Tag: pubmed

Can J Urol. 2025 Aug 29;32(4):359-366. doi: 10.32604/cju.2025.066470.

ABSTRACT

BACKGROUND: The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delayed cancer diagnosis and treatment. In France, transurethral resection of bladder tumors (TURBT) was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma. This study aimed to assess the impact of care reorganization on tumor staging, recurrence, palliative care, and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.

METHODS: We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019 (pre-pandemic), 2020 (early pandemic), 2021 (mid-pandemic), and 2022 (late pandemic) in two French institutions. TURBT indications were categorized as diagnostic, palliative, or staging. Clinical and pathological data were compared across the four periods. Statistical analyses included Chi-square tests, Estimated Annual Percentage Change (EAPC), and multivariable logistic regression adjusted for age, sex, ASA score, and center.

RESULTS: A total of 790 TURBT procedures were analyzed. The proportion of muscle-invasive bladder cancer (pT ≥ 2) declined over time (18.7% in 2019 to 13.2% in 2022; p = 0.63), while superficial tumors (pTa) increased (57.2% to 65.5%). All-cause mortality significantly decreased from 38.0% in 2019 to 22.0% in 2020, 20.5% in 2021, and 19.5% in 2022 (p = 0.006). EAPC showed a significant annual decline in mortality (-24.3%, p = 0.004). In multivariable analysis, 2020, 2021, and 2022 were each associated with significantly lower odds of mortality compared to 2019. Recurrence rates remained stable across all periods (p = 0.93). Inter-hospital variation persisted in mortality and recurrence.

CONCLUSIONS: Despite the pandemic, urothelial bladder cancer outcomes did not worsen through 2022. On the contrary, timely reorganization, prioritization of TURBT, and triage strategies were associated with reduced mortality and palliative care needs, highlighting the resilience of cancer care when guided by adaptive health policies.

PMID:40910335 | DOI:10.32604/cju.2025.066470

Can J Urol. 2025 Aug 29;32(4):309-315. doi: 10.32604/cju.2025.063408.

ABSTRACT

BACKGROUND: Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer (PCa) in those with concurrent significant lower urinary tract symptoms (LUTS). For men who meet this description with marked prostatomegaly, we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy (RASP) followed by external beam radiation therapy (EBRT) for the treatment of clinically significant prostate cancer.

METHODS: A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015-2023. Demographic, peri-operative, and post-radiation treatment functional outcomes are reported.

RESULTS: No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months. The median time from RASP to EBRT was 9 months. Median prostate size was 135 g (IQR 110-165). 13 (76.5%) patients received a pre-EBRT rectal spacer. Median IPSS score preoperatively improved at 90 days post-RASP (13.5 vs. 2.5; IQR 10.8-15.2), and this benefit was sustained post-EBRT with a median IPSS at 3 vs. 12 months (4 vs. 0; IQR 0-5). There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3 (p = 0.677) or 12 (p = 0.627) months. In all 14 patients with localized disease and PSA data, none had recurrence during the study period.

CONCLUSIONS: A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS. We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy. We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.

PMID:40910328 | DOI:10.32604/cju.2025.063408

Can J Urol. 2025 Aug 29;32(4):299-308. doi: 10.32604/cju.2025.064827.

ABSTRACT

OBJECTIVES: Benign prostatic hyperplasia (BPH) is a common benign tumor in men, with an age-related prevalence of multifactorial etiology. The present study aimed to accurately assess and predict the effect of co-existing metabolic syndrome (MtS) upon treatment outcomes of combination medical therapy in select patients of lower urinary tract symptoms (LUTS) due to BPH.

METHODS: After obtaining informed consent from the patients, 70 eligible patients with LUTS due to BPH with and without MtS were enrolled in this study from September 2022 to January 2024 from the outpatient clinic at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi and were treated with a combination of Tamsulosin and Dutasteride, for two months, as per the protocol. The outcomes measured were a change in the International Prostate Symptom Score (IPSS), mean flow rate (MFR), and peak urine flow (Qmax) rates. Data was analysed using SPSS version 23.

RESULTS: The reduction in IPSS was higher in the control group than in the case group (p < 0.001), and the difference in MFR between the groups was also statistically significant (p < 0.001). Although there was a significant change in Qmax in both groups, the difference in the improvement in Qmax between the two groups was not significant (p < 0.829). The control group appeared to have achieved better symptomatic relief after treatment than did the case group.

CONCLUSION: Metabolic syndrome had a negative adverse impact on medical treatment outcomes in selected patients of LUTS due to BPH. The study suggests that urologists should actively consider and appropriately counsel patients with LUTS-BPH and co-existing metabolic syndrome before selecting such patients for combination medical therapy.

PMID:40910327 | DOI:10.32604/cju.2025.064827

Can J Urol. 2025 Aug 29;32(4):271-282. doi: 10.32604/cju.2025.066395.

ABSTRACT

BACKGROUND: Accurate complication reporting in endourology remains challenging, with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems. This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy (URL), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) using both systems.

METHODS: This prospective, single-center, non-interventional study included 473 patients undergoing URL, PCNL, or ESWL from October 2022 to October 2024. Demographic, stone-related, and procedural variables were recorded. Complications were classified using the CDC, and cumulative morbidity was assessed using CCI. Statistical analyses, including univariate and multivariate regression, were performed to identify predictors of higher CCI scores.

RESULTS: PCNL was associated with the highest complication rates, including an 11% transfusion rate. ESWL had the lowest complication burden, while URL demonstrated intermediate risk. CCI scores correlated positively with length of stay (LOS; r = 0.47), highlighting its ability to capture overall morbidity. Multivariate analysis identified stone size, operating time, and positive urine culture as significant predictors of higher CCI scores. The CCI provided a more comprehensive representation of morbidity compared to the CDC.

CONCLUSIONS: CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC, particularly in more invasive procedures such as PCNL. Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.

PMID:40910324 | DOI:10.32604/cju.2025.066395

Can J Urol. 2025 Aug 29;32(4):243-254. doi: 10.32604/cju.2025.066700.

ABSTRACT

BACKGROUND: Intermediate-risk prostate cancer (IR-PC) represents a heterogeneous group requiring nuanced treatment approaches, and recent advancements in radiotherapy (RT), androgen deprivation therapy (ADT), and prostate-specific membrane antigen positron emission tomography (PSMA-PET/CT) imaging have prompted growing interest in personalized, risk-adapted management strategies. This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists’ practices in managing IR-PC, focusing on RT and imaging modalities to identify trends for personalized treatments.

METHODS: A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer (PC) cases annually. The 22-item questionnaire covered IR-PC management aspects such as risk stratification, imaging preferences, androgen deprivation therapy (ADT) use and duration, RT techniques, and treatment combinations. Anonymous responses were analyzed using descriptive statistics.

RESULTS: Thirty radiation oncologists participated, 57% with over 20 years of experience. The median annual number of PC cases treated was 130. For risk stratification, 43% followed the National Comprehensive Cancer Network (NCCN) guidelines, while 30% used the D’Amico classification. Imaging preferences revealed 47% favored PSMA-PET/CT. External beam RT was universally preferred, with 60% adopting ultra-hypofractionation. ADT was used by 97%, with 73% recommending it for unfavorable IR-PC cases. Short-term ADT (4-6 months) was the standard, administered concurrently with RT by 57%. Cardiovascular status influenced decisions for 97% of respondents, while 37% also considered patient age, preferences, and sexual health.

CONCLUSIONS: This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey, marked by selective PSMA-PET/CT use, tailored ADT, and evolving radiotherapy practices. The findings underscore the importance of multidisciplinary collaboration-particularly between urologists and radiation oncologists-to optimize imaging integration and treatment outcomes.

PMID:40910322 | DOI:10.32604/cju.2025.066700

Infect Control Hosp Epidemiol. 2025 Sep 5:1-8. doi: 10.1017/ice.2025.10251. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Enhanced environmental disinfection is linked to reduced hospital-acquired infection rates. In this study, we aimed to evaluate the efficacy of an emerging disinfection technology, a filtered far-UV-C handheld (FFUHH) device, for reducing bacterial loads on high-touch surfaces in shared clinical workrooms, and to isolate, identify and characterize clinically significant environmental pathogens.

METHODS: We compared samples from high-touch items (dictation device, mouse, armchair, desk, and keyboard) before and after FFUHH treatment. Samples were collected weekly: contact plates for colony counts and swabs before and after intervention on standardized adjacent areas for each surface, respectively. The swabs were enriched and cultured on selective media to isolate pathogens. Environmental samples, as well as clinical samples collected from patients during the study period, were validated using MALDI-TOF and whole genome sequencing.

RESULTS: Among the 440 collected plates (220 before and 220 after treatment), the highest mean colony count pre-treatment was detected from armchairs, and the lowest from keyboards. The mean reduction of colony-forming units ranged 53% and 83% and was statistically significant (P < 0.05) across all surfaces except for the keyboard. We characterized multidrug-resistant Staphylococcus epidermidis ST5 and ST16 strains, a carbapenem-resistant Acinetobacter baumannii, and a Klebsiella pneumoniae genetically related to a clinical isolate with a rare sequence type not previously detected in our institution.

CONCLUSION: The FFUHH effectively reduced the microbial burden on high-touch surfaces. It can offer an advantage for surface disinfection and an alternative to routinely used biocides.

PMID:40910299 | DOI:10.1017/ice.2025.10251

Curr Med Imaging. 2025 Aug 29. doi: 10.2174/0115734056389602250826081355. Online ahead of print.

ABSTRACT

INTRODUCTION: Anemia is a common blood disorder caused by a low red blood cell count, reducing blood hemoglobin. It affects children, adolescents, and adults of all genders. Anemia diagnosis typically involves invasive procedures like peripheral blood smears and complete blood count (CBC) analysis. This study aims to develop a cost-effective, non-invasive tool for anemia detection using eye conjunctiva images.

METHOD: Eye conjunctiva images were captured from 54 subjects using three imaging modalities such as a DSLR camera, a smartphone camera, and a smartphone camera fitted with a 3D-printed spacer macro lens. Image processing techniques, including You Only Look Once (YOLOv8) and the Segment Anything Model (SAM), and K-means clustering were used to analyze the image. By using an MLP classifier, the images were classified as anemic, moderately anemic, and normal. The trained model was embedded into an Android application with geotagging capabilities to map the prevalence of anemia in different regions.

RESULTS: Features extracted using SAM segmentation showed higher statistical significance (p < 0.05) compared to K-Means. Comparing high resolution(DSLR modality) and the proposed 3D-printed spacer macrolens shows statistically significant differences (p < 0.05). The classification accuracy was 98.3% for images from a 3D spacer-equipped smartphone camera, on par with the 98.8% accuracy obtained from DSLR camerabased images.

CONCLUSION: The mobile application, developed using images captured with a 3D spacer-equipped modality, provides portable, cost-effective, and user-friendly non-invasive anemia screening. By identifying anemic clusters, it assists healthcare workers in targeted interventions and supports global health initiatives like Sustainable Development Goal (SDG) 3.

PMID:40910296 | DOI:10.2174/0115734056389602250826081355

Endocr Metab Immune Disord Drug Targets. 2025 Aug 29. doi: 10.2174/0118715303410531250815124524. Online ahead of print.

ABSTRACT

INTRODUCTION: Celiac Disease (CeD) is a serious, lifelong autoimmune condition. There remains a significant unmet medical need for effective pharmacological treatments for CeD.

METHODS: We utilized summary statistics for 2,888 druggable genes from the eQTLGen Consortium and the FinnGen Consortium for CeD. In our Mendelian Randomization (MR) analysis, we identified genes associated with CeD that had a false discovery rate (FDR) < 0.05 using the Inverse Variance Weighted (IVW) method. To enhance the reliability of the results, we validated them through colocalization analysis and Summary-data-based Mendelian Randomization (SMR) analyses.

RESULTS: Through our analysis, we identified 18 druggable genes with a causal relationship to CeD under an FDR < 0.05. Subsequent colocalization and SMR analyses highlighted the PRKCD gene as a potential therapeutic target for CeD (IVW method: Odds Ratio 1.319, 95% Confidence Interval 1.182-1.471, P = 6.85E-07, FDR = 0.002). Additionally, these results have passed horizontal pleiotropy tests, heterogeneity analysis, and leave-one-out sensitivity analysis.

DISCUSSION: The identification of PRKCD as a therapeutic target represents a significant advancement in addressing the unmet medical need for CeD treatment. However, the hypothesis that PRKCD contributes to CeD pathogenesis by regulating tight junction proteins and altering intestinal barrier function requires further experimental validation in future studies.

CONCLUSION: Our study is the first to identify the PRKCD gene as a potential therapeutic target for treating CeD, providing new insights into the treatment of CeD and guiding the development of corresponding therapeutic drugs.

PMID:40910294 | DOI:10.2174/0118715303410531250815124524

Curr Neurovasc Res. 2025 Aug 29. doi: 10.2174/0115672026383185250825114834. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to investigate the effect of the serum Total Cholesterol (TC) to High-Density Lipoprotein cholesterol (HDL) ratio (T/H ratio) on Hemorrhagic Transformation (HT) after Intravenous Thrombolysis (IVT) in patients with Acute Cerebral Infarction (ACI).

METHODS: Patients with ACI who received alteplase were enrolled. Subgroups were classified based on the occurrence of hemorrhagic transformation (HT) after intravenous thrombolysis (IVT), whether tirofiban was coadministered, and their 90-day prognosis. The primary observation indicators were HT and the 90-day prognosis. Single-factor and multi-factor analyses were performed to identify independent predictors of HT and prognosis.

RESULTS: Age, TC, and HDL were identified as risk factors for ACI. The T/H ratio and HDL were statistically significant in relation to HT (p < 0.05). A correlation was observed between the T/H ratio and HT, with HT more likely to occur when the T/H ratio was greater than or equal to 3.25. The use of tirofiban after IVT did not increase the risk of HT. Significant differences were observed in HT, type of HT, age, hypertension, baseline National Institutes of Health Stroke Scale (NIHSS) score, platelet volume distribution width, TC, D-dimer, and fibrinogen degradation products between groups with different prognoses.

DISCUSSION: The T/H ratio was statistically associated with HT-ACI and predicted HT-ACI to some extent. However, the study had two limitations: the small sample size and the assessment of prognosis through follow-up phone calls, which affected the final results.

CONCLUSION: Patients with ACI undergoing IVT who had higher baseline NIHSS scores, lower TC, higher HDL, and a higher T/H ratio were at increased risk of HT, which was also associated with long-term outcomes. The T/H ratio may be a valuable predictor of HT following IVT.

PMID:40910292 | DOI:10.2174/0115672026383185250825114834

Pharmacotherapy. 2025 Sep 5. doi: 10.1002/phar.70056. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric plastic bronchitis (PB) is a rare complication of surgically palliated congenital heart disease (CHD). Fibrin casts obstruct airways and can cause respiratory distress. There are no therapeutics approved by the United States Food and Drug Administration to treat PB, but inhaled tissue plasminogen activator (tPA) has been anecdotally used to relieve symptoms. We conducted a phase II open-label clinical trial to test the safety of inhaled tPA in pediatric PB.

METHODS: Patients with an acute exacerbation of PB requiring hospitalization were enrolled to test the safety of an inhaled tPA regimen (5 mg every 6 h). The primary end point was to assess the safety and tolerability of repeated doses of nebulized, inhaled tPA in pediatric patients with acute PB. Safety parameters consisted of clinical laboratories to assess bleeding, which were measured prior to, during, and after tPA treatment. To benchmark efficacy using spirometry and oxygen saturation, children with Fontan-palliated CHD without a history of PB, with and without protein losing enteropathy (PLE), and healthy children were enrolled in a control arm that did not receive tPA.

RESULTS: Of the 10 patients with PB screened for enrollment, eight qualified for immediate treatment with inhaled tPA. A total of 29 non-PB participants (PLE, n = 8 [10-18 yo]; CHD, n = 9 [8-17 yo]; and healthy, n = 12 [7-16 yo]) were enrolled. There were no differences in pretreatment clinical blood laboratory values of hemostasis and those during and after treatment with the study drug (primary safety outcome). However, there were four episodes of self-limiting epistaxis related to the study drug. Inhaled tPA statistically improved oxygen saturation although this was moderate and likely not clinically significant; inhaled tPA did not alter spirometry values.

CONCLUSION: In this small, phase II study, repeated doses of inhaled tPA in patients with an acute exacerbation of PB did not result in disrupted systemic coagulation or hematological homeostasis or serious bleeding. However, patients should be monitored for localized bleeding. Larger, randomized trials are needed to provide more comprehensive assessments of bleeding risk and to further assess efficacy.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02315898.

PMID:40910281 | DOI:10.1002/phar.70056