Guzki tarczycy – przegląd aktualnych zaleceń dotyczących postępowania diagnostyczno-terapeutycznego

 Guzki tarczycy stanowią obecnie bardzo częsty problem kliniczny. Dzięki szerokiej dostępności nieinwazyjnych metod diagnostycznych ich wykrywalność w ostatnich latach diametralnie wzrosła. Rozważny dobór odpowiedniej terapii, w oparciu o właściwą stratyfikację ryzyka złośliwości zmiany, ma podstawowe znaczenie. W celu wykluczenia lub potwierdzenia złośliwości guzka wykorzystuje się różnorodne badania, rozpoczynając zawsze od odpowiednio przeprowadzonego wywiadu i badania fizykalnego. Metodą obrazową o największym znaczeniu jest ultrasonografia, wykorzystywana przy kwalifikacji zmian do biopsji aspiracyjnej cienkoigłowej, stanowiącej podstawę współczesnej diagnostyki.  Klasyfikując obraz cytologiczny według międzynarodowego systemu Bethesda, podejmuje się decyzję dotyczącą postępowania terapeutycznego. Metoda ta ma jednak swoje ograniczenia uniemożliwiające postawienie pewnej diagnozy w niektórych przypadkach. Szczególnie problematyczne są zmiany zaklasyfikowane jako kategoria III lub IV, czyli tak zwane „rozpoznania niepewne”. Niemniej jednak w ich przypadku postępowanie jest także ściśle określone, aczkolwiek konieczna staje się bardzo dokładna analiza wyników badań dodatkowych. Obserwacja zalecana jest w większości przypadków zmian łagodnych (kategoria II wg systemu Bethesda). Zabieg operacyjny jest podstawową metodą leczenia pacjentów z guzkami zakwalifikowanymi do kategorii V i VI, które stanowią niewielki odsetek wszystkich zmian tarczycy. Guzki gruczołu tarczowego w większości przypadków nie powinny stanowić powodu do obaw i być utożsamiane ze złośliwym procesem nowotworowym. Obecne możliwości diagnostyczne znacznie zwiększają szansę na prawidłowe określenie ryzyka złośliwości zmiany i pozwalają uniknąć niepotrzebnych interwencji chirurgicznych w przypadkach zmian łagodnych

Health-promoting properties of pineapple

Pineapple is one of the most popular tropical fruit and an indispensable part of many people’s diet. It was brought to Europe in 1493 by Christopher Columbus. The fruit has been valued for years for its unique taste and richness in nutrients, such as micro- and macronutrients, dietary fibre and a variety of vitamins. Pineapple is low in calories, but rich in nutrients; therefore, it is often included in a weight-watcher menu. Frequent consumption of pineapple almost completely covers the recommended daily intake of vitamin C, manganese and copper. Phytochemical analysis of pineapple leaf extract revealed the presence of alkaloids, flavonoids, saponins and tannins, all of which are said to be hypoglycaemic and analgesic. Studies on bromelain, pineapple’s most complex bioactive compound, demonstrated its antioxidant, anti-inflammatory, digestion-enhancing and cardioprotective effects. The multitude of potential uses of bromelain combined with the effects of many other nutrients found in a pineapple, allow us to appreciate not only its unquestionable taste, but also other benefits of this fruit. Pineapple is no exception and throughout the years many myths about its beneficial and harmful properties have emerged. Fortunately, most of these have never been confirmed scientifically and pineapples have no known negative impact on the human body. The aim of this study was to present the nutritional value of pineapple and its role in medical treatment.Ananas to jeden z najbardziej popularnych owoców tropikalnych i nieodłączny element diety wielu ludzi. Został sprowadzony do Europy przez Krzysztofa Kolumba już w 1493 roku. Od wielu lat jest ceniony ze względu na swój niepowtarzalny smak i bogactwo składników odżywczych, takich jak mikro- i makroelementy, błonnik czy liczna grupa witamin. Ananas jest owocem niskokalorycznym, a zarazem pełnowartościowym, przez co stał się częstym elementem jadłospisu osób dbających o linię. Systematyczne spożywanie ananasów pozwala prawie w całości pokryć dzienne zapotrzebowanie organizmu na witaminę C, mangan czy miedź. Badania fitochemiczne ekstraktu z liści ananasa wykazały obecność alkaloidów, flawonoidów, saponin i garbników, którym przypisuje się właściwości hipoglikemizujące oraz przeciwbólowe. W wyniku badań nad bromeliną – składnikiem ananasa o najbardziej złożonym działaniu biologicznym – odkryto jej efekty antyoksydacyjne, przeciwzapalne, wspomagające trawienie czy kardioprotekcyjne. Mnogość potencjalnych zastosowań bromeliny wspartej działaniem wielu spośród zawartych w ananasie składników pozwala nam docenić oprócz niewątpliwych walorów smakowych również inne atuty tego owocu. Ananasy nie są wyjątkiem i także w odniesieniu do nich z biegiem czasu pojawiło się wiele mitów na temat ich zbawiennego lub szkodliwego działania. Na szczęście większość z nich nigdy nie została potwierdzona w sposób naukowy i ananas nie wykazuje żadnego znanego nam negatywnego wpływu na organizm człowieka. Celem niniejszej pracy jest omówienie wartości żywieniowej ananasa i jego znaczenia w walce z chorobami

Urological Manifestations of the Systemic Vasculitides—A Scoping Review

Background: Vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the human body. They may occur as a primary process (primary systemic vasculitides, PSV) or may be secondary to another underlying disease. In general, in association with the specific type of vasculitis, affected vessels vary in size, type, and location. In the following scoping review, we present clinical characteristics and manifestations of PSV with reference to the genitourinary system. Materials and methods: A non-systematic search of the relevant literature was conducted using three electronic databases (PubMed, Embase, and Web of Science) up to 29 October 2021. Results: Urogenital manifestations of PSV are infrequent, with the most commonly reported findings as prostatic or testicular involvements. However, almost all other organs of the genitourinary system can be affected. Conclusions: Because of the clinical heterogeneity and non-specific symptoms, the proper diagnosis of PSV is often delayed and constricted. Fast identification of urological manifestations of vasculitides is essential in implementing appropriate therapy and avoiding unnecessary, harmful, and invasive surgery

Urological Manifestations of the Systemic Vasculitides—A Scoping Review

Background: Vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the human body. They may occur as a primary process (primary systemic vasculitides, PSV) or may be secondary to another underlying disease. In general, in association with the specific type of vasculitis, affected vessels vary in size, type, and location. In the following scoping review, we present clinical characteristics and manifestations of PSV with reference to the genitourinary system. Materials and methods: A non-systematic search of the relevant literature was conducted using three electronic databases (PubMed, Embase, and Web of Science) up to 29 October 2021. Results: Urogenital manifestations of PSV are infrequent, with the most commonly reported findings as prostatic or testicular involvements. However, almost all other organs of the genitourinary system can be affected. Conclusions: Because of the clinical heterogeneity and non-specific symptoms, the proper diagnosis of PSV is often delayed and constricted. Fast identification of urological manifestations of vasculitides is essential in implementing appropriate therapy and avoiding unnecessary, harmful, and invasive surgery

STAT3 and Its Pathways’ Dysregulation—Underestimated Role in Urological Tumors

Nowadays, molecular research is essential for the better understanding of tumor cells’ pathophysiology. The increasing number of neoplasms is taken under ‘the molecular magnifying glass’; therefore, it is possible to discover the complex relationships between cytophysiology and tumor cells. Signal transducer and activator of transcription 3 (STAT3) belongs to the family of latent cytoplasmic transcription factors called STATs, which comprises seven members: STAT1, STAT2, STAT3, STAT4, STAT5A, STAT5B, and STAT6. Those proteins play important role in cytokine-activated gene expression by transducing signals from the cell membrane to the nucleus. Abnormal prolonged activation results in tumorigenesis, metastasis, cell proliferation, invasion, migration, and angiogenesis. Inhibition of this transcription factor inhibits the previously mentioned effects in cancer cells, whereas normal cells are not affected. Hence, STAT3 might be a viable target for cancer therapy

Patients with Positive Lymph Nodes after Radical Prostatectomy and Pelvic Lymphadenectomy—Do We Know the Proper Way of Management?

Lymph node invasion in prostate cancer is a significant prognostic factor indicating worse prognosis. While it significantly affects both survival rates and recurrence, proper management remains a controversial and unsolved issue. The thorough evaluation of risk factors associated with nodal involvement, such as lymph node density or extracapsular extension, is crucial to establish the potential expansion of the disease and to substratify patients clinically. There are multiple strategies that may be employed for patients with positive lymph nodes. Nowadays, therapeutic methods are generally based on observation, radiotherapy, and androgen deprivation therapy. However, the current guidelines are incoherent in terms of the most effective management approach. Future management strategies are expected to make use of novel diagnostic tools and therapies, such as photodynamic therapy or diagnostic imaging with prostate-specific membrane antigen. Nevertheless, this heterogeneous group of men remains a great therapeutic concern, and both the clarification of the guidelines and the optimal substratification of patients are required

Role of IL-17A and IL-17RA in Prostate Cancer with Lymph Nodes Metastasis: Expression Patterns and Clinical Significance

Prostate cancer (PCa) is the second most frequently diagnosed cancer among men. The use of IL-17A and its receptor IL-17RA as prognostic markers for PCa has shown promising results. We analyzed the clinical data of 77 patients with PCa after radical prostatectomy with lymphadenectomy and lymph node metastasis (LN+). We assessed the expression levels of IL-17A and IL-17RA in cancer cells in prostate and, for the first time, also in LN+. Prostate IL-17A expression positively correlated with BMI (p = 0.028). In LN+, the expression of IL-17A was positively correlated with the percentage of affected lymph nodes (p = 0.006) and EAU risk groups (p = 0.001). Additionally, in the group with high IL-17A expression in LN+, the extracapsular extension (ECE) of the prostate was significantly more frequent (p = 0.033). Also, significant correlations with the level of IL-17RA expression was found—expression was higher in prostate than in LN+ (p = 0.009); in LN+, expression positively correlated with the EAU risk group (p = 0.045), and in the group of high expression in LN+ ECE of lymph nodes was detected significantly more often (p = 0.009). Our findings support the potential role of IL-17A and IL-17RA as PCa markers; however, further studies are needed to determine their roles and potential clinical applications

Influence of Virtual Reality Devices on Pain and Anxiety in Patients Undergoing Cystoscopy Performed under Local Anaesthesia

Background: Bladder cancer is one of the most common malignancies. Its diagnosis is based on transurethral cystoscopy. Virtual reality (VR) is a three-dimensional world generated through the projection of images, the emission of sounds and other stimuli. VR has been proven to be a very effective “distractor” and, thus, a useful tool in managing pain. The aim of this study was to determine whether the use of VR sets is technically feasible during the cystoscopy and whether the use of VR devices would reduce the degree of ailments associated with the procedure; Methods: The study prospectively included both men and women who qualified for rigid cystoscopy due to both primary and follow-up diagnostics. The study group underwent rigid cystoscopy with the VR set and the control group underwent the procedure without the VR set. Patients enrolled in both groups were subjected to blood pressure, heart rate and saturation measurements before, during and after the procedure. Additionally, the patients were asked to describe the severity of fear, pain sensations and nausea associated with the procedure. Non-verbal pain manifestations were assessed using the adult adjusted Faces, Legs, Activity, Cry and Consolability (FLACC) scale; Results: The study population included 103 patients (74M/29F; mean age 64.4 years). Pain intensity differed significantly between the groups, reaching lower values in the VR group. In all analyzed subgroups the use of the VR set was associated with higher levels of nausea. The mean FLACC score reached higher values for patients without the VR set. Blood pressure as well as heart rate increased during the procedure and decreased afterwards. The increase in systolic blood pressure and pulse rate was statistically higher in the control group; Conclusions: This study confirmed that cystoscopy is associated with considerable preprocedural fear and severe pain. Blood pressure and heart rate rise significantly during the cystoscopy. VR sets can lower pain perception during cystoscopy, but they may cause moderate nausea

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU. However, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes. Materials and methods: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed in June 2021. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS). Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR = 1.44, 95% CI: 1.29–1.61, p < 0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR = 1.28, 95% CI: 0.90–1.80, p = 0.16). The results of other analyses showed no significant differences in CSS (HR = 0.94, p = 0.63), OS (HR: 0.94, p = 0.56), and MFS (HR: 0.91, p = 0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC

Assessment of the oncological outcomes of three different bacillus Calmette-Guérin strains in patients with high-grade T1 non-muscle-invasive bladder cancer

Objective: : To determine whether there are significant differences in oncological outcomes between three different bacillus Calmette-Guérin (BCG) strains used for adjuvant intravesical immunotherapy in patients with high-grade T1 (T1HG) non-muscle-invasive bladder cancer (NMIBC). Patients and methods: : Data of 590 patients with a diagnosis of primary T1HG NMIBC were retrospectively reviewed. The study included 138 (23.4%) patients who were treated with the Moreau, 272 (46.1%) with the TICE, and 180 (30.5%) with the RIVM strains. All patients included in the analysis received at least five instillations of an induction course and at least two installations of a maintenance course. Due to existing differences in baseline patient characteristics, the association between oncological outcomes and strain groups was investigated by complementary analysis with the implementation of inverse probability weighting (IPW). Results: : The 5-year recurrence-free survival (RFS) rate was 70.5%, 66.7% and 55.2% for the Moreau, TICE and RIVM groups, respectively (P = 0.016). The 5-year progression-free survival (PFS) rates were 84.4%, 85% and 77.8% in the Moreau, TICE and RIVM groups, respectively (P = 0.215). The IPW-adjusted Cox proportional hazard regression analysis did not show any differences in RFS between the Moreau and TICE groups (P = 0.69), whereas the RIVM strain was significantly associated with worse RFS compared to the Moreau (hazard ratio [HR] 1.69 for RIVM; P = 0.034) and TICE (HR 1.87 for RIVM; P = 0.002) strains. The IPW-adjusted analysis did not show any significant differences between study groups in terms of PFS. Conclusions: : The results of the present study suggest that the Moreau and TICE strains might be superior to the RIVM strain in terms of RFS in patients with T1HG NMIBC.Abbreviations: CIS: carcinoma in situ; IPW: inverse probability weighting; IQR: interquartile range; HR: hazard ratio; HG: high grade; LVI: lymphovascular invasion; MP: muscularis priopria; NMIBC: non-muscle-invasive bladder cancer; PFS: progression-free survival; RCT: randomised controlled trial; RFS: recurrence-free survival; T1HG, high-grade T1; (re-)TURB: (re-staging) transurethral resection of bladder; VH: variant histology