Incidenţa complicaţiilor după litotriția extracorporală (ESWL) pentru calculi renali de peste 15 mm

Abstract On this study we want to evaluate the complication that occure after extracorporeal shock wave lithotripsy on the patients with renal stones bigher thean 1,5 cm. In the last 11 years (02.1995­ 03.2006), in the Urologic Clinic of Târgu-Mureş, we performed extracorporeal shock wave lithotripsy to 9024 patients with renoureteral lithiasis. 4330 patients (47,98%) had ureteral stones and 4696 patients (52,02%) had renal stones. 994 (11,02%) had renal calculi biger that 1,5 cm diameter. On theese 994 patients, we performed 1553 lithotripsy treatments, representing an average of 1,54 extracorporeal lithotripsy patient. To 648 patients (65,19%) we have done one lithotripsy treatment. Despite the size of the calculi, the associated manouvres befor lithotripsy were few, only 0,6% (3 patients with double Jcatheter, 3 patients with endoscopic mobilisation of the stone). Extracorporeal lithotripsy was not efficient to 0,6% of patient, beeing needed other surgical procedures for this stones. Post lithotripsy complications were numerouse (47,28%): acute pyelonephritis (4,7%), impacted calculi in the ureter (5%), steinstrasse (31,48%). To 17,55% of patients (175) were needed other endoscopic procedures of resolving the complications (percutaneous nephrolithotomy to 1,2%, retrograde ureteroscopy + double J catheter to 7,53%, meatotomy to 4,1%. In spite of these complications the stone-free rate at 3 months after lithotripsy was 75,75%. We can conclude that ESWL can be practiced with good results evean on renal calculi biger than 1,5 cm diameter. Introducere. Lucrarea de faţă îşi propune să evalueze incidenţa complicaţiilor (obstructive, infecţioase, hemoragice) apărute după practicarea litotriţiei extracorporale la bolnavii cu calculi renali mai mari de 1,5 cm diametru. Materiale şi metode. În ultimii 11 ani (02.1995-03.2006), în Clinica Urologică Tg-Mureş am practicat litotriţie extracorporală la 9024 bolnavi cu litiază reno-ureterală. 4330 bolnavi (47,98%) au avut calculi ureterali şi 4694 (52,02%) - litiază renală. 11,02% (994 pacienţi) au prezentat calculi renali mai mari de 1,5 cm diametru. La aceşti 994 de pacienţi, am practicat 1533 şedinţe de litotriţie extracorporală, ceea ce reprezintă o medie de 1,54 şedinţe/ pacient. La 648 de pacienţi (65,19%) am practicat o singură şedinţă de litotriţie extracorporală. În ciuda dimensiunii, manevrele associate, efectuate înaintea litotriţiei, au fost puţine, 0,6% (3 pacienţi cu sondă autostatică, 3 pacienţi cu calcul mobilizat înaintea litotriţiei). Rezultate. Litotriţia nu a fost eficientă la 0,6% dintre bolnavi, fiind necesare alte intervenţii chirurgicale. Complicaţiile post ESWL au fost mai numeroase (47,28%): pielonefrită acută 4,7% ), hematoame renale (2,2% ), ureterohidronefroză infectată (3,8%), fragmente inclavate în ureter (5%), steinstrasse (31,58%). La 17,55% dintre bolnavi (175) au fost necesare alte metode endoscopice de rezolvare a complicaţiilor (nefrostomie percutanată - la 12%, ureterorenoscopie retrogradă + sondă autostatică - la 7,53%; pielolitotomie - la 4,1%). Concluzii. În pofida acestor complicaţii şi a evoluţiei post ESWL mai îndelungate, rata de stone-free la 3 luni după litotriţie a fost de 75,75% (757 bolnavi), deci putem conclude că litotriţia extracorporală se poate practica cu rezultate bune şi la calculi renali mai mari de 1,5 cm

Experienţa clinicii de urologie din Târgu-Mureș în tratamentul calculului coralifor

Abstract Percutaneous surgery is a safe and efficient method in the treatment of staghorn calculi. The analysis of our experience in the percutaneous treatment of staghorn calculi over a period of 18 years (1988-2005). During this time practically we have performed open surgery only in a few patient with renal and upper ureteral calculi. From a number of over 6230 patients with renal and upper ureteral calculi treated with the endoscopic method, during the period between 1988-2005, we have performed percutaneous surgery on 1074 patients with staghorn calculi (7 of them were children; 22 patients had bilateral staghorn calculus). The average surgery time was 115 minutes, the average postsurgery hospital care time was 17,5 days. The postoperative “stone free" rate was 914/1074 (85,10%). In 101/1074 (9,40%) cases our patients developed complications and in 3/1074 (0,27%) cases the patient deceased due to hemorrhage and toxico-septic shock. For the successfully treatment of a patient with staghorn calculus using the percutaneous technique it is necessary a good knowledge of the 3D anatomy of the kidney well chosen and correctly executed percutaneous nephrostomy tracks, training, experience and good technical skills in the endourology of the upper urinary tract. Chirurgia percutanată este o metodă sigură şi eficientă în tratamentul litiazei coraliforme. Introducere. Analiza experienţei noastre în tratamentul percutanat al litiazei coraliforme într-o perioadă de 18 ani (1988-2005), în care nu am mai operat deschis, decât un număr foarte mic de pacienţi cu litiază renală şi ureterală superioară. Materiale şi metode. Într-o serie de peste 6230 de pacienţi cu litiază renală şi ureterală superioară rezolvaţi percutanat în intervalul 1988-2005, am operat percutanat 1074 pacienţi cu litiază coraliformă (7 au fost copii; 22 pacienţi au avut litiază coraliformă bilaterală). Rezultate. Timpul operator a fost în medie de 115 minute, durata medie a spitalizării postoperatorii de 17,5 zile. Rata “stone free” postoperator a fost de 914/1074 (85,10%). Am avut complicaţii la 101/1074 (9,40%) pacienţi şi 3/1074 (0,27%) decese prin hemoragie şi şoc toxico-septic. Concluzii. Pentru rezolvarea percutanată cu succes a unui calcul coraliform este necesară o bună cunoaştere a anatomiei tridim ensionale a rinichiului, traiecte de nefrostom ie percutanată bine alese şi corect efectuate, antrenament, experienţă şi o bună tehnicitate în endourologia aparatului urinar superior

Leiomiom al vezicii urinare (prezentare de caz)

Abstract Bladder leiomyoma is a benign tumour, with a rather low incidence, 0,43%, at about 200 cases presented in the literature. The authors present a case of a female patient aged 70 years, who was treated in the Clinic of Urology Târgu-Mureş presenting dysuria and polakysuria. The abdominal ultrasound examination, IVU, cystoscopy revealed a tumour (5x5 cm dimension) localised near the bladder neck on the left lateral wall of the bladder. This tumour had an omogenous structure, produced bladder outlet obstruction, the residual urine was about 150 ml. A transurethral resection was performed for the tumour (weight 50 gr). The endoscopic control revealed a tumour covered with normal urothelium, localised on the left lateral bladder wall near neck. The macroscopic aspect of the tumour was like the adenomatous tissue of the prostate in man. The histopathological finding (hematoxilin eosing dying, imunohistochemical ex.) revealed leiomyoma of the bladder (no signs of malignancy). The patient had no bladder obstruction after the endoscopic procedure. Bladder leiomyoma is a very rare, benign tumour. The one presented is an endovezical one causing bladder obstruction. The endoscopia procedure solved the case, the 3 month follow up revealed a normal bladder. Introducere. Leiomiomul vezicii urinare este o tumoră benignă mezenchimală cu incidenţă scăzută sub 0,43%, în literatura de specialitate raportându-se aproximativ 200 de cazuri. Localizarea leiomiomului poate fi endovezicală, intramurală şi extravezicală. Materiale şi metode. Prezentăm cazul unei bolnave U.V. în vârstă de 70 ani, internată în clinica noastră între 15.11.- 21.11.2005 pentru acuze urinare de tip obstructiv (disurie, polakiurie). Examinările paraclinice (ecografie, urografie în faza cistografică, cistoscopie) pun în evidenţă o formaţiune tumorală de 5/5 cm situată în vecinătatea colului vezical ataşat peretelui stîng al vezicii urinare. Investigaţiile efectuate sugerau existenţa unei tumori bine delimitate, cu structură omogenă şi cu caracter obstructiv tip clapetă pe colul vezical, pacienta având un reziduu urinar de 150 ml. Sunt prezentate imagini radiologice, ecografice, endoscopice şi histologice ale tumorii vezicale benigne. Bolnava a fost supusă unei intervenţii transuretrale cu rezecţia în totalitate a tumorii, în greutate de 50 gr. Rezultate şi discuţii. Intervenţia endoscopică a pus în evidenţă formaţiunea tumorală descrisă, acoperită de un uroteliu normal, având baza de inserţie pe peretele stîng în imediata vecinătate a colului, cu caracterele obstructive amintite. Rezecţia transuretrală a dus la îndepărtarea tumorii în totalitate. Aspectul macroscopic al ţesutului rezecat fiind asemănător cu cel al adenomului de prostată de la bărbat. Ex. histopatologic (coloraţiile hematoxilinăeozină, imunohistochimice) pun diagnosticul de leiomiom al vezicii urinare fără elemente atipice. După îndepărtarea sondei uretrovezicale, fenomenele obstructive semnalate de pacientă au dispărut. Concluzii. Leiomiomul vezical este o tumoră benignă extrem de rară. Forma prezentată în poster este endovezicală obstructivă. Intervenţia endoscopică a dus la îndepărtarea tumorii în totalitate, cu dispariţia simptomatologiei. Controlul endoscopic la 3 luni a relevat o vezică urinară normală

Cistita necrotică - dificultăţi diagnostice şi terapeutice

Abstract Necrotic cystitis, also called incrustation cystitis, raises etiopathological and therapeutical problems, with relapse of the necrosis after removal of pathological tissue. Between 01.01.1999 and 31.12.2005 there have been 55 patients institutionalized in our Clinic, presenting lower urinary tract symptoms (LUTS). Instrumental investigations have demonstrated the thickening of the bladder wall, more frequently in the trigonum area. Ultrasound examination and cystography couldn’t exclude an infiltrative bladder tumor. Cystoscopy which showed necrotic bladder tissue, with calcareous incrustations, followed by the resection of the pathologic tissue. In 45 cases the histopathological result was necrotic cystitis and in 10 cases infiltrative urothelial bladder tumor or epidermoid metaplasia. In order to clarify the etiology of the necrosis an investigation protocol have been used, consisting of laboratory tests for autoimmune diseases, vascular or local causes that initiate the necrosis (previous surgery in the area, endoscopic interventions). In 5 cases with autoimmune disease, the treatment was transurethral resection and plasmapheresis. The evolution was favorable in 4 cases. Failure: 1 patient. In 12 cases the cause of the necrosis appears to be a diabetic vasculitis, judging by the deep necrosis, dispersed over several small areas. The posttherapeutic evolution depends on the correct treatment of diabetes. In 10 patients with previous endoscopic surgery, the necrosis has been induced by inadequate electrical currents or mechanical lesions. In 18 patients the causing factor remained unknown. The limited necrosis of the bladder can be caused by autoimmune diseases, vascular diseases (diabetes) and endo-urethral maneuvers. The endoscopic resection of the necrotic bladder wall to the healthy, well vascularised tissue beneath is an important therapeutic procedure. The treatment of the causing factors (autoimmune, vascular) will consolidate the healing. Not knowing the other causes will lead to failure, and repeated endoscopic treatment will result in short term ameliorations. Introducere. Cistita necrotică, denumită în literatură şi “cistita de incrustaţie”, ridică probleme de etiopatogenie, prezentând dificultăţi terapeutice, cu recidiva necrozei după îndepărtarea ţesuturilor patologice. Materiale şi metode. Între 01.01.1999-31.12.2005 au fost internaţi în clinica noastră 55 de pacienţi cu fenomene urinare joase de tip iritativ. Investigaţiile paraclinice au pus în evidenţă peretele vezical îngroşat, situaţie frecventă în trigon. Ecografia şi cistografia nu puteau exclude aspectul unei tumori vezicale infiltrative.Cistoscopia a evidenţiat un ţesut vezical necrozat, cu incrustaţii calcare, fiind urmată de rezecţia ţesutului patologic. La 45 de pacienţi rezultatul histopatologic a fost de cistită necrotică, iar la 10 bolnavi s-a depistat tumoră vezicală urotelială infiltrativă sau metaplazie epidermoidă. Pentru a elucida etiopatogenia necrozei, s-a aplicat un protocol de investigare care include teste de laborator pentru depistarea unui proces autoimun, a unor cauze vasculare sau a unor cauze locale de declanşare a necrozei (intervenţii în antecedente, manevre endoscopice, etc.). Rezultate şi discuţii. La 5 bolnavi cu proces autoimun, tratamentul a constat din rezecţie transuretrală şi din plasmafereză. Evoluţie favorabilă, cu vindecare - la 4 bolnavi. Eşec: 1 pacientă. La 12 bolnavi cauza necrozei este sugerată a fi o vasculită diabetică, după aspectul profund al necrozei în puncte dispersate, evoluţia postterapeutică este influenţată de tratamentul corect al diabetului. La 10 pacienţi cu manevre chirurgicale endoscopice în antecedente, inducţia procesului necrotic a fost provocat de curenţi electrici inadecuaţi sau de leziuni mecanice. La 18 bolnavi cauza a fost necunoscută. Concluzii. Necroza limitată a vezicii urinare poate avea cauze autoimune, vasculare (diabet), manevre endouretrale. Rezecţia endoscopică a peretelui vezical necrozat până în ţesut bine vascularizat este un gest terapeutic important. Tratamentul cauzal (autoimun, vascular, etc.) consolidează vindecarea. Necunoaşterea şi a altor cauze duce la eşec, iar tratamentul endoscopic repetat - la ameliorări pasagere

Proteome Profiling Outperforms Transcriptome Profiling for Coexpression Based Gene Function Prediction

Coexpression of mRNAs under multiple conditions is commonly used to infer cofunctionality of their gene products despite well-known limitations of this “guilt-by-association” (GBA) approach. Recent advancements in mass spectrometry-based proteomic technologies have enabled global expression profiling at the protein level; however, whether proteome profiling data can outperform transcriptome profiling data for coexpression based gene function prediction has not been systematically investigated. Here, we address this question by constructing and analyzing mRNA and protein coexpression networks for three cancer types with matched mRNA and protein profiling data from The Cancer Genome Atlas (TCGA) and the Clinical Proteomic Tumor Analysis Consortium (CPTAC). Our analyses revealed a marked difference in wiring between the mRNA and protein coexpression networks. Whereas protein coexpression was driven primarily by functional similarity between coexpressed genes, mRNA coexpression was driven by both cofunction and chromosomal colocalization of the genes. Functionally coherent mRNA modules were more likely to have their edges preserved in corresponding protein networks than functionally incoherent mRNA modules. Proteomic data strengthened the link between gene expression and function for at least 75% of Gene Ontology (GO) biological processes and 90% of KEGG pathways. A web application Gene2Net (http://cptac.gene2net.org) developed based on the three protein coexpression networks revealed novel gene-function relationships, such as linking ERBB2 (HER2) to lipid biosynthetic process in breast cancer, identifying PLG as a new gene involved in complement activation, and identifying AEBP1 as a new epithelial-mesenchymal transition (EMT) marker. Our results demonstrate that proteome profiling outperforms transcriptome profiling for coexpression based gene function prediction. Proteomics should be integrated if not preferred in gene function and human disease studies

How many human proteoforms are there?

Despite decades of accumulated knowledge about proteins and their post-translational modifications (PTMs), numerous questions remain regarding their molecular composition and biological function. One of the most fundamental queries is the extent to which the combinations of DNA-, RNA- and PTM-level variations explode the complexity of the human proteome. Here, we outline what we know from current databases and measurement strategies including mass spectrometry-based proteomics. In doing so, we examine prevailing notions about the number of modifications displayed on human proteins and how they combine to generate the protein diversity underlying health and disease. We frame central issues regarding determination of protein-level variation and PTMs, including some paradoxes present in the field today. We use this framework to assess existing data and to ask the question, "How many distinct primary structures of proteins (proteoforms) are created from the 20,300 human genes?" We also explore prospects for improving measurements to better regularize protein-level biology and efficiently associate PTMs to function and phenotype

Fermented wheat germ extract - nutritional supplement or anticancer drug?

<p>Abstract</p> <p>Background</p> <p>Fermented wheat germ extract (FWGE) is a multisubstance composition and, besides others, contains 2-methoxy benzoquinone and 2, 6-dimethoxy benzoquinone which are likely to exert some of its biological effects. FWGE interferes with anaerobic glycolysis, pentose cycle and ribonucleotide reductase. It has significant antiproliferative effects and kills tumor cells by the induction of apoptosis via the caspase-poly [ADP-ribose] polymerase-pathway. FWGE interacts synergistically with a variety of different anticancer drugs and exerted antimetastatic properties in mouse models. In addition, FWGE modulates immune response by downregulation of MHC-I complex and the induction of TNF-α and various interleukins. Data in the F-344 rat model provide evidence for a colon cancer preventing effect of FWGE.</p> <p>Clinical data from a randomized phase II trial in melanoma patients indicate a significant benefit for patients treated with dacarbazine in combination with FWGE in terms of progression free survival (PFS) and overall survival (OS). Similarly, data from studies in colorectal cancer suggested a benefit of FWGE treatment. Besides extension of OS and PFS, FWGE improved the quality of life in several studies.</p> <p>Conclusion</p> <p>In conclusion, available data so far, justify the use of FWGE as a non-prescription medical nutriment for cancer patients. Further randomized, controlled and large scale clinical studies are mandatory, to further clarify the value of FWGE as a drug component of future chemotherapy regimens.</p

A conceptual framework for the adoption of big data analytics by e-commerce startups: a case-based approach

E-commerce start-ups have ventured into emerging economies and are growing at a significantly faster pace. Big data has acted like a catalyst in their growth story. Big data analytics (BDA) has attracted e-commerce firms to invest in the tools and gain cutting edge over their competitors. The process of adoption of these BDA tools by e-commerce start-ups has been an area of interest as successful adoption would lead to better results. The present study aims to develop an interpretive structural model (ISM) which would act as a framework for efficient implementation of BDA. The study uses hybrid multi criteria decision making processes to develop the framework and test the same using a real-life case study. Systematic review of literature and discussion with experts resulted in exploring 11 enablers of adoption of BDA tools. Primary data collection was done from industry experts to develop an ISM framework and fuzzy MICMAC analysis is used to categorize the enablers of the adoption process. The framework is then tested by using a case study. Thematic clustering is performed to develop a simple ISM framework followed by fuzzy analytical network process (ANP) to discuss the association and ranking of enablers. The results indicate that access to relevant data forms the base of the framework and would act as the strongest enabler in the adoption process while the company rates technical skillset of employees as the most important enabler. It was also found that there is a positive correlation between the ranking of enablers emerging out of ISM and ANP. The framework helps in simplifying the strategies any e-commerce company would follow to adopt BDA in future. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

High Throughput Microplate Respiratory Measurements Using Minimal Quantities Of Isolated Mitochondria

Recently developed technologies have enabled multi-well measurement of O2 consumption, facilitating the rate of mitochondrial research, particularly regarding the mechanism of action of drugs and proteins that modulate metabolism. Among these technologies, the Seahorse XF24 Analyzer was designed for use with intact cells attached in a monolayer to a multi-well tissue culture plate. In order to have a high throughput assay system in which both energy demand and substrate availability can be tightly controlled, we have developed a protocol to expand the application of the XF24 Analyzer to include isolated mitochondria. Acquisition of optimal rates requires assay conditions that are unexpectedly distinct from those of conventional polarography. The optimized conditions, derived from experiments with isolated mouse liver mitochondria, allow multi-well assessment of rates of respiration and proton production by mitochondria attached to the bottom of the XF assay plate, and require extremely small quantities of material (1–10 µg of mitochondrial protein per well). Sequential measurement of basal, State 3, State 4, and uncoupler-stimulated respiration can be made in each well through additions of reagents from the injection ports. We describe optimization and validation of this technique using isolated mouse liver and rat heart mitochondria, and apply the approach to discover that inclusion of phosphatase inhibitors in the preparation of the heart mitochondria results in a specific decrease in rates of Complex I-dependent respiration. We believe this new technique will be particularly useful for drug screening and for generating previously unobtainable respiratory data on small mitochondrial samples