Tehnologii medicale avansate – HIFU – tratamentul cancerului prostatic prin ablaţie termică

HIFU Center, Clinica Endoplus, Cluj Napoca, Romania, Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu” Cluj Napoca, Romania, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Cancerul de prostată reprezintă una din cauzele majore de morbiditate şi mortalitate la bărbaţi. Alternativele terapeutice ale acestei patologii variază de la supraveghere activă, chirurgie clasică, radioterapie, la modalităţi inovatoare, miniminvazive, cum este cazul terapiei focale cu ultrasunete (HIFU, High-intensity focused ultrasound) sau chirurgia robotică. HIFU este o procedură medicală de înaltă precizie care utilizează ultrasunetele [1]. Prin focusarea ultrasunetelor şi concentrarea lor într-un punct prestabilit se obţine o temperatură de 65–100°C. Valurile acustice sunt propagate spre ţesutul ţintă, iar undele sunt absorbite cu derularea conversiei termice. Rezultatul este ablaţia ţesutului vizat prin necroză de coagulare, fără efect cumulativ în organul ţintă [2]. Terapia unei anumite zone se efectuează prin mobilizarea sondei sau a braţului robotic de susţinere, cu respectarea unui protocol specific fiecărui organ sau patologie prestabilite de către echipa operatorie. În prezent, singura metodă de cuantificare a distrugerilor tisulare postterapie HIFU este rezonanţa magnetică, cu rezerva dezavantajului că nu se poate aplica (momentan) în timp real [3]

Clinical cases Zinner syndrome: a case report and literature review

Abstract Introduction and objective: Zinner syndrome is a rare congenital abnormality of the mesonephric duct (Wolffian) consisting of unilateral renal agenesis, seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Abnormalities involving the contralateral seminal vesicle or ejaculatory duct are extremely rare. We present the therapeutic approach in a patient with renal agensesis and large contralateral seminal vesicle cyst. Patient, Method and Results: A 24 years old patient known with right congenital solitary kidney presents with dysuria, pollakiuria, nocturia, hypospermia, ejaculatory pain and diffuse hypogastric and perineal pain. The imaging exams (abdominal ultrasound, contrast-enhanced computed tomography) reveal a cystic mass of the lower mid-abdomen of 14/11 cm with mass-effect, the absence of the left kidney, grade II right hydronephrosis and right megaureter. Preoperatively, the transonic mass has been interpreted as a seminal vesicle cyst. We performed the robotic-assisted laparoscopic cyst resection by using an approach similar as for radical prostatectomy. The intraoperative assessment revealed a cystic mass with a point of origin in the right seminal vesicle, contralateral to the renal agenesis, with an aspect suggestive for Zinner syndrome. Conclusions: Zinner syndrome is a rare urological condition that must be suspected in the young adult with recurrent irritative-obstructive lower urinary tract symptoms associated with pelvic pain syndrome, pelvic cystic mass, unilateral renal agenesis and significant alteration in sperm parameters. The conservative approach is limited to asymptomatic cases. The robotic-assisted minimally invasive approach facilitates the accurate delineation and isolation of anatomical structures, in a territory where subsequent to pericystic inflammation and changes in surgical plans, the classic surgical approach to adjacent structures proves difficult

Management of the Two-Week Wait Pathway for Skin Cancer Patients, before and during the Pandemic: Is Virtual Consultation an Option?

Background: Although telemedicine emerged more than 100 years ago, the recent pandemic underlined the role of remote assessment of different diseases. The diagnoses of cutaneous conditions, especially malignant lesions, have placed significant stress on the fast-track pathway for general practitioners (GPs), dermatologists, and plastic surgeons. The aim of the study was to compare (pre- and during the pandemic) the ability of professionals to face the challenge. Methods: The study was composed of 1943 consecutive patients (mean age 61.9 ± 18.3, 53.8% female) assessed by GPs, face-to-face (988 patients, 50.8%, between October 2019 and March 2020) and by virtual (video/photo) visits (955 patients, 49.2%, between March 2020 and October 2020) for skin lesions, and referred to secondary care via the two-week wait pathway for suspected skin malignancy. Results: The two groups had similar primary skin malignancies identification rates (24.3% vs. 22.1%, p = 0.25). The virtual visits identified squamous cell carcinoma (SCC) better than face-to-face consultations (p = 0.04), but identified basal cell carcinoma less-well (BCC, p = 0.02), whereas malignant melanoma (MM) was equally identified in the two groups (p = 0.13). There was no difference in the median breach time (days) of the two-week wait pathway (12, IQR = 6 vs. 12, IQR = 5, p = 0.16) in the two groups. Virtual assessments (by GPs) of skin lesions suspected of malignancy, and referred via the two-week wait pathway, increased the probability of diagnosing SCC by 42.9% (p = 0.03), while for malignant melanomas, face-to-face and virtual consultations were alike (p = 0.12). Conclusions: The equivalent outcomes in the management of skin cancers (SCC, MM) via the two-week pathway through virtual consultations and face-to-face appointments underline the role of telemedicine as a reliable alternative to face-to-face assessments

Preparation and Characterization of Silica Nanoparticles and of Silica-Gentamicin Nanostructured Solution Obtained by Microwave-Assisted Synthesis

In this research work, silica nanoparticles and silica-gentamicin nanostructured solution were synthesized by using the microwave-assisted synthesis, in basic medium, using two silane precursors (tetraethylorthosilicate and octyltriethoxysilane) and the antibiotic (gentamicin sulfate). The prepared materials were characterized through Fourier transform infrared (FTIR) spectroscopy, TGA analysis, transmission electron microscopy (TEM), and atomic force microscopy (AFM) to investigate the morphology and structure. Antimicrobial studies of the silica-gentamicin nanostructured solution versus silica nanoparticles were performed against Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. FTIR spectra showed that the gentamicin has been loaded to the silica nanoparticles. AFM analysis showed that the morphology of the silica-gentamicin nanostructured solution has changed, and agglomerations of particles are present at the surface. Antimicrobial testing, performed using the diffusion method through spot inoculation, indicates that the silica-gentamicin nanostructured solution exhibited activity against the resistant strain. The obtained silica-gentamicin solution can be used as biochemical agent for the prevention and treatment of microorganisms which are deposited on different surfaces (e.g., glass, plastic, ceramic)

B-Type Natriuretic Peptide at Admission Is a Predictor of All-Cause Mortality at One Year after the First Acute Episode of New-Onset Heart Failure with Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) has been assessed extensively, but few studies analysed the predictive value of the NT-proBNP in patients with de novo and acute HFpEF. We sought to identify NT-proBNP at admission as a predictor for all-cause mortality and rehospitalisation at 12 months in patients with new-onset HFpEF. Methods: We analysed 91 patients (73 ± 11 years, 68% females) admitted for de novo and acute HFpEF, using the Cox proportional hazard risk model. Results: An admission NT-proBNP level above the threshold of 2910 pg/mL identified increased all-cause mortality at 12 months (AUC = 0.72, sensitivity = 92%, specificity = 53%, p < 0.001). All-cause mortality adjusted for age, gender, medical history, and medication in the augmented NT-proBNP group was 16-fold higher (p = 0.018), but with no difference in rehospitalisation rates (p = 0.391). The predictors of increased NT-proBNP ≥ 2910 pg/mL were: age (p = 0.016), estimated glomerular filtration rate (p = 0.006), left atrial volume index (p = 0.001), history of atrial fibrillation (p = 0.006), and TAPSE (p = 0.009). Conclusions: NT-proBNP above 2910 pg/mL at admission for de novo and acute HFpEF predicted a 16-fold increased mortality at 12 months, whereas values less than 2910 pg/mL forecast a high likelihood of survival (99.3%) in the next 12 months, and should be considered as a useful prognostic tool, in addition to its utility in diagnosing heart failure

Studying the interaction between charm and light-flavor mesons

International audienceThe two-particle momentum correlation functions between charm mesons ($\mathrm{D^{*\pm}}$ and $\mathrm{D}^\pm$) and charged light-flavor mesons ($\pi^{\pm}$ and K$^{\pm}$) in all charge-combinations are measured for the first time by the ALICE Collaboration in high-multiplicity proton-proton collisions at a center-of-mass energy of $\sqrt{s} =13$ TeV. For $\mathrm{DK}$ and $\mathrm{D^*K}$ pairs, the experimental results are in agreement with theoretical predictions of the residual strong interaction based on quantum chromodynamics calculations on the lattice and chiral effective field theory. In the case of $\mathrm{D}\pi$ and $\mathrm{D^*}\pi$ pairs, tension between the calculations including strong interactions and the measurement is observed. For all particle pairs, the data can be adequately described by Coulomb interaction only, indicating a shallow interaction between charm and light-flavor mesons. Finally, the scattering lengths governing the residual strong interaction of the $\mathrm{D}\pi$ and $\mathrm{D^*}\pi$ systems are determined by fitting the experimental correlation functions with a model that employs a Gaussian potential. The extracted values are small and compatible with zero

Measurement of beauty-quark production in pp collisions at s=13\sqrt{s}=13 TeV via non-prompt D mesons

International audienceThe $p_{\rm T}$-differential production cross sections of non-prompt ${\rm D^0}$, ${\rm D^+}$, and ${\rm D_s^+}$ mesons originating from beauty-hadron decays are measured in proton$-$proton collisions at a centre-of-mass energy $\sqrt{s}$ of 13 TeV. The measurements are performed at midrapidity, $|y| < 0.5$, with the data sample collected by ALICE from 2016 to 2018. The results are in agreement with predictions from several perturbative QCD calculations. The fragmentation fraction of beauty quarks to strange mesons divided by the one to non-strange mesons, $f_{\rm{s}}/(f_{\rm{u}} + f_{\rm{d}})$, is found to be $0.114 \pm 0.016~{\rm (stat.)} \pm 0.006~{\rm (syst.)} \pm 0.003~{\rm (BR)} \pm 0.003~{\rm (extrap.)}$. This value is compatible with previous measurements at lower centre-of-mass energies and in different collision systems in agreement with the assumption of universality of fragmentation functions. In addition, the dependence of the non-prompt D meson production on the centre-of-mass energy is investigated by comparing the results obtained at $\sqrt{s} = 5.02$ and 13 TeV, showing a hardening of the non-prompt D-meson $p_{\rm T}$-differential production cross section at higher $\sqrt{s}$. Finally, the ${\rm b\overline{b}}$ production cross section per unit of rapidity at midrapidity is calculated from the non-prompt ${\rm D^0}$, ${\rm D^+}$, ${\rm D_s^+}$, and $\Lambda_{\rm c}^+$ hadron measurements, obtaining ${\rm d}\sigma/{\rm d}y = 75.2\pm 3.2~(\mathrm{stat.}) \pm 5.2~(\mathrm{syst.})^{+12.3}_{-3.2} ~(\mathrm{extrap.})\text{ } \rm \mu b \;.

Systematic study of flow vector decorrelation in sNN=5.02\mathbf{\sqrt{\textit{s}_{_{\bf NN}}}=5.02} TeV Pb-Pb collisions

International audienceMeasurements of the $p_{\rm T}$-dependent flow vector fluctuations in Pb-Pb collisions at $\sqrt{s_{_{\rm NN}}} = 5.02~\mathrm{TeV}$ using azimuthal correlations with the ALICE experiment at the LHC are presented. A four-particle correlation approach [1] is used to quantify the effects of flow angle and magnitude fluctuations separately. This paper extends previous studies to additional centrality intervals and provides measurements of the $p_{\rm T}$-dependent flow vector fluctuations at $\sqrt{s_{_{\rm NN}}} = 5.02~\mathrm{TeV}$ with two-particle correlations. Significant $p_{\rm T}$-dependent fluctuations of the $\vec{V}_{2}$ flow vector in Pb-Pb collisions are found across different centrality ranges, with the largest fluctuations of up to $\sim$15% being present in the 5% most central collisions. In parallel, no evidence of significant $p_{\rm T}$-dependent fluctuations of $\vec{V}_{3}$ or $\vec{V}_{4}$ is found. Additionally, evidence of flow angle and magnitude fluctuations is observed with more than $5\sigma$ significance in central collisions. These observations in Pb-Pb collisions indicate where the classical picture of hydrodynamic modeling with a common symmetry plane breaks down. This has implications for hard probes at high $p_{\rm T}$, which might be biased by $p_{\rm T}$-dependent flow angle fluctuations of at least 23% in central collisions. Given the presented results, existing theoretical models should be re-examined to improve our understanding of initial conditions, quark--gluon plasma (QGP) properties, and the dynamic evolution of the created system