Endourological management of uretero-ileal anastomosis stricture after cystectomy and Vescica Ileale Padovana (V.I.P.) orthotopic neobladder reconstruction

ABSTRACT Aim To report an endourology management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder reconstruction (Vescica Ileale Padovana, VIP). Materials and methods A nephrostomy was placed to provide a route of access for an anterograde canalization and a secure and working guide placement. These were than taken with a cystoscopy grasp and pulled out trough the neobladder. Laser endoureterotomy of the stricture over a stiff working guide wire was than performed. A DJ stent was than placed in order to protect the urinary flow for the first month after surgery. Results No immediate and late complications occurred during a follow up of 1 year according to the Clavien Dindo classification. The patient continued to be asymptomatic with a renal function stable over the years. Discussion Endourological management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder (VIP) is safe and reproducible. It may avoid the difficulties and complications of invasive surgery and has durable results

Stereotactic Radiotherapy and Androgen Deprivation Therapy for Localized Prostate Cancer: A Retrospective Mono-institutional Experience

Background/Aim: Stereotactic radiotherapy (SRT) is an effective treatment for localized prostate cancer. However, is it not clear whether the addition of androgen deprivation therapy (ADT) to SRT is beneficial. The aim of this study was to analyze the outcomes of a series of patients treated with SRT plus ADT for localized prostate cancer. Patients and Methods: Patients were treated with SRT with 42 Gy in 7 fractions with volumetric-modulated arc therapy plus Image Guided Radiotherapy (V-MAT IGRT) technique. ADT was administered to patients with intermediate unfavorable-and high-risk disease. Study endpoints were biochemical disease-free survival (bDFS), overall survival (OS), acute and late toxicity and patient-reported outcomes (PROs) using international prostate cancer symptoms scale (IPSS) and international index of erectile function (IIEF). Results: A total of 170 consecutive patients were identified, of which 49 (28.8%) with low-risk, 15 (8.8%) with favorable intermediate-risk 76 (44.7%) with unfavorable intermediate risk and 30 (17.6%) with high-risk class. All patients of unfavorable intermediate-and high-risk groups were for administered LHRH analogue concurrently to SRT and for at least 6 months. Patients with unfavorable intermediate and high-risk presented a 5-year bDFS of 81.7% and 76.9%, respectively. Conclusion: SRT consisting of 42 Gy in seven fractions with short-term ADT represents a safe and effective treatment for unfavorable intermediate and high risk prostate cancer. Our results support the need of high quality studies to test the efficacy of ADT combined with SRT for unfavorable intermediate-and high-risk localized prostate cancer

Hypofractionated simultaneous integrated boost (IMRT-SIB) with pelvic nodal irradiation and concurrent androgen deprivation therapy for high-risk prostate cancer: results of a prospective phase II trial

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A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

A lesson from RττK(∗)R_{\tau\tau}^{K^{(\ast)}} and RννK(∗)R_{\nu\nu}^{K^{(\ast)}} at Belle II

Within the assumption of Left-Handed (LH) New Physics (NP), we review the relations between $\mathcal{B}(B\to K^{(\ast)} \tau^+\tau^-)$ and $\mathcal{B}(B\to K^{(\ast)} \nu\bar \nu)$ for several Beyond the Standard Model (BSM) scenarios, commonly considered to explain the Lepton flavor Universality (LFU) violation observed in charged and neutral-current semileptonic $B$ decays. We employ the latest $R_{D^{(\ast)}}$ world averages that include the recent LHCb measurement and assess the possibility of simultaneously explaining the $B$-anomalies without spoiling current bounds on di-neutrino and di-tau modes. This is particularly relevant in light of the upcoming results by Belle II on neutrinos and the continuing improvement in accuracy and sensitivity achieved in tau modes

Metabolic syndrome and stone disease

: Metabolic syndrome is a clustering of several pathological medical conditions including hypertension, impaired glucose tolerance/diabetes, abdominal obesity and dyslipidemia. In the last two decades, MetS has reached an epidemic stage, with an estimated prevalence in the range of 30% among the American adult population and a constant increase for all age categories. The incidence of nephrolithiasis between different geographical areas, ranging 1% to 13%; however, a worldwide increase has been recently reported. There is consistent evidence in the literature both about the association between metabolic syndrome/metabolic syndrome traits and kidney stones. Conversely, less is known about the underlying mechanisms and the complex interplay between metabolic syndrome traits. In this work, we sought to review the literature and to summarize the available evidence regarding the association between metabolic syndrome and nephrolithiasis, the biological mechanisms linking metabolic syndrome and its trait to stone formation, and stone composition in individuals affected by metabolic syndrome. In conclusion, we would like to stress the concept of "appropriate" dietary habits and lifestyle as a key concept in the prevention of both metabolic syndrome and nephrolithiasis

How accurately do Solsona and European Association of Urology risk groups predict for risk of lymph node metastases in patients with squamous cell carcinoma of the penis?

OBJECTIVES: To compare the prognostic accuracy of the Solsona and European Association of Urology (EAU) risk groups in the identification of lymph node involvement in a cohort of patients with squamous cell carcinoma of the penis. METHODS: The clinical and pathologic data of 175 patients who had undergone surgery for squamous cell carcinoma of the penis from 1980 to 2002 at 11 urologic centers of northeastern Italy were retrospectively collected. RESULTS: According to the EAU risk group, 25 patients were categorized as at low (15.1\%), 23 (13.9\%) as intermediate, and 118 (71.1\%) as high risk of lymph node metastasis. Similarly, using the criteria of the Solsona risk group stratification, 25 (15.1\%), 55 (33.1\%), and 86 patients (51.8\%) were categorized as at low, intermediate, and high risk. At the median follow-up of 26 months, lymph node involvement was observed in 71 (40.6\%) of 175 patients. Receiver operating characteristic curve analysis showed that both the EAU risk group (area under the curve = 0.632) and Solsona risk group (area under the curve = 0.697) had a low accuracy for predicting lymph node involvement. Both risk groups were independent predictors of lymph node involvement, as well as the clinical stage of lymph node involvement and the presence of vascular and/or lymphatic embolization. CONCLUSIONS: The Solsona and EAU risk groups were both independent predictors of lymph node involvement, although the receiver operating characteristic curve analysis showed that both risk groups had low predictive accuracy

Prostate Cancer Treatment-Related Toxicity: Comparison between 3D-Conformal Radiation Therapy (3D-CRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques

Objective: This paper illustrates the results of a mono-institutional registry trial, aimed to test whether gastrointestinal (GI) and genitourinary (GU) toxicity rates were lower in localized prostate cancer patients treated with image-guided volumetric modulated arc therapy (IG-VMAT) compared to those treated with IG-3D conformal radiation therapy (IG-3DCRT). Materials and Methods: Histologically proven prostate cancer patients with organ-confined disease, treated between October 2008 and September 2014 with moderately hypofractionated radiotherapy, were reviewed. Fiducial markers were placed in the prostate gland by transrectal ultrasound guide. The prescribed total dose was 70 Gy in 28 fractions. The mean and median dose volume constraints for bladder and rectum as well as total volume of treatment were analyzed as potentially prognostic factors influencing toxicity. The Kaplan–Meier method was applied to calculate survival. Results: Overall, 83 consecutive patients were included. Forty-two (50.6%) patients were treated with 3D-CRT and 41 (49.4%) with the VMAT technique. The median follow-up for toxicity was 77.26 months for the whole cohort. The VMAT allowed for a dose reduction to the rectum and bladder for the large majority of the considered parameters; nonetheless, the only parameter correlated with a clinical outcome was a rectal dose limit V66 > 8.5% for late GI toxicity G ≥ 2 (p = 0.045). Rates of G ≥ 2 toxicities were low among the whole cohort of these patients treated with IGRT. The analysis for rectum dose volume histograms (DVHs) showed that a severe (grade ≥ 2) late GI toxicity was related with the rectal dose limit V66 > 8.5% (p = 0.045). Conclusions: This study shows that moderate hypofractionation is feasible and safe in patients with intermediate and high-risk prostate cancer. Daily IGRT may decrease acute and late toxicity to organs at risk and improve clinical benefit and disease control rate, cutting down the risk of PTV geographical missing. The adoption of VMAT allows for promising results in terms of OAR sparing and a reduction in toxicity that, also given the small sample, did not reach statistical significance