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International Journal of Surgery Case... Apr 2024Perineal impalements, although rare, exhibit high morbidity and mortality, associated with penetrating traumas by long objects, often resulting from falls or assaults....
INTRODUCTION
Perineal impalements, although rare, exhibit high morbidity and mortality, associated with penetrating traumas by long objects, often resulting from falls or assaults. The risk of pelvic bleeding and the need for immediate intervention to preserve vital organs are characteristics of these injuries, whose severity demands a multidisciplinary approach.
CASE DESCRIPTION
A 57-year-old male patient, a victim of a 5-meter fall, suffered an extensive perineal impalement. With stable vital signs, he underwent the ATLS protocol, followed by whole-body computed tomography (WBCT), revealing a metallic object traversing the perineum, abdomen, and thorax. The surgery involved laparotomy, sternotomy, and removal of the object under direct visualization, with repair of prostatic, vesical, hepatic, and diaphragmatic injuries. The postoperative period included transfusions and urological follow-up.
DISCUSSION
Perineal impalements require immediate attention, and their approach is influenced by clinical factors and the extent of the object. The importance of preoperative evaluation with tomography, removal of the object under direct visualization, and comprehensive surgical management is highlighted. The decision for conservative treatment is reserved for less severe cases. This work has been reported in line with the SCARE criteria.
CONCLUSION
Perineal impalements demand a rapid and integrated approach to optimize survival. Object removal, often performed by exploratory laparotomy, stands out as an essential procedure. Multidisciplinary expertise is crucial for the effective management of these complex injuries.
METHODS
This work has been reported in line with the SCARE criteria.
PubMed: 38815442
DOI: 10.1016/j.ijscr.2024.109652 -
PloS One 2024Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may...
INTRODUCTION
Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening.
METHODS
A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test.
RESULTS
Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001).
CONCLUSIONS
Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.
Topics: Humans; Male; Prostatic Neoplasms; Middle Aged; Health Knowledge, Attitudes, Practice; Early Detection of Cancer; Aged; Cross-Sectional Studies; Spain; Prostate-Specific Antigen; Surveys and Questionnaires; Adult
PubMed: 38814917
DOI: 10.1371/journal.pone.0303203 -
European Urology Open Science Jun 2024Several surgical procedures have been reported for treatment of male patients with lower urinary tract symptoms (LUTS) secondary to large benign outlet obstruction...
BACKGROUND AND OBJECTIVE
Several surgical procedures have been reported for treatment of male patients with lower urinary tract symptoms (LUTS) secondary to large benign outlet obstruction (BOO). The diffusion of robotic surgery offers the possibility to perform open simple prostatectomy (SP) with a minimally-invasive approach. Our aim was to report outcomes of the Retzius-sparing robot-assisted SP (RS-RASP) technique.
METHODS
This was a single centre, prospective study. Patients with LUTS secondary to BOO and a prostate volume of >100 ml underwent RS-RASP performed with a da Vinci surgical system in four-arm configuration for a transperitoneal approach. Data for intraoperative and perioperative complications were collected. Functional outcomes were assessed via validated patient questionnaires. Univariable and multivariable regression analyses were used to identify predictors of complications and achievement of a trifecta composite outcome.
KEY FINDINGS AND LIMITATIONS
The median patient age was 69 yr and the median prostate volume was 150 ml. The median operative time was 175 min, with estimated blood loss of 350 ml. The median in-hospital stay and median catheterisation time were 3 d and 9 d, respectively. Within 90 d, the incidence of complications was 3% for grade 1, 19% for grade 2, and 2% for grade 3 complications. At 7-mo follow-up, statistically significant improvements in International Prostate Symptom Scores (total score and quality of life), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scores, and the maximum flow rate were observed (all < 0.0001). According to ICIQ-UI SF scores, 20%, 6%, and 3% of the patients had slight, moderate, or severe urinary incontinence (UI), respectively. Urgency UI was experienced by 14% of the patients and stress UI by 10%. Most of the patients with UI reported leakage of a small amount of urine and they did not wear pads.
CONCLUSIONS
RS-RASP was associated with good perioperative outcomes and a low prevalence of high-grade complications. Significant LUTS relief was achieved, but some patients experienced slight urgency or stress UI at short-term follow-up.
PATIENT SUMMARY
We explored a surgical technique called Retzius-sparing robot-assisted simple prostatectomy to treat men with bothersome urinary symptoms caused by a large prostate. The technique led to good results, with minimal bleeding and few complications during surgery. This surgery could be a beneficial choice for patients with stubborn urinary symptoms and a large prostate gland.
PubMed: 38812921
DOI: 10.1016/j.euros.2024.05.002 -
European Urology Open Science Jun 2024Radical prostatectomy (RP) is an established treatment for localised prostate cancer that can have a significant impact on urinary and sexual function, with recovery...
Urinary and Sexual Impact of Robotic Radical Prostatectomy: Reporting of Patient-reported Outcome Measures in the First Year after Radical Prostatectomy in a Contemporary Multicentre Cohort in the United Kingdom.
BACKGROUND AND OBJECTIVE
Radical prostatectomy (RP) is an established treatment for localised prostate cancer that can have a significant impact on urinary and sexual function, with recovery over time. Our aim was to describe functional recovery in the first year after RP, reporting descriptive outcomes alongside validated patient-reported outcome measure scores (Expanded Prostate Cancer Index Composite, EPIC-26).
METHODS
Men undergoing RP between September 2015 and November 2019 completed EPIC-26 at baseline and 1, 3, 6, and 12 mo.
KEY FINDINGS AND LIMITATIONS
Overall, 2030 men consented to participation, underwent RP, and completed EPIC-26. At baseline, 97% were pad-free (1928/1996; 95% confidence interval [CI] 96-97%) and 77% were leak-free and pad-free (1529/1996; 95% CI 75-78), with a median EPIC-26 incontinence domain score of 100 (interquartile range [IQR] 86-100). At 12 mo, 65% were pad-free (904/1388; 95% CI 63-68%) and 42% were leak-free and pad-free (583/1388; 95% CI 39-45%), with a median EPIC-26 score of 76 (IQR 61-100). While one in three men reported wearing a pad at 12 mo, fewer than one in ten men needed more than 1 pad/d. At baseline, 1.9% reported a "moderate or big problem" with urine leakage, which increased to 9.7% at 12 mo. At baseline, the median sexual domain score among 1880 men was 74 (IQR 43-92) and 52% had erections sufficient for intercourse without medication (975/1880; 95% CI 50-54%). Among these 975 men, 630 responded at 12 mo, of whom 17% reported sufficient erections for intercourse (105/630; 95% CI 14-20%), without medication in 6% (37/630; 95% CI 4-8%) and needing medication in 11% (68/630; 95% CI 9-13%); the median EPIC-26 domain score was 26 (IQR 13-57).
CONCLUSIONS AND CLINICAL IMPLICATIONS
Reporting of functional outcomes after RP in terms of easily understood concepts such as pad-free and leak-free status, and erections with and with medication, alongside the classical report using EPIC-26 domain scores, increases the understanding of RP recovery patterns over the first year.
PATIENT SUMMARY
At 12 months after surgery for prostate cancer, one in ten men reported a moderate or big problem with urine leakage and one in five men reported sufficient erections.
PubMed: 38812920
DOI: 10.1016/j.euros.2024.05.003 -
Frontiers in Oncology 2024Neuroendocrine prostate neoplasms, encompassing small cell carcinoma, carcinoid, and large cell carcinoma, are infrequently observed in malignant prostate tumors. The...
Neuroendocrine prostate neoplasms, encompassing small cell carcinoma, carcinoid, and large cell carcinoma, are infrequently observed in malignant prostate tumors. The occurrence of large cell neuroendocrine prostate cancer (LCNEPC) is exceedingly rare. In this study, the patient initially presented with a persistent dysuria for a duration of one year, accompanied by a serum prostate-specific antigen (PSA) level of 17.83ng/mL. Prostate magnetic resonance imaging (MRI) and chest computed tomography (CT) scan showed that a neoplastic lesion was considered, and prostate biopsy confirmed prostate adenocarcinoma with a Gleason score of 7 (4 + 3). Then, thoracoscopic lung tumor resection was performed, and the pathological examination revealed the presence of primary moderately differentiated invasive adenocarcinoma of the lung and metastatic prostate adenocarcinoma, the Gleason score was 8 (4 + 4). After 1 year of endocrine therapy with goserelin acetate and bicalutamide, he underwent a laparoscopic radical prostatectomy (LRP), the pathological report indicated the presence of adenocarcinoma mixed with NE carcinoma. Two months after the LRP, the patient experienced gross hematuria and sacral tail pain. Further examination revealed multiple metastatic lesions throughout the body. He also underwent transurethral resection of bladder tumor (TURBT) for bladder tumor and received etoposide+ cisplatin chemotherapy three weeks post-surgery. The patient eventually died of multi-organ failure due to myelosuppression after chemotherapy. This case report presents an uncommon instance of LCNEPC with widespread systemic metastases, while also providing a comprehensive review of existing literature to facilitate improved management and treatment strategies for similar patients in subsequent cases.
PubMed: 38812779
DOI: 10.3389/fonc.2024.1398673 -
Acta Biochimica Polonica 2024To evaluate the clinical efficacy of different androgen deprivation therapies for prostate cancer (PCa) based on dynamic-contrast enhanced magnetic resonance imaging...
OBJECTIVE
To evaluate the clinical efficacy of different androgen deprivation therapies for prostate cancer (PCa) based on dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI).
METHODS
104 patients with PCa were studied, all of whom were treated with androgen deprivation therapy. The patients were divided into a continuous group (continuous androgen deprivation therapy) and an intermittent group (intermittent androgen deprivation therapy) by random number table method, 52 cases/group. The therapeutic effect and DCE-MRI indices were compared and the relationship between DCE-MRI indices and clinical efficacy and the evaluation value of therapeutic efficacy were analyzed.
RESULTS
The objective response rate (ORR) of the intermittent group was higher than that of the continuous group ( < 0.05), and there was no significant difference in disease control rate (DCR) between the two groups ( > 0.05). After treatment, volume transfer coefficient (K), reverse transfer constant (K), volume fraction (Ve), blood volume (BV), and blood flow (BF) in both groups were lowered, and those in the intermittent group were lower than the continuous group ( < 0.05). K, K, Ve, BF, and BV in the ORR group were lower than those in the non-ORR group ( < 0.05). K, K, Ve, BF, and BV were correlated with the therapeutic effect of PCa ( < 0.05). The AUC value of the combined detection of DCE-MRI indices in evaluating the therapeutic effect of PCa was greater than that of each index alone ( < 0.05).
CONCLUSION
Compared with continuous androgen deprivation therapy, intermittent androgen deprivation therapy has better clinical efficacy in the treatment of PCa, and DCE-MRI indices are related to the treatment efficacy of PCa and have an evaluation value.
Topics: Humans; Male; Prostatic Neoplasms; Magnetic Resonance Imaging; Androgen Antagonists; Aged; Middle Aged; Contrast Media; Treatment Outcome
PubMed: 38812492
DOI: 10.3389/abp.2024.12473 -
Frontiers in Bioscience (Landmark... May 2024This review article explores the intricate correlation between growth factors and bone metastases, which play a crucial role in the development of several types of... (Review)
Review
This review article explores the intricate correlation between growth factors and bone metastases, which play a crucial role in the development of several types of malignancies, namely breast, prostate, lung, and renal cancers. The focal point of our discussion is on crucial receptors for growth factors, including Epidermal Growth Factor Receptor (EGFR), Transforming Growth Factor-β (TGFβ), Vascular Endothelial Growth Factor Receptor (VEGFR), and Fibroblast Growth Factor Receptor (FGFR). These receptors, which are essential for cellular activities including growth, differentiation, and survival, have important involvement in the spread of cancer and the interactions between tumors and the bone environment. We discuss the underlying mechanisms of bone metastases, with a specific emphasis on the interaction between growth factor receptors and the bone microenvironment. EGFR signaling specifically enhances the process of osteoclast development and the formation of osteolytic lesions, especially in breast and lung malignancies. TGFβ receptors have a role in both osteolytic and osteoblastic metastases by releasing TGFβ, which attracts cancer cells and promotes bone remodeling. This is a crucial element in the spread of prostate cancer to the bones. The functions of FGFR and VEGFR in the processes of bone formation and tumor angiogenesis, respectively, highlight the complex and diverse nature of these interactions. The review emphasizes the possibility of targeted therapeutics targeting these receptors to interrupt the cycle of tumor development and bone degradation. Therapeutic approaches include focusing on the VEGF/VEGFR, EGF/EGFR, FGF/FGFR, and TGFβ/TGFβR pathways. These include a variety of compounds, such as small molecule inhibitors and monoclonal antibodies, which have shown potential to interfere with tumor-induced alterations in bone. The text discusses clinical trials and preclinical models, offering insights into the effectiveness and constraints of various treatments. Ultimately, this study provides a succinct but thorough summary of the present knowledge and treatment strategies focused on growth factor receptors in bone metastases. This highlights the significance of comprehending the signaling of growth factor receptors in the microenvironment where tumors spread to the bones, as well as the possibility of using targeted therapies to enhance the results for cancer patients with bone metastases. The advancement of treating bone metastases hinges on the development of treatments that specifically target the intricate relationships between malignancies and bone.
Topics: Humans; Bone Neoplasms; Receptors, Growth Factor; Signal Transduction; Transforming Growth Factor beta; ErbB Receptors; Receptors, Fibroblast Growth Factor; Animals; Receptors, Vascular Endothelial Growth Factor
PubMed: 38812320
DOI: 10.31083/j.fbl2905184 -
Molecular Cancer May 2024Prostate cancer develops through malignant transformation of the prostate epithelium in a stepwise, mutation-driven process. Although activator protein-1 transcription...
BACKGROUND
Prostate cancer develops through malignant transformation of the prostate epithelium in a stepwise, mutation-driven process. Although activator protein-1 transcription factors such as JUN have been implicated as potential oncogenic drivers, the molecular programs contributing to prostate cancer progression are not fully understood.
METHODS
We analyzed JUN expression in clinical prostate cancer samples across different stages and investigated its functional role in a Pten-deficient mouse model. We performed histopathological examinations, transcriptomic analyses and explored the senescence-associated secretory phenotype in the tumor microenvironment.
RESULTS
Elevated JUN levels characterized early-stage prostate cancer and predicted improved survival in human and murine samples. Immune-phenotyping of Pten-deficient prostates revealed high accumulation of tumor-infiltrating leukocytes, particularly innate immune cells, neutrophils and macrophages as well as high levels of STAT3 activation and IL-1β production. Jun depletion in a Pten-deficient background prevented immune cell attraction which was accompanied by significant reduction of active STAT3 and IL-1β and accelerated prostate tumor growth. Comparative transcriptome profiling of prostate epithelial cells revealed a senescence-associated gene signature, upregulation of pro-inflammatory processes involved in immune cell attraction and of chemokines such as IL-1β, TNF-α, CCL3 and CCL8 in Pten-deficient prostates. Strikingly, JUN depletion reversed both the senescence-associated secretory phenotype and senescence-associated immune cell infiltration but had no impact on cell cycle arrest. As a result, JUN depletion in Pten-deficient prostates interfered with the senescence-associated immune clearance and accelerated tumor growth.
CONCLUSIONS
Our results suggest that JUN acts as tumor-suppressor and decelerates the progression of prostate cancer by transcriptional regulation of senescence- and inflammation-associated genes. This study opens avenues for novel treatment strategies that could impede disease progression and improve patient outcomes.
Topics: Male; Prostatic Neoplasms; Animals; Mice; Humans; PTEN Phosphohydrolase; Disease Progression; Tumor Microenvironment; Senescence-Associated Secretory Phenotype; Proto-Oncogene Proteins c-jun; Gene Expression Regulation, Neoplastic; Cell Line, Tumor; Gene Expression Profiling; Cellular Senescence; Disease Models, Animal
PubMed: 38811984
DOI: 10.1186/s12943-024-02022-x -
Cancer Cell International May 2024
PubMed: 38811962
DOI: 10.1186/s12935-024-03381-7 -
BMC Cancer May 2024The aim is to establish and verify reference intervals (RIs) for serum tumor markers for an apparently healthy elderly population in Southwestern China using an indirect...
BACKGROUND
The aim is to establish and verify reference intervals (RIs) for serum tumor markers for an apparently healthy elderly population in Southwestern China using an indirect method.
METHODS
Data from 35,635 apparently healthy elderly individuals aged 60 years and above were obtained in West China Hospital from April 2020 to December 2021. We utilized the Box-Cox conversion combined with the Tukey method to normalize the data and eliminate outliers. Subgroups are divided according to gender and age to examine the division of RIs. The Z-test was used to compare differences between groups, and 95% distribution RIs were calculated using a nonparametric method.
RESULTS
In the study, we observed that the RIs for serum ferritin and Des-γ-carboxy prothrombin (DCP) were wider for men, ranging from 64.18 to 865.80 ng/ml and 14.00 to 33.00 mAU/ml, respectively, compared to women, whose ranges were 52.58 to 585.88 ng/ml and 13.00 to 29.00 mAU/ml. For other biomarkers, the overall RIs were established as follows: alpha-fetoprotein (AFP) 0-6.75 ng/ml, carcinoembryonic antigen (CEA) 0-4.85 ng/ml, carbohydrate antigen15-3 (CA15-3) for females 0-22.00 U/ml, carbohydrate antigen19-9 (CA19-9) 0-28.10 U/ml, carbohydrate antigen125 (CA125) 0-20.96 U/ml, cytokeratin 19 fragment (CYFRA21-1) 0-4.66 U/ml, neuron-specific enolase (NSE) 0-19.41 ng/ml, total and free prostate-specific antigens (tPSA and fPSA) for males 0-5.26 ng/ml and 0-1.09 ng/ml. The RIs for all these biomarkers have been validated through our rigorous processes.
CONCLUSION
This study preliminarily established 95% RIs for an apparently healthy elderly population in Southwestern China. Using real-world data and an indirect method, simple and reliable RIs for an elderly population can be both established and verified, which are suitable for application in various clinical laboratories.
Topics: Humans; Male; Female; Aged; Biomarkers, Tumor; China; Reference Values; Middle Aged; Aged, 80 and over; Prothrombin; Neoplasms; alpha-Fetoproteins; Ferritins; CA-19-9 Antigen; Carcinoembryonic Antigen; CA-125 Antigen; Phosphopyruvate Hydratase; Keratin-19; Protein Precursors; Biomarkers
PubMed: 38811867
DOI: 10.1186/s12885-024-12408-1