We present results for neutron star models constructed with a new equation of state for nuclear matter at zero temperature. The ground state is computed using the auxiliary field diffusion Monte ...Carlo (AFDMC) technique, with nucleons interacting via a semiphenomenological Hamiltonian including a realistic two-body interaction. The effect of many-body forces is included by means of additional density-dependent terms in the Hamiltonian. In this Letter, we compare the properties of the resulting neutron star models with those obtained using other nuclear Hamiltonians, focusing on the relations between mass and radius, and between the gravitational mass and the baryon number.
Flexible ureteroscopy (fURS) is one of the recommended treatments for urinary stones. Urosepsis is one of the most frequent complications of fURS however its predictive factors remain uncertain. Our ...objective was to assess the septic complications rates of fURS and to determinate predictive factors of these complications in patients undergoing fURS.
Our retrospective analysis included all patients admitted for any fURS for stone disease in our center from December 2009 to April 2013. Patients' medical history, urine culture, stone composition, surgical and anesthetic characteristics were collected. The primary endpoint was defined by the presence of any septic complication (i.e. postoperative fever, urosepsis, septic shock or death). We used multivariate logistic regression to assess predictive factors of septic complication related to fURS.
Two hundred and eighty-two patients were included in this study. Urosepsis rate was 9.8% while 18.9% developed postoperative hyperthermia (>37.5°C). In multivariate analysis, the predictive risk factors of septic complication were: a neurologic disorder (OR=6.1; CI95%: 2.9-17.1), a history of urinary tract infection (UTI) (OR=19.6; CI95%: 7.3-52.1), exposure to peroperative nitrous oxide (OR=3.2; CI95%: 1.5-6.8) and intraoperative use of a laser (OR=8.0; CI95%: 13.0-30.3).
The use of fURS is associated with relatively frequent septic complications. Patients with neurologic disorders or a history of UTI carry an increased risk of postoperative complications. Limitations should be drawn with the use of peroperative nitrous oxide. These results should be further validated.
3. Retrospective cohort study.
To compare quality of life and functional outcomes associated with orthotopic neobladder (ONB) and ileal conduit (IC) after anterior pelvic exenteration for bladder cancer in women, through a ...multicentric cross-sectional study.
All women who have undergone an anterior pelvic exenteration associated with ONB or IC for a bladder cancer between January 2004 and December 2014 within the three participating university hospital centers and that were still alive in February 2016 were included. Three distinct auto-administered questionnaires were submitted to the patients: the EORTC QLQ-C30, the EORTC QLQ-BLmi30 and the SF-12. Comparison of response to these questionnaires between women with ONB and those with IC were studied with Mann-Whitney U tests, with a statistically significant P-value set at<0.05. The primary endpoint was the "global health status" sub-score extracted from the EORTC QLQ-C30 questionnaire. The secondary endpoints were the functional sub-scores and symptoms sub-scores obtained with the EORTC QLQ-C30 questionnaire as well as the sub-scores obtained with the EORTC QLQ-BLmi30 and the SF-12 questionnaires.
Forty women were included in the study (17 ONB, 23 IC). The primary endpoint was comparable between the ONB and IC women (83.3 vs. 66.7 P=0.22). Similarly, no significant statistical difference could be pointed between the ONB and IC women in terms of secondary endpoints.
The present study did not report any significance difference in terms of quality of life and functional outcomes between women with ONB and those with IC after pelvic exenteration for bladder cancer.
3.
Purpose
To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics of upper urinary tract urothelial carcinomas (UTUCs).
...Materials and methods
We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with apparent diffusion coefficient (ADC) maps calculated between
b
= 0 and
b
= 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours were compared with that of normal renal parenchyma using an unpaired Student’s
t
test. Association between ADC values and histological features was tested using non-parametric tests.
Results
Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (
p
= 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (
p
< 0.001). No statistical association was found between ADC values and pathological features (location,
p
= 0.35; grade,
p
= 0.98; muscle-invasive disease,
p
= 0.76 and locally advanced stage,
p
= 0.57).
Conclusion
DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need further investigations in a large prospective multi-institutional study.
Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary ...treatment for localised PCa.
From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increase>nadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed.
Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (>0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively.
sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients.
4.
To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical ...prostatectomy (RP) specimen.
We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter>10mm) were evaluated using logistic regression.
Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% 1.01-8.88; P=0.04), as was age (OR=1.17; CI95% 1.05-1.31; P=0.004) and PSAD (OR=1.10; CI95% 1.01-1.20; P=0.02).
Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program.
4.
To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS).
A single-center, retrospective cohort ...study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score>6 and/or a maximum tumor length>5mm.
Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density>0.15ng/mL/cm
(RR=2.75), PSA doubling time<3 years (RR=9.28), suspicious lesion on MRI diagnosis (RR=2.79) and occurrence of MRI progression during follow-up (RR=2). Sensitivity, specificity, PPV and NPV of MRI to assess progression for reclassification were 61 %, 69 %, 45 % and 81 %, respectively.
For patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification.
4.
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