Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder

Study design: Case series. Objectives: The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB). Setting: An Italian tertiary referral center for NB. Methods: We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019. Results: We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months. Conclusions: BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage

Prognostic role of chromosome 9P deletion in patients with clear cell renal cell carcinoma

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Case report of life-threatening complications following cystectomy in a woman with neurogenic lower urinary tract dysfunction treated with indwelling bladder catheter for about 30 years

Patients with neurogenic lower urinary tract dysfunction (NLUTD), specially with indwelling bladder catheter (iBC), have an increased risk of developing bladder stones, incomplete bladder emptying, recurrent urinary tract infections, sepsis, urethral trauma and bladder cancer. We present the case of a patient with a large bladder stone in iatrogenic NLUTD treated with iBC for about 30 years, who underwent a cystectomy followed by several life-threatening complications, like septic episodes and multiple surgeries. Our case outlines the importance of limiting the time of iBC in favor of CIC to avoid severe complications. Clinicians should instruct on the correct CIC technique and hygiene practices, and monitor patients with periodic abdominal US in order to diagnose and treat precociously any disease, like bladder stones. (www.actabiomedica.it)

Bladder cancer risk in users of selected drugs for cardiovascular disease prevention

The aim of this study was to investigate the relation between bladder cancer risk and the use of selected drugs for cardiovascular disease (CVD) prevention, such as aspirin, statins, and calcium channel blockers (CCBs). We analyzed data from a multicentric case-control study carried out in Italy between 2003 and 2014, including 690 bladder cancer cases and 665 hospital controls. Odds ratios (ORs) of bladder cancer and corresponding 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models. The ORs for bladder cancer were 1.21 (95% CI: 0.87-1.68) for regular use of aspirin, 0.72 (95% CI: 0.54-0.97) for use of any CCBs, and 1.32 (95% CI: 0.87-1.99) for use of any statins. A slight inverse association was found with duration of use of CCBs, whereas no consistent association was found with duration of use, age at first use, and frequency for aspirin and statin use, or with indication of use for aspirin (as an analgesic or, for CVD prevention). No significant association was found for various combinations of drugs or for all drugs combined (OR=1.23, 95% CI: 0.31-4.85). Our data indicate the lack of a relevant association between the use of selected drugs for CVD prevention and bladder cancer risk, although suggest a potential favorable role for CCBs

HOW MUCH DANGEROUS IS CT ACCORDING TO PATIENTS AND HOW DOES DOSE BILL AFFECT THEIR PERCEPTION OF IONIZING RADIATION?

In our work, we attempted to assess patients' understanding of relative radiation exposure by asking them to compare the amount of radiation exposure from CT compared to other carcinogenic factors before and after knowing their dose bill

Performance and Reliability Analysis of Cross-Layer Optimizations of NAND Flash Controllers

NAND flash memories are becoming the predominant technology in the implementation of mass storage systems for both embedded and high-performance applications. However, when considering data and code storage in non-volatile memories (NVMs), such as NAND flash memories, reliability and performance be- come a serious concern for systems' designer. Designing NAND flash based systems based on worst-case scenarios leads to waste of resources in terms of performance, power consumption, and storage capacity. This is clearly in contrast with the request for run-time reconfigurability, adaptivity, and resource optimiza- tion in nowadays computing systems. There is a clear trend toward supporting differentiated access modes in flash memory controllers, each one setting a differentiated trade-off point in the performance-reliability optimization space. This is supported by the possibility of tuning the NAND flash memory performance, reli- ability and power consumption acting on several tuning knobs such as the flash programming algorithm and the flash error correcting code. However, to successfully exploit these degrees of freedom, it is mandatory to clearly understand the effect the combined tuning of these parameters have on the full NVM sub-system. This paper performs a comprehensive quantitative analysis of the benefits provided by the run-time reconfigurability of an MLC NAND flash controller through the combined effect of an adaptable memory programming circuitry coupled with run-time adaptation of the ECC correction capability. The full non- volatile memory (NVM) sub-system is taken into account, starting from the characterization of the low level circuitry to the effect of the adaptation on a wide set of realistic benchmarks in order to provide the readers a clear figure of the benefit this combined adaptation would provide at the system leve

Racial Group Membership Is Associated to Gaze-Mediated Orienting in Italy

Viewing a face with averted gaze results in a spatial shift of attention in the corresponding direction, a phenomenon defined as gaze-mediated orienting. In the present paper, we investigated whether this effect is influenced by social factors. Across three experiments, White and Black participants were presented with faces of White and Black individuals. A modified spatial cueing paradigm was used in which a peripheral target stimulus requiring a discrimination response was preceded by a noninformative gaze cue. Results showed that Black participants shifted attention to the averted gaze of both ingroup and outgroup faces, whereas White participants selectively shifted attention only in response to individuals of their same group. Interestingly, the modulatory effect of social factors was context-dependent and emerged only when group membership was situationally salient to participants. It was hypothesized that differences in the relative social status of the two groups might account for the observed asymmetry between White and Black participants. A final experiment ruled out an alternative explanation based on differences in perceptual familiarity with the face stimuli. Overall, these findings strengthen the idea that gaze-mediated orienting is a socially-connoted phenomenon

Surgical activity in the COVID-19 era. Trend of slowdown from a multicentre observational study

COVID-19 outbreak represented an unprecedented event that led to a redefinition of health care systems worldwide. The impact of the emergency required a deviation of the care toward the assistance to COVID-19 patients, with reduction of resources for elective activities, including surgery. We aim to report the decrease of urological surgical activity during the first weeks from the beginning of the pandemic, aiming to highlight the prioritization we applied to select patients for surgery

The dramatic COVID-19 outbreak in italy is responsible of a huge drop in urological surgical activity: A multicenter observational study

OBJECTIVE: Italy is facing the COVID-19 outbreak with an abrupt reorganization of its national health-system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID-19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. MATERIALS AND METHODS: Thirty-three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive-cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, the country with the highest fatality rate from COVID-19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre-planning in other countries not so hardly hit by the disease yet