Prostate cancer (PC) is known as an androgen-dependent tumor with testosterone as its natural growth factor, its action is mediated by the androgen receptor (AR) important for the biology and ...progression of PC. During aging a progressive decline in testosterone levels begins, caused by disability of aged Leydig cells to produce testosterone in response to luteinizing hormone. Surgical treatment of PC can influence the hypothalamic-pituitary-gonadal axis with less impact on it compared to patients treated with radiation. Patients with pre-operative low baseline testosterone level had mean Gleason score higher and AR expression was higher; significantly lower testosterone levels were recorded in patients with lymph node metastases. But some data are conflicting, and some results are opposite to those mentioned before. These data show that there is no significant association between all sex hormone in men and lethal PC or total mortality. In patients with metastatic PC, results showed that elevation of baseline androstenedione levels was predictive of prostate-specific antigen (PSA) response; higher baseline androstenedione levels were associated with an improved overall survival. In these patients, the relationship between serum testosterone and PC prognosis varies in different clinical settings and according to androgen deprivation therapy administration.
There is limited data on the effect of sacubitril-valsartan on the echocardiographic parameters in acute decompensated heart failure (ADHF). We prospectively enrolled 68 consecutive patients with ...ADHF who received sacubitril-valsartan (
N
= 34, S/V group) or angiotensin inhibition-based therapy (
N
= 34, ACEi/ARB group). Two-dimensional echocardiography with speckle tracking (2D-STE) was performed at baseline and after 3 months of treatment. Changes in 2D-STE parameters, including global longitudinal strain (GLS), were compared between the groups by
t
test and ANCOVA. Baseline characteristics were similar between the groups. Following 3 months of treatment, LVEF and GLS significantly improved in the S/V group (mean LVEF from 27 to 34.5% and GLS from − 6.6 to − 9.4%) but not in ACEi/ARB group. The improvement in LVEF and GLS was more prominent in patients with non-ischemic cardiomyopathy. In patients with ADHF 3-month treatment with sacubitril-valsartan, compared to guideline directed medical therapy without sacubitril, improves LVEF and GLS.
Graphical Abstract
A typical change in GLS in a patient with acute decompensated heart failure after 3 months of sacubitril-valsartan
Background and purpose: Cyclic biaxial burst test is a novel approach in biomechanical testing of fetal membranes. The purpose of the study is to determine are there differences between cyclic ...biaxial burst test and standard burst test. Relations between newborn and maternal anthropometric data and membrane biomechanics were investigated.Materials and methods: Thirty-nine fetal membranes were tested. Each membrane was cut in half acquiring one half closer to placenta and one closer to cervix. Samples for tensile, biaxial cyclic and standard tests were taken from each. Maternal and newborn anthropometric data was examined.Results: Cyclic burst pressures were significantly higher than standard burst pressures in samples closer to placenta (83.8 ± 19.4 vs 69.3 ± 17.9 mmHg;p<0.001) and cervix (67.9 ± 23.4 vs 58.1 ± 15.8 mmHg;p=0.013). When compared according to type of delivery, cyclic pressures were higher than standard in c-section samples (80.6 ± 22.4 vs 59.1 ± 14.8 mmHg;p<0.001) and vaginally delivered samples (73.5 ± 22.7 vs 65.9 ± 18.6 mmHg; p=0.017). Positive correlation between pregnancy BMI and uniaxial test rupture force was established.Conclusions: Cyclic biaxial test is closer to physiological conditions and tests membrane viscoelastic properties better than standard test. A positive correlation between maternal pregnancy BMI and uniaxial force-to-rupture may indicate a connection between maternal nutritional status and fetal membrane strength.
Cilj: Transuretralna resekcija predstojne žlijezde (prostate) (TURP) često se izvodi kao jednodnevni kirurški zahvat. Iako je procedura relativno sigurna, ipak su moguće teške perioperativne ...komplikacije. Sindrom
TURP-a rijetka je komplikacija, ali potencijalno opasna za život. Cilj su ovog rada trenutačni klinički pregled i analiza učestalosti, patofiziologije i kliničke prezentacije sindroma TURP-a temeljem najnovije objavljene medicinske literature. Metode: Pretraženi su medicinski podatci s pomoću bazâ PubMed, Ovid Medline® i Google Scholar za razdoblje od 1. siječnja 2017. do 1. siječnja 2020. godine. Rezultati: Više čimbenika ima ulogu u patofiziologiji sindroma TURP-a. Klinički simptomi variraju od blagih do teških, a ovise o brzini i količini intravaskularne apsorpcije
i vrsti otopine za ispiranje te o čimbenicima koji se odnose na bolesnika i operaciju. Akutno povećanje cirkulacijskog volumena može dovesti do plućnog edema i srčanog zastoja, dok promjene u koncentraciji otopljenih tvari u plazmi poput hiponatremije te hipotoničnosti i hipoosmolalnosti plazme mogu dovesti do poremećaja središnjega živčanog sustava (SŽS). Rane kliničke simptome teško je otkriti u anesteziranog bolesnika, ali rano prepoznavanje presudno je za pravodobni tretman. Liječenje treba biti u skladu s težinom kliničkih simptoma i znakova. Spinalna anestezija ima prednosti pred općom anestezijom jer su olakšani nadzor i rano prepoznavanje simptoma središnjega živčanog sustava kada je bolesnik pri svijesti. Zaključci: Ovaj narativni pregledni članak iznosi novije činjenice u vezi sa sindromom TURP-a, s naglaskom na sadašnja stajališta o prevenciji, ranoj dijagnozi i liječenju ove ijatrogene komplikacije. Bolje razumijevanje etiologije i preventivnih mjera, novije kirurške tehnike i intenzivni nadzor bolesnika pridonose daljnjem sniženju rizika od nastanka sindroma TURP-a.
Rak testisa najčešći je solidni tumor u muškaraca u dobi od 15. do 34. godine. Incidencija raka testisa u svijetu udvostručena je u posljednjih 40 godina. Tumori zametnih stanica čine 95% svih tumora ...testisa, a podijeljeni su u dva osnovna histološka tipa: seminomi i neseminomi. Osobito značenje daje im velik postotak izlječivosti i u diseminiranoj fazi bolesti. Tom je uspjehu najviše pridonijela kemoterapija, ali kirurgija je i dalje neizostavan dio uspješnog liječenja. U znatnog dijela bolesnika danas se nastoji odrediti terapijski minimum kojim se izbjegava niz nuspojava, a dovodi do jednakog uspjeha kao i donedavno agresivniji terapijski pristup. U tekstu koji slijedi iznesene su kliničke upute radi standardizacije dijagnostike, liječenja i praćenja bolesnika s tumorima
zametnih stanica testisa u Republici Hrvatskoj.
Relevant literature mentions exposure to war events as a significant factor in the emergence of not only mental but also physical illnesses. Enormous effort is being put into finding new and better ...ways of treatment while, at the same time, efforts are expended on the development and acquisition of weapons and other material that could cause disease and adverse health outcomes. The Homeland War in the Republic of Croatia was fought between 1990 and 1995, and it is estimated that over 500 000 soldiers fought in the war. Croatian defenders can unquestionably be singled out as a particularly vulnerable group due to long-term and serious consequences of war-related sufferings. The available data in Zagreb City Office for Health and War Veterans state malignant neoplasms as a leading cause of death among war veterans between 2006 and 2011. Furthermore, the research on disease incidence and mortality of the general population conducted in Zadar County in 2005 puts malignant neoplasms in second place, just after leading cardiovascular diseases, but the research on the veteran population is deficient. Wartime events always cause a large amount of stress associated with the emergence of malignant neoplasms. It is well-known that hormones such as cortisol, norepinephrine and adrenaline, which are released during stressful situations, change the immune status of the body and the ability to fight cancer. Thus, psychological and neurophysiological occurrences in the body are crucial for immune system functioning or the ability of the body to efficiently cope with stressful situations.
Adenokarcinom prostate najčešća je zloćudna neoplazma u muškaraca u Republici Hrvatskoj. Klinički je često asimptomatski, a najčešće se otkriva na osnovi povišenih vrijednosti PSA u serumu. Odluka o ...liječenju
donosi se na temelju TNM-klasifikacije, gradusne skupine i vrijednosti PSA. Klinički lokalizirana bolest vrlo se uspješno liječi radikalnom prostatektomijom ili radikalnom radioterapijom s hormonskom terapijom ili bez nje. Klinički lokalno uznapredovala bolest najčešće se liječi združenom primjenom radikalne radioterapije i hormonske
terapije. Metastatska bolest godinama se može kontrolirati androgenom deprivacijom, a nakon razvoja kastracijski rezistentne bolesti opravdani su kemoterapija ili dodatni oblici hormonske terapije. U radu su prikazane kliničke upute radi ujednačenja postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnika s rakom prostate u Republici Hrvatskoj.
Prostate cancer (PC) is known as an androgen-dependent tumor with testosterone as its natural growth factor, its action is mediated by the androgen receptor (AR) important for the biology and ...progression of PC. During aging a progressive decline in testosterone levels begins, caused by disability of aged Leydig cells to produce testosterone in response to luteinizing hormone. Surgical treatment of PC can influence the hypothalamic-pituitary-gonadal axis with less impact on it compared to patients treated with radiation. Patients with pre-operative low baseline testosterone level had mean Gleason score higher and AR expression was higher; significantly lower testosterone levels were recorded in patients with lymph node metastases. But some data are conflicting, and some results are opposite to those mentioned before. These data show that there is no significant association between all sex hormone in men and lethal PC or total mortality. In patients with metastatic PC, results showed that elevation of baseline androstenedione levels was predictive of prostate-specific antigen (PSA) response; higher baseline androstenedione levels were associated with an improved overall survival. In these patients, the relationship between serum testosterone and PC prognosis varies in different clinical settings and according to androgen deprivation therapy administration. Key words: Prostate Cancer, Androgen Deprivation Therapy, Metastatic Prostate Cancer, Serum Testosterone Karcinom prostate (KP) je androgen-ovisan tumor kojem je testosteron prirodni faktor rasta, njegovo djelovanje je posredovano putem androgenih receptora (AR) vanih za biologiju i progresiju KP. Tijekom starenja zapocinje progresivni pad serumske razine testosterona uzrokovan nesposobnocu ostarjelih Leydigovih stanica za stvaranje testosterona kao odgovor na stimulaciju luteinizirajuceg hormona. Kirurko lijecenje KP moe utjecati na os hipotalamus-hipofiza-gonade, ali s manjim utjecajem u usporedbi s pacijentima lijecenim radioterapijom. Kod pacijenata s niim preoperativnim razinama testosterona biljee se poviene srednje vrijednosti Gleason zbroja i pojacana ekspresija AR; znacajno nie razine testosterona zabiljeene su kod pacijenata s metastazama u limfnim cvorovima. Ipak, neki podaci su kontradiktorni i u suprotnosti s prethodno navedenim. Ovi podaci pokazuju da ne postoji znacajna povezanost izmedu spolnih hormona u mukaraca i letalnog KP te ukupnog mortaliteta. Kod pacijenata s metastatskim KP, elevacija pocetnih razina androstendiona se pokazala prediktivnom u odgovoru prostata-specificnog antigena (PSA) i poboljanju opceg preivljenja. Kod tih pacijenata, odnos izmedu serumskih razina testosterona i prognoze KP varira u razlicitim klinickim okolnostima i ovisno o aplikaciji androgen deprivacijske terapije. Kljucne rijeci: rak prostate, androgen deprivacijska terapija, metastatski karcinom prostate, testosteron u serumu
Karcinom prostate (KP) je androgen-ovisan tumor kojem je testosteron prirodni faktor rasta, njegovo djelovanje je posredovano putem androgenih receptora (AR) važnih za biologiju i progresiju KP. ...Tijekom starenja započinje progresivni pad serumske razine testosterona uzrokovan nesposobnošću ostarjelih Leydigovih stanica za stvaranje testosterona kao odgovor na stimulaciju luteinizirajućeg hormona. Kirurško liječenje KP može utjecati na os hipotalamus-hipofiza-gonade, ali s manjim utjecajem u usporedbi s pacijentima liječenim radioterapijom. Kod pacijenata s nižim preoperativnim razinama testosterona bilježe se povišene srednje vrijednosti Gleason zbroja i pojačana ekspresija AR; značajno niže razine testosterona
zabilježene su kod pacijenata s metastazama u limfnim čvorovima. Ipak, neki podaci su kontradiktorni i u suprotnosti s prethodno navedenim. Ovi podaci pokazuju da ne postoji značajna povezanost između spolnih hormona u muškaraca i letalnog KP te ukupnog mortaliteta. Kod pacijenata s metastatskim KP, elevacija početnih razina androstendiona se pokazala prediktivnom u odgovoru prostata-specifičnog antigena (PSA) i poboljšanju općeg preživljenja. Kod tih pacijenata, odnos između serumskih razina testosterona i prognoze KP varira u različitim kliničkim okolnostima i ovisno o aplikaciji androgen
deprivacijske terapije.
Adherence to European Association of Urology guidelines to refrain from giving neoadjuvant androgen deprivation therapy (ADT) before prostate cancer surgery is variable, especially in high-risk ...subgroups. Inappropriate ADT use may cause serious harm to patients and the consequences are burdensome and costly for health care providers and payers.
Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available.
To assess current ADT use before prostate cancer surgery in Europe.
This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres.
Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence.
We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one’s mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated.
EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued.
Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.
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