed that GH63 is also a promising phylogenetic marker. Finally, a very high proportion of GH63 proteins was predicted to be secreted. This molecular tool could be a new phylogenetic marker of fungal species as well as potential indicator of functional diversity of basidiomycetes fungal communities in term of secretory capacities.

Comparison of intra-ocular pressure changes with liquid or flat applanation interfaces in a femtosecond laser platform.

Cataract surgery is the most common surgical procedure and femtosecond laser assisted cataract surgery (FLACS) has gained increased popularity. FLACS requires the application of a suction device to stabilize the laser head and focus the laser beam accurately. This may cause a significant escalation in intra-ocular pressure (IOP), which poses potential risks for patients undergoing cataract surgery. In this study we aimed to assess the effect of the Ziemer LDV Z8 femtosecond cataract machine on IOP. We demonstrated through a porcine model that IOP was significantly higher with a flat interface but could be abrogated by reducing surgical compression and vacuum. Pressure was lower with a liquid interface, and further altering angulation of the laser arm could reduce the IOP to 36 mmHg. A pilot series in patients showed comparable pressure rises with the porcine model (30 mmHg). These strategies may improve the safety profile in patients vulnerable to high pressure when employing FLACS with the Ziemer LDV Z8.

Factores predictores, características patológicas y evolución de las recidivas vesicales después de nefroureterectomía / Predictors, pathological characteristics and outcomes of bladder recurrences following nephroureterectomy

Objetivos: Analizar las variables predictoras de recidiva vesical (RV) tras nefroureterectomía (NU) por tumor de tracto urinario superior (TTUS), así como sus características patológicas, evolución y repercusión en supervivencia. Material y métodos: Estudio retrospectivo de 117 pacientes sometidos a NU laparoscópica por TTUS entre 2007-2012 en nuestro centro. Los posibles factores predictores de RV se analizaron mediante regresión de Cox y para el estudio de supervivencia se utilizaron las curvas de Kaplan-Meier. Resultados: Fueron 85 hombres (73%) y 32 mujeres (27%) con una edad media de 70 años. Tras un seguimiento medio de 26 meses, 23 presentaron RV (19,6%). En el análisis multivariante, el género (p = 0,003; HR mujer 3,8) y la localización del TTUS en uréter distal (p = 0,002; HR 4,8) fueron predictores independientes de RV. La mediana de tiempo hasta la RV fue de 8 meses. Quince pacientes presentaron una RV no músculo-invasiva (65,2%) y 8 músculo-invasiva (34,8%). Todas las RV excepto 2, aparecieron durante los primeros 2 años. Cinco casos con RV no músculo-invasiva presentaron nueva RV. Seis pacientes con RV músculo-invasiva murieron sin poderse definir si fue por tumor vesical o de vías. La aparición de RV no mostró repercusión en la supervivencia de los pacientes con TTUS. Conclusiones: El género (mujer) y la localización del TTUS (uréter distal) son factores predictores de RV tras NU. Pacientes con estas características podrían beneficiarse de tratamiento adyuvante intravesical y de un seguimiento más estricto. La aparición de RV no tiene impacto en la supervivencia de los pacientes con TTU

Objectives: To analyze the predictors for bladder recurrence (BR) after nephroureterectomy (NU) for upper urinary tract tumors (UUTT), as well as its pathological characteristics, outcomes and impact on survival. Material and methods: Retrospective study of 117 patients who underwent laparoscopic nephroureterectomy by UUTT between 2007-2012 at our center. The potential predictors for BR were analyzed using Cox regression; Kaplan-Meier curves were employed to study survival. Results: The sample was composed of 85 men (73%) and 32 women (27%), with a mean age of 70 years. After a mean follow-up of 26 months, 23 patients presented BR (19.6%). In the multivariate analysis, sex (p = .003; HR [female], 3.8) and the location of the UUTT in the distal ureter (p = .002; HR, 4.8) were independent predictors for BR. The median time to BR was 8 months. Fifteen patients presented a nonmuscle-invasive BR (65.2%), and 8 presented a muscle-invasive BR (34.8%). All BRs, except for 2, appeared during the first 2 years. Five cases with nonmuscle-invasive BR presented a new BR. Six patients with muscle-invasive BR died before it could be determined whether cause of death was the BR or an UUTT relapse. The onset of BR showed no repercussion on the survival of patients with UUTT. Conclusions: Sex (female) and the location of the UUTT (distal ureter) are predictors for BR after NU. Patients with these characteristics might benefit from adjuvant intravesical treatment and closer monitoring. The onset for RV has no impact on the survival of patients with UUTT

Predictors, pathological characteristics and outcomes of bladder recurrences following nephroureterectomy.

OBJECTIVES: To analyze the predictors for bladder recurrence (BR) after nephroureterectomy (NU) for upper urinary tract tumors (UUTT), as well as its pathological characteristics, outcomes and impact on survival. MATERIAL AND METHODS: Retrospective study of 117 patients who underwent laparoscopic nephroureterectomy by UUTT between 2007-2012 at our center. The potential predictors for BR were analyzed using Cox regression; Kaplan-Meier curves were employed to study survival. RESULTS: The sample was composed of 85 men (73%) and 32 women (27%), with a mean age of 70 years. After a mean follow-up of 26 months, 23 patients presented BR (19.6%). In the multivariate analysis, sex (p=.003; HR [female], 3.8) and the location of the UUTT in the distal ureter (p=.002; HR, 4.8) were independent predictors for BR. The median time to BR was 8 months. Fifteen patients presented a nonmuscle-invasive BR (65.2%), and 8 presented a muscle-invasive BR (34.8%). All BRs, except for 2, appeared during the first 2 years. Five cases with nonmuscle-invasive BR presented a new BR. Six patients with muscle-invasive BR died before it could be determined whether cause of death was the BR or an UUTT relapse. The onset of BR showed no repercussion on the survival of patients with UUTT. CONCLUSIONS: Sex (female) and the location of the UUTT (distal ureter) are predictors for BR after NU. Patients with these characteristics might benefit from adjuvant intravesical treatment and closer monitoring. The onset for RV has no impact on the survival of patients with UUTT.

The HLA-DQ2 genotype selects for early intestinal microbiota composition in infants at high risk of developing coeliac disease.

OBJECTIVE: Intestinal dysbiosis has been associated with coeliac disease (CD), but whether the alterations are cause or consequence of the disease is unknown. This study investigated whether the human leukocyte antigen (HLA)-DQ2 genotype is an independent factor influencing the early gut microbiota composition of healthy infants at family risk of CD. DESIGN: As part of a larger prospective study, a subset (n=22) of exclusively breastfed and vaginally delivered infants with either high genetic risk (HLA-DQ2 carriers) or low genetic risk (non-HLA-DQ2/8 carriers) of developing CD were selected from a cohort of healthy infants with at least one first-degree relative with CD. Infant faecal microbiota was analysed by 16S rRNA gene pyrosequencing and real time quantitative PCR. RESULTS: Infants with a high genetic risk had significantly higher proportions of Firmicutes and Proteobacteria and lower proportions of Actinobacteria compared with low-risk infants. At genus level, high-risk infants had significantly less Bifidobacterium and unclassified Bifidobacteriaceae proportions and more Corynebacterium, Gemella, Clostridium sensu stricto, unclassified Clostridiaceae, unclassified Enterobacteriaceae and Raoultella proportions. Quantitative real time PCR also revealed lower numbers of Bifidobacterium species in infants with high genetic risk than in those with low genetic risk. In high-risk infants negative correlations were identified between Bifidobacterium species and several genera of Proteobacteria (Escherichia/Shigella) and Firmicutes (Clostridium). CONCLUSIONS: The genotype of infants at family risk of developing CD, carrying the HLA-DQ2 haplotypes, influences the early gut microbiota composition. This finding suggests that a specific disease-biased host genotype may also select for the first gut colonisers and could contribute to determining disease risk.

Terapia focal en cáncer de próstata. Racionalidad, indicaciones y selección / Focal Therapy for Prostate Cancer. Rationale, Indications and Selection

Contexto: El tratamiento del cáncer de próstata localizado está sujeto a gran controversia en lo referente a sus posibilidades de tratamiento, radical o seguimiento activo. El objetivo de este trabajo es analizar la racionalidad de la terapia focal, selección de tumores y pacientes en el entorno de las alternativas existentes. Adquisición de evidencia: Revisamos la literatura actual en Medline, relacionada con las ventajas e inconvenientes sobre el tratamiento de cáncer de próstata localizado, así como la información publicada sobre la terapia focal en referencia a la selección de tumores, características e indicaciones para terapia focal. Síntesis de evidencia: Los tumores de bajo riesgo, PSA < 10-15, Gleason ≤ 6, junto con las biopsias guiadas apoyadas con la resonancia magnética nuclear (RMN) y la unilateralidad deben ser el estándar para dicha selección. Existen dudas sobre la conveniencia de la terapia focal en los casos de bilateridad o aquellos de Gleason 3 + 4 o PSA > 15. Conclusiones: La terapia focal puede ser una alternativa para tratar el cáncer de próstata localizado, si bien algunos de sus aspectos diagnósticos y de selección deberán ser definidos por estudios prospectivos, que esperamos nos puedan aportar conocimiento sobre la indicación de la terapia focal

Context: The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. Evidence acquisition: Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumor selection, characteristics and indications cited in MEDLINE search were reviewed. Summary of evidence: Focal therapy standardized criteria must be: low risk tumors, PSA < 10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3 + 4 or PSA > 15. Conclusions: Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy

Perfil de expresión génica en el cáncer de próstata: identificación de marcadores candidatos para el diagnóstico no invasivo / Gene expression profiles in prostate cancer: Identification of candidate non-invasive diagnostic markers

Objetivo: Analizar los perfiles de expresión génica del cáncer de próstata (CaP) e identificar los genes diferencialmente expresados. Determinar si la expresión diferencial en tejido se mantiene en muestras de orina-posmasaje prostático (PMP). Material y métodos: Un total de 46 muestras de tejido prostático (36 de pacientes con CaP y 10 controles) y 158 orinas-PMP (113 de pacientes con CaP y 45 controles) se recogieron entre diciembre de 2003 y mayo de 2007. Se utilizaron microarrays de ADN para identificar los genes diferencialmente expresados entre las muestras de tejido tumorales y las controles. Diez genes fueron seleccionados para la validación técnica de los microarrays en las mismas muestras tisulares mediante PCR cuantitativa (RT-qPCR). Se seleccionaron 42 genes para ser validados en muestras de orina-PMP mediante RT-qPCR. Resultados: El gráfico de escalado multidimensional mostró una clara separación entre las muestras de tejido tumorales y las controles. Se han identificado 1.047 genes diferencialmente expresados (FDR ≤ 0,1) entre los 2 grupos. La correlación entre los datos de microarrays y RT-qPCR fue alta (r = 0,928, p < 0,001). Trece genes mantuvieron el mismo sentido de expresión diferencial al ser analizados en orinas-PMP y 4 de ellos (HOXC6, PCA3, PDK4 y TMPRSS2-ERG) mostraron diferencias de expresión estadísticamente significativas entre orinas-PMP tumorales y controles (p < 0,05). Conclusión: Existe un perfil de expresión génica diferencial en el CaP. Aunque la extrapolación de la expresión génica obtenida en tejido prostático a orina-PMP se debe realizar con precaución, el análisis del tejido prostático permite la identificación de nuevos biomarcadores para diagnóstico no invasivo del CaP

Objective: To analyze gene expression profiles of prostate cancer (PCa) with the aim of determining the relevant differentially expressed genes and subsequently ascertain whether this differential expression is maintained in post-prostatic massage (PPM) urine samples. Material and methods: Forty-six tissue specimens (36 from PCa patients and 10 controls) and158 urine PPM-urines (113 from PCa patients and 45 controls) were collected between December 2003 and May 2007. DNA microarrays were used to identify genes differentially expressed between tumour and control samples. Ten genes were technically validated in the same tissue samples by quantitative RT-PCR (RT-qPCR). Forty two selected differentially expressed genes were validated in an independent set of PPM-urines by qRT-PCR. Results: Multidimensional scaling plot according to the expression of all the microarray genes showed a clear distinction between control and tumour samples. A total of 1047 differentially expressed genes (FDR≤0.1) were indentified between both groups of samples. We found a high correlation in the comparison of microarray and RT-qPCR gene expression levels (r = 0.928,P < 0.001). Thirteen genes maintained the same fold change direction when analyzed in PPM urine samples and in four of them (HOXC6, PCA3, PDK4 and TMPRSS2-ERG), these differences were statistically significant (P < 0.05). Conclusion: The analysis of PCa by DNA microarrays provides new putative mRNA markers for PCa diagnosis that, with caution, can be extrapolated to PPM-urines

Focal therapy for prostate cancer. Rationale, indications and selection.

CONTEXT: The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. EVIDENCE ACQUISITION: Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed. SUMMARY OF EVIDENCE: Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA>15. CONCLUSIONS: Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.

Mujer fértil con rectorragia periódica / Fertile woman with periodic rectal bleeding

No disponible

Gene expression profiles in prostate cancer: identification of candidate non-invasive diagnostic markers.

OBJECTIVE: To analyze gene expression profiles of prostate cancer (PCa) with the aim of determining the relevant differentially expressed genes and subsequently ascertain whether this differential expression is maintained in post-prostatic massage (PPM) urine samples. MATERIAL AND METHODS: Forty-six tissue specimens (36 from PCa patients and 10 controls) and 158 urine PPM-urines (113 from PCa patients and 45 controls) were collected between December 2003 and May 2007. DNA microarrays were used to identify genes differentially expressed between tumour and control samples. Ten genes were technically validated in the same tissue samples by quantitative RT-PCR (RT-qPCR). Forty two selected differentially expressed genes were validated in an independent set of PPM-urines by qRT-PCR. RESULTS: Multidimensional scaling plot according to the expression of all the microarray genes showed a clear distinction between control and tumour samples. A total of 1047 differentially expressed genes (FDR≤.1) were indentified between both groups of samples. We found a high correlation in the comparison of microarray and RT-qPCR gene expression levels (r=.928, P<.001). Thirteen genes maintained the same fold change direction when analyzed in PPM-urine samples and in four of them (HOXC6, PCA3, PDK4 and TMPRSS2-ERG), these differences were statistically significant (P<.05). CONCLUSION: The analysis of PCa by DNA microarrays provides new putative mRNA markers for PCa diagnosis that, with caution, can be extrapolated to PPM-urines.