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Olavarria OA, Lyons NB, Bernardi K, Dhanani NH, Neela N, Arakelians A, Cohen BL, Mohebzad K, Coelho R, Holihan JL, Liang MK. Impact of disclosure of radiographic test results on quality of life among patients with hernias: a randomized controlled trial. Hernia 2024; 28:411-418. [PMID: 37369887 DOI: 10.1007/s10029-023-02824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Hernias noted on radiographic imaging are common. We aimed to determine if informing patients of the presence of a clinically apparent or occult hernia on imaging would change their abdominal wall quality of life (AW-QOL). METHODS This study was registered on clinicaltrials.gov (NCT04355819) in April 2020. Patients with a ventral hernia on elective CT abdomen/pelvis were enrolled. Patients underwent standardized abdominal examination by surgeons, and completed the modified Activities Assessment Scale, a validated, hernia-specific AW-QOL survey. On this scale, 1 is poor AW-QOL, 100 is perfect, and the minimally clinically important difference is five for a minor change. Patients were randomized to complete the one-year follow-up survey before or after being informed of the presence of a hernia on their imaging results. Primary outcome was follow-up AW-QOL adjusted for baseline AW-QOL. RESULTS Of 169 patients randomized, 126 (75%) completed follow up at one-year. Among patients with occult hernias, those who completed the follow-up survey after being informed of having a hernia had a lower follow-up AW-QOL (mean difference - 7.6, 95% CI = - 20.8 to 5.7, p = 0.261) compared to those who completed the survey before being informed. Conversely, for patients with clinical hernias, those who completed the survey after being informed had higher adjusted follow-up AW-QOL (mean difference 10.3, 95% CI = - 3.0 to 23.6, p = 0.126) than those that completed it after. CONCLUSION Conveying findings of hernias found on CT imaging can influence patients' AW-QOL. Future research should focus on identifying and addressing patients' concerns after disclosure of CT results.
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Affiliation(s)
- O A Olavarria
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N B Lyons
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Ryder Trauma Center, Suite T-215, 1800 NW 10Th Ave, Miami, FL, 33136, USA.
| | - K Bernardi
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N H Dhanani
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N Neela
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
| | - A Arakelians
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - B L Cohen
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Suite T-215, 1800 NW 10Th Ave, Miami, FL, 33136, USA
| | - K Mohebzad
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
| | - R Coelho
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
| | - J L Holihan
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M K Liang
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
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Soares P, Lima T, do Nascimento L, Coelho R, Franco D, Pereira A, Ferreira L. Co‐detection of copper and lead in artisanal sugarcane spirit using caffeic acid‐modified graphite electrodes. ELECTROANAL 2022. [DOI: 10.1002/elan.202200302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3
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Moutinho-Ribeiro P, Adem B, Batista I, Silva M, Silva S, Ruivo CF, Morais R, Peixoto A, Coelho R, Costa-Moreira P, Lopes S, Vilas-Boas F, Durães C, Lopes J, Barroca H, Carneiro F, Melo SA, Macedo G. Exosomal glypican-1 discriminates pancreatic ductal adenocarcinoma from chronic pancreatitis. Dig Liver Dis 2022; 54:871-877. [PMID: 34840127 DOI: 10.1016/j.dld.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
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Affiliation(s)
- P Moutinho-Ribeiro
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - B Adem
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - I Batista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - M Silva
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Silva
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro
| | - C F Ruivo
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - R Morais
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - A Peixoto
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - R Coelho
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - P Costa-Moreira
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Lopes
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - F Vilas-Boas
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - C Durães
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - J Lopes
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - H Barroca
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - F Carneiro
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S A Melo
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - G Macedo
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal.
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Bastos DA, Coelho R, Cardili L, Galiza F, Ilario EN, Viana P, Murta CB, Guglielmetti G, Cordeiro M, Pontes Jr J, Muniz DQB, Silva JA, Mota JM, Fialho de Freitas G, Leite KRM, Buchpiguel CA, Nahas WC. Randomized phase II trial of neoadjuvant androgen deprivation therapy plus abiraterone and apalutamide for patients with high-risk localized prostate cancer: Pathologic response and PSMA imaging correlates. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5085 Background: Patients (pts) with high-risk localized prostate cancer (HRLPC) have a significant risk of disease recurrence and metastasis after radical prostatectomy (RP). Neoadjuvant therapy remains investigational but there may be a role for the next-generation androgen signaling inhibitors. We sought to evaluate pathologic and imaging response after the intense neoadjuvant approach. Methods: This is a phase II investigator-initiated randomized trial of 3-month neoadjuvant therapy with goserelin (androgen deprivation therapy, ADT) + abiraterone acetate and prednisone (AAP arm) or AAP + apalutamide (A-APA arm) before RP for pts with HRLPC (Gleason ≥ 8 and/or cT3N0-1 and/or PSA ≥ 20 ng/mL). The primary endpoint was the rate of pathologic complete response (pCR) or minimal residual disease (MRD, tumor ≤ 0.5 cm). The secondary endpoints were safety, rate of residual cancer burden ≤0.25 cm3 (RCB = tumor volume x cellularity), Gallium 68 prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/magnetic resonance correlates and rate of biochemical relapse (BR). Results: Sixty-two pts were randomized to A-APA (N = 31) or AAP (N = 31). Median age was 65 (range 47-77) years. NCCN risk groups included high-risk disease in 19%, very high-risk in 76% and regional (N1) disease in 5% (79% cT3, 65% Gleason 8-10, 57% PSA ≥ 20 ng/mL). Outcomes after intense neoadjuvant ADT are described in the Table. There was no statistically significant difference between study arms regarding pCR/MRD or RCB ≤ 0.25 cm3 rates. Patients with complete PSMA-PET response (psmaCR) demonstrated a RCB ≤ 0.25 cm3 rate of 50% compared to 7.5% in pts without a psmaCR ( P= 0.001). The rate of BR was 14% for pts with RCB ≤ 0.25 cm3 versus 38% in pts with RCB > 0.25 cm3 ( P= 0.118). At current median follow-up of 2.6 years, all patients with both psmaCR and RCB ≤ 0.25cm3 (N = 11, 18%) are free of BR. There were 2 grade (G) 5 adverse events (AEs) in the AAP arm (pulmonary embolism and sudden death, both after surgery). Nine (14.5%) pts (6 in A-APA; 3 in AAP) experienced G3-4 treatment-related AEs. The most common G3-4 AEs were hypertension (11.3%), AST/ALT elevations (3.2%) and skin rash (1.6%). Conclusions: No difference in pCR or MRD was observed between arms. Although pCR or MRD after intense neoadjuvant ADT was infrequent, a significant proportion of pts achieved a favorable pathologic response with RCB ≤ 0.25 cm3. PSMA-PET response is a potential surrogate for pathologic response. Clinical trial information: NCT02789878. [Table: see text]
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Affiliation(s)
| | - Rafael Coelho
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Felipe Galiza
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Públio Viana
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | - Jose Pontes Jr
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Tozzi A, Coelho R, Disler M, Lombardo F, Fedier A, Nunez Lopez M, Freuler F, Jacob F, Heinzelmann-Schwarz V. 1P Comprehensive assessment of gene mutations revealed overlapping responses for PARPi and chemotherapy in ovarian cancer cells. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Ferreira J, Parreira L, Farinha JM, Esteves AF, Coelho R, Pinheiro A, Mesquita D, Marinheiro R, Amador P, Lopes A, Caria R. Specialty-related asymmetries in treatment and outcomes of younger patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is the most common arrhythmia and one of the most frequent motives for presentation in the emergency department (ED). However, there are still significant inequalities concerning its treatment.
Purpose
We aimed to assess if management and outcomes of patients with AF differed according to the specialty to which they were referred at hospital discharge.
Methods
We conducted a retrospective single-centre analysis including adult patients admitted to the ED in 2016 with the International Classification of Diseases codes correspondent to AF. Patients older than 75 years and those whose electronic medical file was not accessible were excluded. Patient referral at discharge was not based on any pre-specified criteria but rather performed at the discretion of the physician in the ED.
We divided our sample into 3 groups according to whom the patients were referred at hospital discharge: A) patients referred to an electrophysiologist; B) patients referred to a general cardiologist; and C) those referred to a non-cardiologist (general practitioner or internist).
We assessed patient characteristics, delay to first appointment, treatment strategies as well as stroke and all-cause mortality at 3 years of follow-up.
Results
Of the 372 patients initially screened, 184 were excluded due to age over 75 and 85 patients due to inaccessible medical records, resulting in a final sample of 103 patients with a median age of 65 (58-71) years and median CHA2DS2-VASc of 2 (1-3).
At discharge from the index admission, one third of patients were referred to an electrophysiologist (group A), 41% to a general cardiologist (group B) and the remaining 26% to a non-cardiologist (group C). There were no significant differences in baseline characteristics or type of AF between the groups.
The delay from index hospital admission to the first appointment was superior in groups A and B compared with C (3 and 2 vs 0 months, p=0.050).
Patients referred to an electrophysiologist were more frequently started on a rhythm-control strategy compared with those referred to other physicians (71% vs 38% and 26%, p=0.004). Similarly, significantly more patients in group A underwent catheter ablation (47% vs 12% and 4%, p<0.001), around 2 years after the diagnosis (tendentially earlier than those in group B).
At 3 years follow-up, mortality was higher in group C compared with the other groups (15% vs 0 in group A and 2% in group B, p=0.019). Stroke rates did not differ between groups.
Conclusion
In this group of AF patients, referral to an electrophysiologist at discharge was associated with a higher rate of a rhythm-control strategy, including catheter ablation. In the long-term, those patients showed better survival. These results suggest that, in patients under 75 years, an earlier referral to an electrophysiologist might be beneficial.
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Affiliation(s)
- J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - AF Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Marinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Lopes
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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Parreira A, Carmo P, Marinheiro R, Mesquita D, Marques L, Mancelos S, Ferreira A, Goncalves A, Nunes S, Chmelevsky M, Ferreira J, Coelho R, Goncalves P, Marques H, Adragao P. Assessment of activation duration across the right ventricular outflow tract in patients with premature ventricular contractions using noninvasive electrocardiographic mapping: a validation study. Europace 2022. [DOI: 10.1093/europace/euac053.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Learning Health
Introduction
Previous studies have reported that wavefront propagation speed across the right ventricular outflow tract (RVOT) can distinguish premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin.
Aim
Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of RVOT activation duration (AD) during PVCs and assess its value as a predictor of the origin of the PVCs.
Methods
We studied 18 consecutive patients, 8 males, median age 55 (35-63) years that underwent ablation of frequent (> 10.000 per 24 h) idiopathic PVCs with inferior axis, that had and an ECGI performed before ablation and the RVOT mapped in PVC. The ECGI was performed with the Amycard system, and invasive mapping was performed with the Carto or Ensite system. Isochronal activation maps of the RVOT in PVC were obtained with the activation direction method (ADM) of the ECGI, and with the Carto and Ensite systems. Total RVOT AD was measured as the time interval between the earliest and the latest activated region. Agreement between the two methods was performed using a Bland-Altman plot and linear regression . The cutoff value of AD to predict PVC origin was calculated with ROC curve.
Results
PVCs originated from the RVOT in 11 (61%) patients. The median (Q1-Q3) RVOT AD measured with ECGI was 54 (39-68) ms and with invasive map 57 (36-70) ms. The agreement between both methods was good with an R2 of 0.747, p<0.0001. Figure displays the Bland-Altman plot (panel A), the linear regression plot (panel B). and two examples of the ECGI isochronal map (panel C). The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and Carto, respectively 62 (58-73) vs 37 (33-40) ms, p<0.0001 and 68 (60-75) vs 34 (30-40) ms, p<0.0001. The cutoff value of 43 ms for AD measured with ECGI, predicted the origin of the PVCs with a sensitivity and specificity of 100%.
Conclusions
We found good agreement between ECGI and Carto. The AD obtained with ECGI was accurate to predict the origin of the PVCs.
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Affiliation(s)
| | - P Carmo
- Hospital Luz, Lisbon, Portugal
| | | | - D Mesquita
- Hospital Center of Setubal, Setubal, Portugal
| | - L Marques
- Hospital Center of Setubal, Setubal, Portugal
| | | | | | - A Goncalves
- Hospital Center of Setubal, Setubal, Portugal
| | - S Nunes
- Hospital Luz, Lisbon, Portugal
| | - M Chmelevsky
- Almazov National Medical Research Center, St Petersburg, Russian Federation
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
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Ferreira J, Fonseca M, Goncalves S, Farinha J, Esteves A, Pinheiro A, Coelho R, Costa C, Caria R. STEMI with mid-range ejection fraction: a group of intermediate risk not to be forgotten. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reduced left ventricular ejection fraction (LVEF) <40% is an important negative prognostic factor in the setting of ST-elevation acute myocardial infarction (STEMI). On the other hand, data concerning mid-range LVEF (mrEF) post-STEMI are scarce. Consequently, recommendations regarding reassessment of LVEF or administration of neurohormonal medication in this group of patients (pts) are also lacking.
Purpose
To assess the current treatment and prognosis of STEMI with mrEF.
Methods
Retrospective study including all consecutive pts hospitalized for STEMI and submitted to primary percutaneous coronary intervention in a Cardiology centre in 2018. Pts were divided into 3 groups according to LVEF assessed before hospital discharge: preserved EF (pEF: LVEF ≥50%), mid-range EF (mrEF: LVEF 40–49%) and reduced EF (rEF: LVEF <40%). We analysed clinical characteristics, treatment, evolution of LVEF post-STEMI and clinical outcomes - death, myocardial infarction (MI) and hospitalization for heart failure (HF) – of the mrEF group and compared it with pEF.
Results
188 pts with a mean age of 61 years were admitted for STEMI in 2018. The majority (58%, n=109) had pEF; 29% (n=55) had mrEF and 13% (n=24) were in the rEF group. Pts in the mrEF group had similar baseline characteristics to the others. However, compared with pEF, culprit-lesion was more often located in left main or left anterior descending arteries (80% vs 35%, p<0.001) and NT-proBNP levels were higher in mrEF pts (2270 vs 881 pg/mL, p<0.001).
At discharge, all mrEF patients were medicated with a renin-angiotensin-aldosterone blocker and 91% with a beta-blocker.
After a median of 8 months, LVEF improved a mean of 4% (± 9%) in the mrEF group. However, in 12.5% LVEF worsened to <40% (vs 0 in the pEF group, p=0.006).
At a median follow-up of 2.6 years, there was an increase in mortality according to the EF group (pEF 4% vs mrEF 13% vs rEF 48%, log-rank: p<0.001 – fig. 1) with a hazard ratio (adjusted for age) of 3.75 (95% CI 1.1–12.8, p=0.035) for mrEF vs pEF. There was also a non-significant tendency to higher rates of the composite endpoint of MI and hospitalization for HF in the mrEF group vs pEF (8.2% vs 2.9%, p=0.213).
Conclusions
This study confirms previous reports of the worse prognosis of STEMI with mrEF and suggests the existence of a continuum of risk of adverse clinical outcomes according to LVEF. Therefore, this group of intermediate risk might also benefit from neurohormonal medication, which is only specifically recommended for rEF in current STEMI guidelines. It also highlights the importance of a closer follow-up (with reassessment of LVEF) of mrEF pts since a non negligeable proportion ultimately progress to rEF and may require additional medical treatment or even an implantable cardioverter defibrillator. Further research with larger samples is required to identify predictors of worsening LVEF and assess the impact of neurohormonal modulation in this population.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier Survival Analysis
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Affiliation(s)
- J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - S Goncalves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - J.M Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A.F Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - C Costa
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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9
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Esteves A, Parreira L, Fonseca M, Farinha J, Ferreira J, Pinheiro A, Coelho R, Mesquita D, Amador P, Lopes A, Fonseca N, Caria R. Aortic plaques in patients with atrial fibrillation: an often-forgotten risk factor for thromboembolism. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
CHA2DS2-VASc risk score is the main determinant for maintaining anticoagulation after atrial fibrillation (AF) ablation, irrespective of the procedure outcome. The presence of aortic plaques is included in the score, but isn't regularly assessed previously to AF ablation. This way, risk factors for coronary artery disease (CAD) other than arterial hypertension and diabetes mellitus may influence stroke risk in patients with AF, albeit not being included in the CHA2DS2-VASc score.
Purpose
We sought to evaluate the prevalence of aortic plaques diagnosed during transesophageal echocardiography (TOE) in patients submitted to AF ablation and to assess its determinants and clinical impact on the CHA2DS2-VASc score.
Methods
Retrospective study of patients submitted to AF ablation that performed TOE prior to the procedure, with assessment of aortic plaques. CHA2DS2-VASc risk score was evaluated in the pre-ablation patient evaluation and reassessed after TOE. Demographic, clinical and echocardiographic data, including cardiovascular risk factors, were analyzed. We assessed AF recurrence rate, cerebrovascular events and death during follow-up.
Results
120 patients were submitted to TOE prior to AF ablation from November 2015 to December 2020, mean age 66.6 (±9.55) years, 48% male. In 30 (25%) patients aortic plaques were identified in TOE. Mean CHA2DS2-VASc was 2.2 (±1.47) in pre-ablation evaluation and 2.5 (±1.69) post-TOE, increasing in all patients with aortic plaques and prompting beginning of oral anticoagulation in 5 patients. AF was paroxysmal in 74% and persistent in 26% of patients, mean duration of 6.28 (±3.76) years. Arterial hypertension was present in 79 (66%) of patients, type 2 diabetes mellitus in 24 (20%) and dyslipidemia in 67 (56%). 17 (14%) patients had a prior stroke. During a mean follow-up of 30 (±18.3) months, 32 (27%) patients had AF recurrence and 10 (8%) were submitted to redo procedures. 107 (89%) patients remained under oral anticoagulation, stroke occurred in 1 patient and 2 patients died.
In univariate analysis, age, type 2 diabetes mellitus and dyslipidemia predicted an increase in CHA2DS2-VASc score after TOE (respectively, OR 1.113, 95% CI 1.041–1.190, p-value 0.002; OR 2.907, 95% CI 1.145–7.379, p-value 0.025; and OR 2.442, 95% CI 1.016–5.868, p-value 0.046).
In multivariate analysis, age is the only independent predictor of increased CHA2DS2-VASc score after TOE (OR 1.095, 95% CI 1.013–1.185, p-value 0.023). No risk factor for CAD was independently associated with the presence of aortic plaques (Table 1).
Conclusion
In this population, single CAD risk factors were not independent predictors of aortic plaques. If TOE had not been performed prior to AF ablation, 25% of patients would have had an underestimated CHA2DS2-VASc score and would be off anticoagulation after the procedure, unprotected from thromboembolic events.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- A.F Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - J.M Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Setubal, Portugal
| | - A Lopes
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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10
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Farinha J, Fonseca M, Parreira L, Esteves A, Pinheiro A, Ferreira J, Coelho R, Mesquita D, Marinheiro R, Amador P, Caria R. Left atrial stiffness measured by echocardiography is a stronger predictor of atrial fibrillation recurrence after radiofrequency catheter ablation than left atrial volume. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left atrial volume (LAV) is an accepted predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation, stronger than AF duration.
Objective
The aim of this study was to assess the value of left atrial stiffness (LAS) index as a new parameter evaluated by echocardiography to the prediction of AF recurrence after radiofrequency catheter ablation.
Methods
We retrospectively studied consecutive patients with paroxysmal or persistent AF submitted to radiofrequency catheter ablation at our institution between 2017 and 2019. We used transthoracic echocardiography to measure the LAV indexed to body surface area and the LAS index, defined as the ratio between the mitral E/e' (obtained with pulsed Doppler at the tip of the mitral leaflets – E, and tissue Doppler imaging at the mitral annulus – e') and the left atrial strain during the reservoir phase (obtained by speckle tracking echocardiography) [LAS index = (E/e') / LA reservoir strain]. The left ventricular ejection fraction (LVEF) was also evaluated. Patients with poor quality echocardiographic images were excluded. We compared 2 groups of patients, according to the recurrence of AF after the blanking period. We analysed the clinical characteristics and echocardiographic findings. The effect of clinical and echocardiography parameters on AF recurrence was evaluated by univariate and multivariate Cox Regression analysis.
Results
We studied 33 patients, 27 with paroxysmal AF and 6 with persistent AF. Baseline patients' characteristics are presented in Table 1. During a mean follow-up time of 17.9±10.4 months, 7 patients (21%) had AF recurrence, and none died. Patients with AF recurrence had a higher LAS index. After adjusting for confounding variables, only LAS index and LAV were independently associated with AF recurrence (Table 2). Every one unit increase in LAS index was associated with an 11-fold increased risk of AF recurrence (HR 10.86, 95% CI 1.38–85.56; p=0.024), while every one unit increase in LAV index was only associated with a 6% increased risk of AF recurrence (HR 1.06, 95% CI 1.01–1.11, p=0.010).
Conclusion
LAS index evaluated by echocardiography was a much stronger predictor of AF recurrence after radiofrequency catheter ablation than left atrial volume.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J.M Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A.F Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Marinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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11
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Farinha JM, Parreira L, Esteves AF, Fonseca M, Pinheiro A, Ferreira J, Coelho R, Mesquita D, Marinheiro R, Amador P, Caria R. Patients with reflex syncope have a higher prevalence of atrial fibrillation than general population which is predicted by the type of the tilt table test response. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF).
Objective
The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF.
Methods
We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF.
Results
We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043).
Conclusions
Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J M Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A F Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Marinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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12
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Candjondjo A, Ferreira J, Esteves A, Farinha J, Fonseca M, Coelho R, Gama L, Sa C, Lopes A, Fernandes A, Perdigao A, Seixo F, Fonseca N, Santos R, Caria R. Predictors of patient and system delay for primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The delay times of the patient and the system for primary percutaneous coronary intervention (p-PCI) have a determining impact on the prognosis of patients with acute myocardial infarction with ST segment elevation (STEMI).
Purpose
To identify the predictors of patient and system delay for p-PCI in the period of 2020 at a reference hospital for p-PCI.
Methods
Patients submitted to p-PCI in the period from March to September 2020 were included and compared with the same period in 2019. We analyzed the differences between the two groups regarding the patient's delay times, time from the onset of symptoms to the first medical contact (FCM) and the system (time from the first contact with the health system to p-ICP). Data collection of the patient's previous history, coronary intervention performed and post-PCI follow-up was performed using the electronic patient record. Univariate analysis and logistic regression models from multivariate analysis were used to determine the predictors of “patient delay” and “system delay” and adjusted for confounding factors. The analysis was performed with a significance level of 5%.
Results
We included in the study 255 patients who underwent p-PCI, of which 122 in the period from 2020 and 133 in the period from 2019. Regarding the characteristics of the population, there were no significant differences between the two periods. Regarding the patient's delay time, there were no statistically significant differences. The variable first medical contact with a non p-PCI center was the only variable associated with system delay>90 minutes in the multivariate analysis, OR (6.18: 95% CI, 1.91–20), p=0.002. There was a statistically significant association between the period of 2020 (pandemic period) and total ischemia time, but with a negative effect, dependent variable adjusted for confounding factors [adjusted OR: −0.10; 95% CI: −107.61 to −5.57; p=0.03].
Conclusion
In this study, the patient's admission to a non p-PCI centers was identified as the only predictor of longer delay until p-PCI (system delay). However, these results should serve as a contribution to decision making in order to mitigate risks, regardless of any associated catastrophe and eventually alert the population not to neglect the symptoms suspected of acute myocardial infarction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - A Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - J Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - L Gama
- Unidade local de Saúde do Litoral Alentejano, EPE, Alentejo, Portugal
| | - C Sa
- Centro Hospitalar Barreiro/Montijo, EPE / Hospital Nossa Senhora do Rosário, Setúbal, Portugal
| | - A Lopes
- Hospital Center of Setubal, Setubal, Portugal
| | - A Fernandes
- Hospital Center of Setubal, Setubal, Portugal
| | - A Perdigao
- Hospital Center of Setubal, Setubal, Portugal
| | - F Seixo
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Santos
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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13
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Bhat KRS, Covas Moschovas M, Sandri M, Reddy S, Onol FF, Noel J, Rogers T, Schatloff O, Coelho R, Ko YH, Roof S, Rocco B, Patel VR. Stratification of Potency Outcomes Following Robot-Assisted Laparoscopic Radical Prostatectomy Based on Age, Preoperative Potency, and Nerve Sparing. J Endourol 2021; 35:1631-1638. [PMID: 34569807 DOI: 10.1089/end.2021.0141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: To identify factors affecting potency and to predict ideal patient subgroups who will have the highest chance of being potent after robot-assisted laparoscopic prostatectomy (RALP) based on nerve sparing (NS). Materials and Methods: Analysis of 7268 patients who underwent RALP between 2008 and 2018 with a minimum of 12 months of follow-up was performed. The patients were then categorized into four separate neurovascular bundle-sparing groups (NVB 1-4). A Cox regression analysis was used to determine the independent factors predicting potency outcomes. Cumulative incidence functions were used to depict the probability and time to potency between the NS groups stratified by age and preoperative sexual health inventory in men (SHIM). Results: Cox regression analysis of age, preoperative SHIM score, and grades of NS significantly predicted potency outcomes post-RALP. Patients with SHIM score ≥22 had a better chance of potency vs patients with SHIM <17 (odds ratio [OR]: 1.69, confidence interval [CI]: 1.47-1.79). NVB1 had better potency vs NVB4 (OR: 3.1, CI: 2.51-3.83). Patients <55 years with NVB1 and no preoperative erectile dysfunction had the best potency rates of 92.5%. However, we did not see any statistical difference between NVB2 and NVB3 in this group, implying that in patient groups with SHIM ≥22 and age <55, NVB1 provided the best chance of potency recovery. As age increased and preoperative SHIM worsened, the curves corresponding to NVB 2 and 3 showed significant differences, suggesting that NVB 2 and 3 may be predictive in unfavorable age and preoperative SHIM groups, especially NVB 2 > NVB 3. Conclusions: Preoperative SHIM, age, and NS are the most influential factors for potency recovery following RALP. Patients with good baseline sexual function had similar postoperative potency, irrespective of their grades of partial NS. In patients with decreased baseline SHIM and older age, a higher grade of partial NS resulted in a significantly better potency compared with a lower grade of partial nerve spare.
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Affiliation(s)
| | | | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Sunil Reddy
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
| | - Fikret F Onol
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
| | - Jonathan Noel
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
| | - Travis Rogers
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
| | | | - Rafael Coelho
- Department of Urology, Institute of Laparoscopy and Robotics, São Paulo, Brazil
| | - Young Hwii Ko
- Department of Urology, Yeungnam University, Daegu, Republic of Korea
| | - Shannon Roof
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Vipul R Patel
- Global Robotics Institute, Advent Health Celebration Health, Celebration, Florida, USA
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14
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Khauli R, Ferrigno R, Guimarães G, Bulbulan M, Uson Junior PLS, Salvajoli B, Palhares DMF, Racy D, Gil E, de Arruda FF, Lemos GC, Carvalhal GF, de Carvalho IT, Martins IAF, Gimpel IFP, Salvajoli JV, Chambo JL, Pontes J, Filho LAR, Nogueira L, Freitas MRP, Wroclawski M, Arap MA, Sadi MV, Coelho R, Gadia R, Roja RAL, Hanriot RDM, Baroni R, Zequi S, Nahas WC, Alfer W, Maluf FC. Treatment of Localized and Locally Advanced, High-Risk Prostate Cancer: A Report From the First Prostate Cancer Consensus Conference for Developing Countries. JCO Glob Oncol 2021; 7:530-537. [PMID: 33856890 PMCID: PMC8162969 DOI: 10.1200/go.20.00421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To generate and present survey results on important issues relevant to treatment and follow-up of localized and locally advanced, high-risk prostate cancer (PCa) focusing on developing countries. METHODS A panel of 99 PCa experts developed more than 300 survey questions of which 67 questions concern the main areas of interest of this article: treatment and follow-up of localized and locally advanced, high-risk PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up of localized and locally advanced, high-risk PCa in areas of limited resources discussed in this article. RESULTS The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion and not on a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations considered cost-effectiveness as well as the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. Results were tabulated in real time. CONCLUSION The voting results and recommendations presented in this article can guide physicians managing localized and locally advanced, high-risk PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment of localized and locally advanced, high-risk PCa in developing countries have not been defined, this article will serve as a point of reference when confronted with this disease.
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Affiliation(s)
- Raja Khauli
- Naef K. Basile Cancer Institute, Beirut, Lebanon
| | | | | | | | | | - Bernardo Salvajoli
- Instituto do Câncer de São Paulo, São Paulo, Brazil.,Hospital do Coração, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - João Victor Salvajoli
- Instituto do Câncer de São Paulo, São Paulo, Brazil.,Hospital do Coração, São Paulo, Brazil
| | | | - José Pontes
- Instituto do Câncer de São Paulo, São Paulo, Brazil
| | | | - Lucas Nogueira
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | | | | | - Stenio Zequi
- Hospital do Câncer AC Camargo, São Paulo, Brazil
| | | | | | - Fernando Cotait Maluf
- Hospital BP, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
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15
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Esteves AF, Parreira L, Fonseca M, Farinha JM, Pinheiro A, Ferreira J, Coelho R, Mesquita D, Amador P, Fonseca N, Santos R, Seixo F, Costa C, Caria R. Rapid atrial fibrillation increases cardiac biomarkers: decision to perform coronary angiography based on novel high-sensitivity Troponin I peak. Europace 2021. [DOI: 10.1093/europace/euab116.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Since January 2018 the availability of high sensitivity Troponin I (hsTnI) has improved ischemia diagnosis. In patients with rapid atrial fibrillation (AF), the decision to undergo coronary angiography is usually due to elevated cardiac biomarkers. However, evidence to support the rentability of this approach is sparse.
Purpose
Evaluate if hsTnI in patients with rapid AF and elevated cardiac biomarkers has a good discriminative power to predict a positive coronary angiography.
Methods
We retrospectively studied consecutive patients admitted to the emergency department (ED) between January 2018 and December 2019 with rapid AF that underwent coronary angiography and had multiple hsTnI values obtained. We analysed risk factors, initial and peak hsTnI, time from ED admission to peak hsTnI and ST-T segment abnormalities (ST depression and/or T wave inversion). We evaluated the presence of significant coronary artery stenosis with the need of revascularization at coronary angiography. Univariable and multivariable analysis was performed to obtain the Odds Ratio (OR, 95% CI, p-value) for significant coronary artery disease (CAD).
Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of peak hsTnI as predictor of a positive coronary angiography. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value.
Results
From 1407 patients admitted to the ED with rapid AF, 30 patients, 60% male, median age 74 (IQR 61.25-80.75) years, were submitted to coronary angiography. Significant coronary artery stenosis was present in 17 (57%) patients.
Age, ST-T segment abnormalities and peak hsTnI were predictors of significant CAD, respectively 1.203, 1.064-1.361, 0.003; 25.00, 3.522-177.477, 0.001; and 1.000, 1.000-1.001, 0.015.
Optimal cut-point value for predicting the presence of significant coronary artery stenosis at coronary angiography was a peak hsTnI of 359 pg/mL (AUC 0.869, p-value 0.001, 95% CI 0.742-0.995). The two groups with hsTnI < 359 and hsTnI >359 differed in age and ST-T segment abnormalities (see Table).
After adjustment, peak hsTnI >359 pg/mL was the only independent predictor of significant CAD (23.894, 1.310-435.669, 0.032).
Conclusion
In this group of patients with rapid AF, peak hsTnI >359 pg/mL was the only independent predictor of significant coronary artery disease. Therefore, those patients should undergo coronary angiography. Abstract Figure.
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Affiliation(s)
- AF Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Santos
- Hospital Center of Setubal, Setubal, Portugal
| | - F Seixo
- Hospital Center of Setubal, Setubal, Portugal
| | - C Costa
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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16
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Esteves AF, Parreira L, Mesquita D, Fonseca M, Farinha JM, Pinheiro A, Ferreira J, Coelho R, Amador P, Lopes A, Fonseca N, Caria R. Optimal percentage of biventricular pacing to obtain CRT response: how high is high enough. Europace 2021. [DOI: 10.1093/europace/euab116.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The greatest benefit with cardiac resynchronization therapy (CRT) is achieved when biventricular pacing (BivP) percentage (%) is close to 100%. However, in some patients that goal can be challenging to obtain.
Purpose
Determine whether a lower BivP% could lead to similar CRT response and events, as compared with patients with BivP% >98%.
Methods
Patients with CRT followed up in a remote-monitoring network were retrospectively analyzed. BivP% was assessed and response to CRT was defined as an absolute increase in left ventricle ejection fraction (LVEF) >5% or a relative increase in LVEF >15%.
Low BivP% was defined as <98%. Clinical, echocardiographic data and all-cause death during follow-up were evaluated. ROC curve and AUC were obtained to determine the discriminative power of BivP% as predictor of CRT response. Optimal cut-point value was obtained and patients were divided according to this value. Kaplan-Meyer survival function was used to compare survival in the different groups and the Log-rank test was used for comparison between the groups.
Results
88 patients, 76% male, median age 73.5 (IQR 65.75-79.25) years were included. A CRT-D was implanted in 69%. Etiology was ischemic in 44%. 93% were under beta-blockers. Median LVEF before CRT was 27% (IQR 20.25-32).
44 patients (50%) had low BivP% (median 91%, IQR 96-99), 55% due to atrial fibrillation and 52% due to frequent premature ventricular complexes. After optimization of medical therapy, device programming and/or interventional procedures, we obtained a BivP >98% in 26 out of the 44 patients (59%). However, in 18 patients (20%) BivP% was <98% (median 95, IQR 92.25-96). 66% patients were CRT responders. Median follow-up was 36 (IQR 23.75-84) months. During follow-up, all-cause mortality was 27% (24 patients).
Optimal cut-point value for predicting CRT response was 91% BivP% (AUC 0.644, p-value 0.047, 95% CI 0.496-0.792). The characteristics of the two groups didn’t differ significantly (Table).
Survival was significantly higher in patients with BivP% >91% (Log-rank 3.667, p-value 0.050) – Figure.
Conclusion
In this population, BivP% >91% was sufficient to achieve CRT-response and was associated with a better survival. BivP% <91%(n = 4)BivP% >91%(n = 84)p-valueAge in years, median (IQR)72.50 (70.50-73.75)74.00 (65.00-80.00)0.666CRT-D, n (%)3 (75.0)58 (69.0)0.999Ischemic cardiopathy, n (%)3 (75.0)35 (41.7)0.311LVEF before CRT, median (IQR)27 (19-39)27 (20-32)0.795Beta-blockers, n (%)4 (100.0)78 (95.1)0.999Abstract Figure.
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Affiliation(s)
- AF Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Setubal, Portugal
| | - A Lopes
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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17
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Ferreira J, Fonseca M, Costa C, Farinha JM, Esteves AF, Pinheiro A, Coelho R, Silvestre I, Caria R. Clinical impact of transoesophageal echocardiography in acute brain ischaemia: who should we select? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Stroke is a prevalent disease and is still the leading cause of death in Portugal. Transoesophageal echocardiography (TOE) is a sensitive test often performed to detect embolic sources. However, since its most common findings such as patent foramen ovale (PFO) and atheroma plaques do not necessarily mandate a change in treatment, there is still debate over its clinical impact in the context of brain ischaemia (BI) and which patients (pts) should be submitted to it.
Purpose
To assess the clinical impact of TOE following BI and to identify clinical and diagnostic testing results that could help predict which pts benefit from it.
Methods
A retrospective study was conducted including all pts submitted to TOE in our hospital after acute BI in 2018 and 2019. Clinical and testing data (brain, vascular and cardiac imaging and 24h-Holter monitoring) was analysed and compared between 2 groups: the pts who had findings in TOE compatible with a source of embolism which resulted in a change in treatment ("relevant TOE" group) vs all other pts who had no such findings or whose findings did not result in change in treatment ("others"). Predictors of relevant TOE were also analysed.
Results
Of the 87 pts (mean age of 57 and maximum of 83) included in the study, 51 (59%) had findings compatible with a potential source of embolism in TOE, PFO being the most common (n = 42). In only half of them did these findings result in a change in treatment (the relevant TOE group: n = 25; 29% of the overall population).
Age and other baseline characteristics did not significantly differ between groups. Pts with a relevant TOE presented more often with visual-field defects (32% vs 10%, p = 0.020) and were more likely to have visible acute lesions on brain imaging (96% vs 76%, p = 0.032) compared with the others. There was also a borderline significant association between the presence of infarct in the territory of the superior cerebellar artery and a relevant TOE (p = 0.054). On the contrary, the presence of significant lesions in extracranial arteries was negatively associated with a relevant TOE (p = 0.016).
Considering the whole population, there were no transthoracic echocardiography (TTE) predictors of a relevant TOE but when analysing only younger patients (age < 50), the presence of any abnormality in TTE became associated with a relevant TOE (OR 8.5, CI 1.1-63.9; p = 0.044). We found no predictors of relevant TOE in 24h-Holter results.
Conclusions
TOE commonly identified potential sources of brain embolism, which proved relevant in half the cases. In the impossibility of submitting all BI patients to TOE, this study suggests that brain and vascular imaging rather than age or other baseline characteristics may be useful in predicting a relevant result. Moreover, TTE does not seem to be an adequate screening method to select patients for TOE, except possibly in younger patients. Studies with larger samples are needed to confirm these results.
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Affiliation(s)
- J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - C Costa
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - AF Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - I Silvestre
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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18
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Cheong SL, Yau SL, Silva G, Coelho R. Unusual cutaneous manifestations and congenital hearing loss in a patient with GJB2 (F142L) mutation. Clin Exp Dermatol 2021; 46:1338-1340. [PMID: 33914937 DOI: 10.1111/ced.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S L Cheong
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macau SAR, China
| | - S L Yau
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macau SAR, China
| | - G Silva
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macau SAR, China
| | - R Coelho
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macau SAR, China
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19
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Ferreira J, Fonseca M, Farinha JM, Esteves AF, Pinheiro A, Coelho R, Goncalves S, Costa C, Caria R. Acute coronary syndrome in COVID-19 times: could it be business as usual? European Heart Journal. Acute Cardiovascular Care 2021. [PMCID: PMC8135328 DOI: 10.1093/ehjacc/zuab020.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background In an attempt to cope with the COVID-19 pandemic, several measures of social distancing and reorganization of health care systems have been adopted. In Portugal, these included suspending elective clinical activity and a temporary national lockdown. Data from multiple centres, including central hospitals in Portugal, has shown a reduction in hospital admissions for acute coronary syndrome (ACS) during the COVID-19 outbreak. Fear of going to the hospital and physical inactivity have been pointed as possible explanations. Purpose to assess the impact of this pandemic and the measures taken against it on the pattern of admissions and treatment of patients with ACS in a district hospital. Methods A single-centre retrospective study was conducted in the Cardiology Department of a Portuguese district hospital, capable of performing 24h percutaneous coronary intervention. We analyzed the admissions for ACS during the peak of the first COVID-19 outbreak in Portugal (16th of March to 3rd of May 2020, coinciding with the suspension of elective activity) and compared it with two control periods: one immediately preceding the study period (27th of January to 15th of March - 2020 control) and one exactly one year before (16th of March to 3rd of May 2019 - 2019 control). Results During the 7 weeks of the first COVID-19 outbreak, 46 patients were hospitalized for ACS in our department, while 54 had been admitted during the 2020 control period and 40 in the 2019 control period, with a mean of 7 admissions/week (vs 8 and 6, respectively; p > 0.05). There were no significant differences between the study group and both controls regarding basal characteristics. Their presentation did not differ: the majority of patients (57%) was admitted for ST-elevation myocardial infarction and median time from symptom onset to admission to the emergency room was 3 hours, with 4% of patients presenting in Killip class ≥III (p > 0.05 for all). We also found no significant differences in the treatment administered nor in the outcomes (96% submitted to coronary angiography, median length of hospitalization of 4 days and in-hospital mortality rate of 2%, p > 0.05 for all). Conclusions Our study suggests that the reduction in admissions for ACS during the COVID-19 outbreak is not universal. Additionally, severity at presentation, treatment administered and outcomes did not seem to differ. The relatively low prevalence of COVID-19 in our hospital"s region might be the cause, since people might fear and refrain less from going to the hospital. Larger studies with other centres in low-prevalence regions are needed to confirm this hypothesis.
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Affiliation(s)
- J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - AF Esteves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - S Goncalves
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - C Costa
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
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20
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Tandogdu Z, Collins J, Shaw G, Rohn J, Koves B, Sachdeva A, Ghazi A, Haese A, Mottrie A, Kumar A, Sivaraman A, Tewari A, Challacombe B, Rocco B, Giedelman C, Wagner C, Rogers CG, Murphy DG, Pushkar D, Ogaya-Pinies G, Porter J, Seetharam KR, Graefen M, Orvieto MA, Moschovas MC, Schatloff O, Wiklund P, Coelho R, Valero R, de Reijke TM, Ahlering T, Rogers T, van der Poel HG, Patel V, Artibani W, Wagenlehner F, Maes K, Rha KH, Nathan S, Bjerklund Johansen TE, Hawkey P, Kelly J. Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement. BJU Int 2021; 127:729-741. [PMID: 33185026 DOI: 10.1111/bju.15299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.
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Affiliation(s)
- Zafer Tandogdu
- Department of Urology, University College London Hospital, London, UK.,Medical School, University College London, London, UK
| | - Justin Collins
- Department of Urology, University College London Hospital, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Jennifer Rohn
- Medical School, University College London, London, UK
| | - Bela Koves
- Department of Urology, Budapest Hospital, Budapest, Hungary
| | - Ashwin Sachdeva
- Department of Urology, NHS Foundation Trust, Freeman Hospital, Newcastle Upon-Tyne, UK
| | - Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Alexander Haese
- Leitender Arzt für Roboterassistierte Urologie, Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
| | - Anup Kumar
- Department Urology, Robotics and Renal Transplant, Safdarjang Hospital and VMMC, New Delhi, India
| | | | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bernardo Rocco
- Department of Urology AOU di Mldena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Christian Wagner
- Head of Robotic Urology, St. Antonius - Hospital Gronau, Gronau, Germany
| | - Craig G Rogers
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | | | | | | | | | - Markus Graefen
- Martini-Klinik, University-Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael Coelho
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rair Valero
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Travis Rogers
- Adventhealth Global Robotics Institute, Celebration, FL, USA
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vipul Patel
- Adventhealth Global Robotics Institute, Celebration, FL, USA
| | | | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Koon H Rha
- Department of Urology, Institute of Urological Science, Yonsei University, Seoul, Korea
| | - Senthil Nathan
- Department of Urology, University College London Hospital, London, UK
| | | | - Peter Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - John Kelly
- Department of Urology, University College London Hospital, London, UK.,Medical School, University College London, London, UK
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21
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Otaola-Arca H, Coelho R, Patel VR, Orvieto M. Totally intracorporeal robot-assisted urinary diversion for bladder cancer (Part 1). Review and detailed characterization of ileal conduit and modified Indiana pouch. Asian J Urol 2021; 8:50-62. [PMID: 33569272 PMCID: PMC7859455 DOI: 10.1016/j.ajur.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To review the most used robot-assisted cutaneous urinary diversion (CUD) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images Methods A non-systematic review of the literature with the keywords “bladder cancer”, “cutaneous urinary diversion”, and “radical cystectomy” was performed. Results Twenty-four studies of intracorporeal ileal conduit (ICIC) and two of intracorporeal Indiana pouch (ICIP) were included in the analysis. Regarding ICIC, the patients’ age ranged from 60 to 76 years. The operative time to perform a urinary diversion ranged from 60 to 133 min. The total estimated blood loss ranged from 200 to 1 117 mL. The rate of positive surgical margins ranged from 0% to 14.3%. Early minor and major complication rates ranged from 0% to 71.4% and from 0% to 53.4%, respectively. Late minor and major complication rates ranged from 0% to 66% and from 0% to 32%, respectively. Totally ICIP data are limited to one case report and one clinical series. Conclusion The most frequent type of CUD is ICIC. Randomized studies comparing the performance of the different types of CUD, the performance in an intra- or extracorporeal manner, or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature. To this day, there are not enough quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images for each technique.
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Affiliation(s)
- Hugo Otaola-Arca
- Department of Urology, Clínica Alemana, Santiago, Chile.,School of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Rafael Coelho
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, Brazil
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, United States
| | - Marcelo Orvieto
- Department of Urology, Clínica Alemana, Santiago, Chile.,School of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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22
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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23
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Romanelli M, Coelho R, Coster D, Ferreira J, Fleury L, Henderson S, Hollocombe J, Imbeaux F, Jonsson T, Kogan L, Meneghini O, Merle A, Pinches SD, Sauter O, Tardini G, Yadykin D, Smith S, Strand P, WPCD Team. Code Integration, Data Verification, and Models Validation Using the ITER Integrated Modeling and Analysis System (IMAS) in EUROfusion. Fusion Science and Technology 2020. [DOI: 10.1080/15361055.2020.1819751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Romanelli
- UKAEA, Culham Science Centre, Abingdon, OX143DB, United Kingdom
| | - R. Coelho
- ISFN, Instituto Superior Técnico, Lisbon, Portugal
| | - D. Coster
- Max-Planck Institute for Plasma Physics, Garching, Germany
| | - J. Ferreira
- ISFN, Instituto Superior Técnico, Lisbon, Portugal
| | - L. Fleury
- CEA, IRFM, Saint-Paul-lez-Durance, France 13067
| | - S. Henderson
- UKAEA, Culham Science Centre, Abingdon, OX143DB, United Kingdom
| | - J. Hollocombe
- UKAEA, Culham Science Centre, Abingdon, OX143DB, United Kingdom
| | - F. Imbeaux
- CEA, IRFM, Saint-Paul-lez-Durance, France 13067
| | - T. Jonsson
- Royal Institute of Technology, Stockholm, Sweden
| | - L. Kogan
- UKAEA, Culham Science Centre, Abingdon, OX143DB, United Kingdom
| | | | - A. Merle
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015, Lausanne, Switzerland
| | - S. D. Pinches
- ITER Organization, 13067 St Paul-lez-Durance Cedex, France
| | - O. Sauter
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015, Lausanne, Switzerland
| | - G. Tardini
- Max-Planck Institute for Plasma Physics, Garching, Germany
| | - D. Yadykin
- SEE, Chalmers University of Technology, Gothenburg, Sweden
| | - S. Smith
- General Atomics, San Diego, California
| | - P. Strand
- SEE, Chalmers University of Technology, Gothenburg, Sweden
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24
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Huang YL, Liang CY, Ritz D, Coelho R, Septiadi D, Estermann M, Rimmer N, Vlajnic T, David L, Rothen-Rutishauser B, Jacob F, Heinzelmann-Schwarz V. Integrin α2-collagen interaction promotes ovarian cancer metastasis. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Y.-L Huang
- Universitätsspital Basel, Department of Biomedicine
| | - C.-Y Liang
- Universitätsspital Basel, Department of Biomedicine
| | - D Ritz
- Universität Basel, Biozentrum
| | - R Coelho
- University of Porto, Institute of Molecular Pathology and Immunology of the University of Porto
| | - D Septiadi
- University of Fribourg, Adolphe Merkle Institute
| | - M Estermann
- University of Fribourg, Adolphe Merkle Institute
| | - N Rimmer
- Universitätsspital Basel, Department of Biomedicine
| | - T Vlajnic
- Universitätsspital Basel, Institute of Pathology
| | - L David
- University of Porto, Institute of Molecular Pathology and Immunology of the University of Porto
| | | | - F Jacob
- Universitätsspital Basel, Department of Biomedicine
| | - V Heinzelmann-Schwarz
- Universitätsspital Basel, Department of Biomedicine
- Universitätsspital Basel, Gynecological Cancer Center
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25
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Porter J, Blau E, Gharagozloo F, Martino M, Cerfolio R, Duvvuri U, Caceres A, Badani K, Bhayani S, Collins J, Coelho R, Rocco B, Wiklund P, Nathan S, Parra-Davila E, Ortiz-Ortiz C, Maes K, Dasgupta P, Patel V. Society of Robotic Surgery review: recommendations regarding the risk of COVID-19 transmission during minimally invasive surgery. BJU Int 2020; 126:225-234. [PMID: 32383520 PMCID: PMC7267386 DOI: 10.1111/bju.15105] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To determine the risk of COVID‐19 transmission during minimally invasive surgical (MIS) procedures Methods Surgical society statements regarding the risk of COVID transmission during MIS procedures were reviewed. In addition, the available literature on COVID‐19 and other viral transmission in CO2 pneumoperitoneum, as well as the presence of virus in the plume created by electrocautery during MIS was reviewed. The society recommendations were compared to the available literature on the topic to create our review and recommendations to mitigate COVID‐19 transmission. Results The recommendations promulgated by various surgical societies evolved over time as more information became available on COVID‐19 transmission. Review of the available literature on the presence of COVID‐19 in CO2 pneumoperitoneum was inconclusive. There is no clear evidence of the presence of COVID‐19 in plume created by electrocautery. Technologies to reduce CO2 pneumoperitoneum release into the operating room as well as filter viral particles are available and should reduce the exposure risk to operating room personnel. Conclusion There is no clear evidence of COVID‐19 virus in the CO2 used during MIS procedures or in the plume created by electrocautery. Until the presence or absence of COVID‐19 viral particles has been clearly established, measures to mitigate CO2 and surgical cautery plume release into the operating room should be performed. Further study on the presence of COVID‐19 in MIS pneumoperitoneum and cautery plume is needed.
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Affiliation(s)
- James Porter
- Department of Urology, Swedish Medical Centre, Seattle, WA, USA
| | - Elliot Blau
- Department of Urology, Swedish Medical Centre, Seattle, WA, USA
| | - Farid Gharagozloo
- Center for Advanced Thoracic Surgery, Florida Hospital Celebration Health, University of Central Florida, Celebration, FL, USA
| | - Martin Martino
- Department of Gynaecologic Oncology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Robert Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Aileen Caceres
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Ketan Badani
- Department of Urology, Mount Sinai Medical School, New York, NY, USA
| | - Sam Bhayani
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Rafael Coelho
- Department of Urology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, Brazil
| | - Bernard Rocco
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Senthil Nathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | - Kris Maes
- Center for Robotic and Minimally Invasive Surgery, Hospital da Luz Lisboa, Lisboa, Portugal
| | | | - Vipul Patel
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, Orlando, FL, USA
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Cerejeira A, Cunha S, Coelho R, Macedo G, Barkoudah E, Azevedo F, Lisboa C. Perianal warts as a risk marker for anal high-risk-human papillomavirus (HPV) detection and HPV-associated diseases. J Eur Acad Dermatol Venereol 2020; 34:2613-2619. [PMID: 32713086 DOI: 10.1111/jdv.16834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Genital warts are the most common sexually transmitted infection (STI) and are caused by human papillomavirus (HPV). Persistent anal infection by oncogenic genotypes of HPV is a determinant for anal cancer. Currently, anal cancer screening is not widely implemented. OBJECTIVES Our aim is to evaluate the role of perianal warts as a risk marker for anal high-risk (HR) HPV detection and anal dysplasia. METHODS In this observational, retrospective, cohort study of attendees of a STI outpatient clinic between January 2010 and June 2018, all human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) who performed anal cytology, anal HPV DNA detection and anoscopy were included. A comparison was made between patients with and without perianal warts. Primary endpoint: proportion of patients with an abnormal anal cytology. Secondary endpoints: proportion of patients with (i) anal HR-HPV detection; (ii) anal HPV 16 detection; (iii) abnormal anal biopsy; and (iv) anal high-grade squamous intraepithelial lesion (HSIL). RESULTS Seventy-eight individuals were included: 39 with perianal warts and 39 without perianal warts. Subjects with perianal warts more frequently had an abnormal anal cytology (71.8% vs. 38.5%; P = 0.003). This group also had a higher rate of anal HPV 16 detection (38.5% vs. 12.8%; P = 0.01). No differences were detected in the proportion of patients with anal HR-HPV detection, with an abnormal anal biopsy or with anal HSIL. Perianal warts was an independent risk factor for an abnormal anal cytology (OR: 7.2) and for anal HPV 16 detection (OR: 6.7). CONCLUSION Given the high risk of anal cancer in HIV-positive MSM, effective screening strategies are greatly needed. This study suggests that the presence of perianal warts is a suitable risk marker for anal HPV 16 detection and anal dysplasia.
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Affiliation(s)
- A Cerejeira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, EPE Porto, Porto, Portugal
| | - S Cunha
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - R Coelho
- Department of Gastroenterology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - G Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - E Barkoudah
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - F Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, EPE Porto, Porto, Portugal
| | - C Lisboa
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, EPE Porto, Porto, Portugal.,Microbiology Service, Department of Pathology and CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Bastos DA, Mattedi RL, Barreiro R, dos Santos FF, Buzatto V, Masotti C, Souza JM, de Lima MZT, Friguglietti GW, Dzik C, Jardim DLF, Coelho R, Ribeiro Filho LA, Cordeiro MD, Nahas WC, de Mello ES, Chammas R, Reis LFL, Bettoni F, Galante PAF, Camargo AA. Genomic Biomarkers and Underlying Mechanism of Benefit from BCG Immunotherapy in Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND: Optimal therapy for high-risk non-muscle invasive bladder cancer (NMIBC) includes intravesical instillation of Bacillus Calmette-Guérin (BCG). However, about 25-45% of patients do not benefit from BCG immunotherapy, and there is no biomarker to guide therapy. Also, many questions regarding BCG mechanisms of action remain unanswered. OBJECTIVE: To identify genomic biomarkers and characterize the underlying mechanism of benefit from BCG in NMIBC. PATIENTS AND METHODS: Pre-treatment archival index-tumors of 35 patients with NMIBC treated with BCG were analyzed by whole-exome sequencing (WES). Tumor mutation burden (TMB) and neoantigen load (NAL) were correlated with BCG response rate (RR) and recurrence-free survival (RFS). The presence of deleterious mutations in DNA damage response (DDR) genes was also compared between BCG-responsive (BCG-R, N = 17) and unresponsive (BCG-UR, N = 18) subgroups. RESULTS: TMB and NAL were higher in BCG-R compared to BCG-UR patients (median TMB 4.9 vs. 2.8 mutations/Mb, P = 0.017 and median NAL 100 vs. 65 neoantigens, P = 0.032). Improved RR and RFS were observed in patients with high vs. low TMB (RR 71% vs. 28%, P = 0.011 and mRFS 38.0 vs. 15.0 months, P = 0.009) and with high vs. low NAL (RR 71% vs. 28%, P = 0.011 and mRFS 36.0 vs. 18.5 months, P = 0.016). The presence of deleterious mutations in DDR genes was associated with improved RFS (mRFS 35.5 vs. 11.0 months, P = 0.017). CONCLUSIONS: In our cohort, improved outcomes after BCG immunotherapy were observed in patients with high TMB, high NAL and deleterious mutations in DDR genes. BCG may induce tumor-specific immune response by enhancing the recognition of neoantigens.
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Affiliation(s)
- Diogo A. Bastos
- Medical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Romulo L. Mattedi
- Department of Pathology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Barreiro
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
- Department of Biochemistry, Chemistry Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Vanessa Buzatto
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Cibele Masotti
- Translational Oncology Center, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Jussara M. Souza
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | | | - Carlos Dzik
- Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Department of Urology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Maurício D. Cordeiro
- Department of Urology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - William C. Nahas
- Department of Urology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Evandro S. de Mello
- Department of Pathology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Roger Chammas
- Translational Oncology Center, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Fabiana Bettoni
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Rodrigues G, Sierra P, Albuquerque E, Gallucci FP, Ilario EN, de Carvalho PA, Muniz DQB, Sarkis A, Coelho R, Cordeiro M, Nahas WC. Neutrophil-to-lymphocyte ratio as a predictor of oncologic outcomes in locally advanced non-metastatic clear cell renal carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
661 Background: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse oncologic outcomes in several malignancies, its prognostic role in kidney cancer, specifically in the non metastatic setting is controversial. We aimed to evaluate if an elevated NLR in patients with locally advanced non metastatic clear cell renal cell carcinoma (CCRCC) is associated with a worse survival and/or a higher cancer recurrence rate. Methods: We retrospectively identified 880 nephrectomies performed between 01/2009 to 12/2016 in a single center, reviewed data from 478 consecutive radical nephrectomies (RN) for kidney tumors and identified 187 patients with locally advanced non-metastatic CCRCC patients (pT3-T4 N0M0). The cut-off point of NLR = 2.5 was obtained using the receiver operating curve analysis (ROC). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. Cox regression models were utilized to evaluate predictors of recurrence and survival. Results: Median follow up was 48.7 months. The 3 year OS was significantly lower for patients with NLR ≥ 2.5 than those with NLR < 2.5 (70% vs 85%, p = 0.049). In patients with a Fuhrman nuclear grade of differentiation of 3-4, the median time to recurrence was significantly shorter for patients with NLR ≥ compared to those with NLR < 4 (24 vs 55 months p 0.045). On multivariable analysis adjusted for NLR ≥ 2.5, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index, only nuclear grade of differentiation was found to be an independent predictor for recurrence (hazard ratio= 2.18; 95% confidence interval [CI]: 1.07 – 4.92, p = 0.03). Conclusions: Patients with non-metastatic CCRCC with higher nuclear grade of differentiation and a high preoperative NLR have shorter RFS and worse OS compared to patients with lower NLR.
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Affiliation(s)
| | - Pablo Sierra
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | | | | | | | | | | | - Alvaro Sarkis
- São Paulo State Cancer Institute-University of São Paulo, São Paulo, Brazil
| | - Rafael Coelho
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Bellomo C, Alonso D, Coelho R, Iglesias A, Periolo N, Martínez V. A newborn infected by Andes virus suggests novel routes of hantavirus transmission: a case report. Clin Microbiol Infect 2020; 26:130-131. [DOI: 10.1016/j.cmi.2019.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
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Oliveira L, Descalço A, Silva A, Coelho R, Martins Â, Ferreira R. Which central apnea index must support further investigation? 5-years at a paediatric sleep laboratory. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coelho R, Descalço A, Paixão E, Martins Â, Silva A, Oliveira L, Ferreira R. Reliability of QuePedS in the screening of pediatric sleep disordered breathing. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Magro F, Lopes S, Silva M, Coelho R, Portela F, Branquinho D, Correia L, Fernandes S, Cravo M, Caldeira P, Sousa HT, Patita M, Lago P, Ramos J, Afonso J, Redondo I, Machado P, Cornillie F, Lopes J, Carneiro F. Low Golimumab Trough Levels at Week 6 Are Associated With Poor Clinical, Endoscopic and Histological Outcomes in Ulcerative Colitis Patients: Pharmacokinetic and Pharmacodynamic Sub-analysis of the Evolution Study. J Crohns Colitis 2019; 13:1387-1393. [PMID: 30989180 DOI: 10.1093/ecco-jcc/jjz071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Golimumab has an established exposure-response relationship in patients with ulcerative colitis [UC]. However, the association of serum golimumab trough levels [TL] with objective markers of disease activity, such as endoscopic and histological activity scores and concentrations of biomarkers, remains less understood. This report describes the relationship of serum golimumab TL at the end of the induction period [Week 6] with clinical, endoscopic, histological, and biomarker parameters. METHODS This was an open-label, uncontrolled, prospective and interventional study. Moderate to severely active UC patients naïve to biologic therapy were treated with golimumab. Serum golimumab TL and faecal calprotectin levels were measured at baseline [Week 0 of induction] and Week 6. RESULTS A total of 34 patients completed the induction phase [Week 6] and were included in this analysis. Overall, 47.1% and 14.7% of patients achieved clinical response and remission with significantly higher serum golimumab TL in patients with early response or remission [3.7 μg/mL vs 1.3 μg/mL, p = 0.0013; and 3.1 μg/mL vs 1.7 μg/mL, p = 0.0164, respectively]. In addition, golimumab TL were significantly higher in patients achieving histological remission [4.2 μg/mL vs 1.7 μg/mL, p = 0.0049]. Week 6 golimumab TL were inversely correlated with the total Mayo score [rs = -0.546; p = 0.0008], the Mayo endoscopic subscore [rs = -0.381; p = 0.0262], the Geboes histological activity score [rs = -0.464; p = 0.0057], and faecal calprotectin levels [rs = -0.497; p = 0.0044]. CONCLUSIONS A higher early exposure to golimumab is associated with a better objective response in active UC patients and appears to drive the outcome at Week 6.
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Affiliation(s)
- F Magro
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - S Lopes
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - M Silva
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - R Coelho
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - F Portela
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - D Branquinho
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - L Correia
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - S Fernandes
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - M Cravo
- Hospital Beatriz Ângelo, Departamento de Gastrenterologia, Loures, Portugal
| | - P Caldeira
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - H T Sousa
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - M Patita
- Hospital Garcia de Orta, Departamento de Gastrenterologia, Almada, Portugal
| | - P Lago
- Centro Hospitalar do Porto, Departamento de Gastrenterologia, Porto, Portugal
| | - J Ramos
- Centro Hospitalar Lisboa Central, Departamento de Gastrenterologia, Lisboa, Portugal
| | - J Afonso
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - I Redondo
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | - P Machado
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | | | - J Lopes
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Carneiro
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto [Ipatimup], i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Onol FF, P Ganapathi H, Rogers T, Palmer K, Coughlin G, Samavedi S, Coelho R, Jenson C, Sandri M, Rocco B, Patel V. Changing clinical trends in 10 000 robot-assisted laparoscopic prostatectomy patients and impact of the 2012 US Preventive Services Task Force's statement against PSA screening. BJU Int 2019; 124:1014-1021. [PMID: 31301265 DOI: 10.1111/bju.14866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate the clinical trend changes in our robot-assisted laparoscopic prostatectomy (RALP) practice and to investigate the effect of 2012 US Preventive Services Task Force (USPSTF) statement against PSA screening on these trends. PATIENTS AND METHODS Data of 10 000 RALPs performed by a single surgeon between 2002 and 2017 were retrospectively analysed. Time trends in successive 1000 cases for clinical, surgical and pathological characteristics were analysed with linear and logistic regression. Time-trend changes before and after the USPSTF's statement were compared using a logistic regression model and likelihood-ratio test. RESULTS Unfavourable cancer characteristics rate, including D'Amico high risk, pathological non-organ-confined disease and Gleason score ≥4+4 increased from 11.5% to 23.3%, 14% to 42.5%, and 7.7% to 20.9%, respectively, over time (all P < 0.001). Significant time-trend changes were detected after the USPSTF's statement with an increase in the positive trend of Gleason ≥4+4 and increase in the negative trends of Gleason ≤3+4 tumours. There was a significant negative trend in the rate of full nerve-sparing (NS) with a decrease from 59.3% to 35.7%, and a significant positive trend in partial NS with an increase from 15.8% to 62.5% over time (both P < 0.001). The time-trend slope in 'high-grade' partial NS significantly decreased and 'low-grade' partial NS significantly increased after the USPSTF's statement. The overall positive surgical margin rate increased from 14.6% to 20.3% in the first vs last 1000 cases (P < 0.001), with a significant positive slope after the USPSTF's statement. CONCLUSIONS The proportion of high-risk patients increased in our series over time with a significant impact of the USPSTF's statement on pathological time trends. This stage migration resulted in decreased utilisation of high-quality NS and increased performance of poor-quality NS.
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Affiliation(s)
- Fikret F Onol
- Florida Hospital Global Robotics Institute, Celebration, FL, USA
| | | | - Travis Rogers
- Florida Hospital Global Robotics Institute, Celebration, FL, USA
| | - Kenneth Palmer
- Florida Hospital Global Robotics Institute, Celebration, FL, USA
| | | | | | - Rafael Coelho
- Department of Urology, Instituto do Cancer, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
| | - Cathy Jenson
- Florida Hospital Global Robotics Institute, Celebration, FL, USA
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Vipul Patel
- Florida Hospital Global Robotics Institute, Celebration, FL, USA
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Ogaya-Pinies G, Abdul-Muhsin H, Palayapalayam-Ganapathi H, Bonet X, Rogers T, Rocco B, Coelho R, Hernandez-Cardona E, Jenson C, Patel V. Safety of Live Robotic Surgery: Results from a Single Institution. Eur Urol Focus 2019; 5:693-697. [DOI: 10.1016/j.euf.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/19/2017] [Accepted: 08/05/2017] [Indexed: 10/19/2022]
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Coelho M, Coelho R. O5 The Needs of Health Literacy on Sexuality and Affections in Adolescence - a systematic review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz098.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Coelho
- University Hospital- North Lisbon Center, Lisbon, PORTUGAL
| | - R Coelho
- Family Health Unit of São João da Talha, ACES Loures-Odivelas, Sacavém, PORTUGAL
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Viana P, Rodrigues T, Mota DAM, Guglielmetti G, Bastos DA, Fazoli A, Nahas WC, Coelho R, Cordeiro M, Horvat N. Tumor contact length used as a biomarker to predict extracapsular extension, lymph node involvement, and biochemical recurrence. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16588 Background: Prostate cancer (PC) is the cancer most commonly diagnosed in men and the second leading cause of death. Multiparametric magnetic resonance imaging (mpMRI) is the benchmark imaging standard for local staging of PC. Patients with pathological extraprostatic tumor (pEPE) have a worse prognosis than those with confined organ disease with a higher risk of biochemical recurrence (BCR) after radical prostatectomy (RP). These factors, in addition to positive lymph nodes (PLN), are pivotal in the decision-making process regarding treatment. However, the subjective MRI analysis has low sensitivity in the detection of EPE and is plagued by the low interobserver agreement. Tumor contact length (TCL) is an objective parameter of mpMRI defined as the length of prostate cancer in contact with the prostate capsule, which may provide additional information about prostate cancer outcomes. We aimed to evaluate TCL as a predictor of pECE, PLN, and BCR in patients undergoing RP. Methods: In this Institutional Review Board approved single-institution prospective study, we update the follow-up of 148 patients and included 31 new patients, with prostate cancer who underwent prostate MRI before radical prostatectomy from March 2014 to november 2018. TCL was measured using T2-weighted magnetic resonance images.Postoperative prostate-specific antigen (PSA) values were obtained every 3 months in the first year, then biannually and annually thereafter. BCR was defined as PSA≥0.2ng/mL. The exclusion criterion was prior treatment. Results: The median follow-up was 44 months. 76/179 (42,4%) patients had pEPE, 12/179 (6,7%) had pLN, and 29/179 (16,2%) had BCR. TCL values were significantly higher in patients with pathological pECE ( 20,6 mm vs 9,9 mm, p < 0.001). Using a cut-off of 11,9 mm we found area under curve (AUC) of 0,71 to predict pathological ECE, with sensitivity 72,5% and specificity 67,5% . Using a cut-off of 16,5 mm we found AUC of 0,64 to predict BCR, with sensitivity 54,2% and specificity 67,8% and with a cut-off of 21,7 mm the AUC to predict PLN was 0,77, with sensitivity 66,7% and specificity 83,6%. Conclusions: We prospectively demonstrated in our population that TCL values were significantly higher in patients with pEPE , PLN and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making.
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Affiliation(s)
- Públio Viana
- Cancer Institute of São Paulo University (ICESP) - Radiology Department, São Paulo, Brazil
| | | | | | | | | | - Arnaldo Fazoli
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Rafael Coelho
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Natally Horvat
- Radiology Department, São Paulo Cancer Institute, São Paulo, Brazil
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Viana P, Horvat N, Pessoa RR, Horvat J, Park R, Guglielmetti G, Bastos DA, Cordeiro M, Coelho R, Vargas HA, Nahas WC. Multiparametric magnetic resonance imaging (mpMRI) and PSA density for the prediction of reclassification among patients under active surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16606 Background: To study the role of mpMRI and PSA density in predicting the likelihood of disease reclassification on re-biopsy and on final pathology among men with low-risk prostate cancer (PCa) enrolled in active surveillance (AS) protocol. Methods: In this IRB-approved prospective study, consecutive patients on AS for low-risk PCa (clinical stage cT1–T2a, Gleason score ≤6, serum PSA < 10 ng/mL, no more than 3 positive cores on biopsy, and all biopsy cores with < 50% of tumor involvement) from March 2015 to August 2017 were selected. The exclusion criteria were previous PCa treatment, contraindication to mpMRI or transrectal ultrasound-guided (TRUS) biopsy. All patients underwent mpMRI ≥3 months from initial biopsy and MRI-targeted TRUS-guided re-biopsy within 6-12 months. One experienced radiologist evaluated all mpMRI studies using the PI-RADS v2. The performance of mpMRI and PSA density for the prediction of reclassification on re-biopsy and final pathology was assessed. A single genitourinary pathologist reviewed all the final specimens who was blinded to the initial biopsy results. Results: A total of 154 patients were included in the final analysis. Among patients classified as PI-RADS ≤3, 11/69 (15.9%) were upgraded on re-biopsy whereas 65/85 (76.5%) were upgraded among those with PI-RADS 4 or 5 lesions. With regards to prostatectomy 7/49 (14.2%) patients classified as PI-RADS ≤3 were upgraded, while 42/49 (85.7%) were upgraded among those with PI-RADS 4 or 5. mpMRI sensitivity was 85.5% and specificity 74.4% on re-biopsy and 85.7% and in predicting upgrade on reclassification. Patients with PI-RADS 4 or 5 and PSA density > 0.15 ng/mL/cm3 had 94.6% of chance of having clinically significant PCa, while patients with PI-RADS 1, 2 or 3 and PSA density ≤ 0.08 ng/mL/cm3 had only 4.2% probability. Conclusions: mpMRI and PSA density are significant tools for predicting severity reclassification on re-biopsy and final pathology among patients under active surveillance. Reclassification was low among patients with PI-RADS ≤3 and low PSA density. Overall, patients with PI-RADS 4 or 5 and PSA density > 0.15 were almost invariably found to harbor significant prostate cancer.
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Affiliation(s)
- Públio Viana
- Cancer Institute of São Paulo University (ICESP) - Radiology Department, São Paulo, Brazil
| | - Natally Horvat
- Radiology Department, São Paulo Cancer Institute, São Paulo, Brazil
| | | | - Joao Horvat
- University Hospital of Sao Paulo, Sao Paulo, Brazil
| | - Rubens Park
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | - Rafael Coelho
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Brás JP, Pinto S, Almeida MI, Prata J, von Doellinger O, Coelho R, Barbosa MA, Santos SG. Peripheral Biomarkers of Inflammation in Depression: Evidence from Animal Models and Clinical Studies. Methods Mol Biol 2019; 2011:467-492. [PMID: 31273717 DOI: 10.1007/978-1-4939-9554-7_28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Depression is a highly prevalent psychiatric condition, with over 300 million sufferers, and is an important comorbidity for other conditions, like cardiovascular disorders or diabetes. Therapy is largely based on psychotherapy and/or pharmacological intervention, particularly aimed at altering neurotransmitter levels in the central nervous system, but inadequate response to treatment remains a significant clinical problem. Herein, evidence supporting a molecular link between inflammation and depression will be discussed, particularly the increased prevalence of depression in chronic inflammatory diseases and the evidence on the use of anti-inflammatory drugs to treat depression. Moreover, the potential for the levels of peripheral inflammatory molecules to act as depression biomarkers, in the diagnosis and monitoring of depression will be examined, considering clinical- and animal model-based evidence.
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Affiliation(s)
- J P Brás
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - S Pinto
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M I Almeida
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - J Prata
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - O von Doellinger
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - R Coelho
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M A Barbosa
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - S G Santos
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Prata J, Machado AS, von Doellinger O, Almeida MI, Barbosa MA, Coelho R, Santos SG. The Contribution of Inflammation to Autism Spectrum Disorders: Recent Clinical Evidence. Methods Mol Biol 2019; 2011:493-510. [PMID: 31273718 DOI: 10.1007/978-1-4939-9554-7_29] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Autism comprises a complex and heterogeneous spectrum of neurodevelopmental disorders, usually termed autism spectrum disorders (ASD). It is more prevalent in males than females, and genetic and environmental factors are believed to account in similar percentages to the development of ASD. In recent years, the contribution of inflammation and inflammatory mediators to disease aetiology and perpetuation has been the object of intense research. In this chapter, inflammatory aspects that contribute to ASD are discussed, including abnormal microglia activation and polarization phenotypes, increased systemic levels of pro-inflammatory mediators, and altered patterns of immune cell response to activation stimuli. Also, inflammation in the context of gut microbiome and the impact of inflammation on gender prevalence of ASD are considered. Finally, treatment impact on inflammatory parameters and the potential for use of anti-inflammatory drugs, alone or in combination with antipsychotics, to manage ASD are examined.
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Affiliation(s)
- J Prata
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A S Machado
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar UniversitÃrio São João, Porto, Portugal
| | - O von Doellinger
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - M I Almeida
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - M A Barbosa
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - R Coelho
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Centro Hospitalar UniversitÃrio São João, Porto, Portugal
| | - S G Santos
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
- INEB-Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) encompasses other symptoms besides inattention, hyperactivity, and impulsivity, such as language problems. ADHD can have a non-remitting course and is also found in older individuals, although there are no studies on language problems in elderly individuals with the disorder.
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Affiliation(s)
- Rafael Coelho
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | - Paulo Mattos
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rosemary Tannock
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,Ontario Institute of Studies in Education, University of Toronto, Toronto, ON, Canada
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Coelho R, Ricardo S, Theodorakis I, Jacob F, David L, Amaral A. PO-247 Mesothelin regulates invasion and peritoneal metastization of ovarian cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Viana P, Rodrigues T, Pachani D, Horvat N, Carvalho AF, Guglielmetti G, Coelho R, Bastos DA, Nahas WC. Can tumor contact length predict extracapsular extension, lymph node involvement, and biochemical recurrence? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Públio Viana
- Cancer Institute of São Paulo University (ICESP) - Radiology Department, São Paulo, Brazil
| | | | - Danilo Pachani
- Radiology Department, University of São Paulo, São Paulo, Brazil
| | - Natally Horvat
- Radiology Department, São Paulo Cancer Institute, São Paulo, Brazil
| | - Arnaldo Fazoli Carvalho
- Sao Paulo State Cancer Institute - Urology Department of University of Sao Paulo, São Paulo, Brazil
| | | | - Rafael Coelho
- Sao Paulo Cancer Institute ICESP - University of Sao Paulo FMUSP, São Paulo, Brazil
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Murta CB, Pontes Jr J, Furuya TK, Uno M, Carrasco A, Sichero L, Villa LL, Cordeiro M, Guglielmetti G, Coelho R, Leite KRM, Srougi M, Chammas R, Nahas WC. Correlation of microRNA expression profile and prognosis of penile cancer: A prospective study using microarray data analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jose Pontes Jr
- Laboratory of Medical Research, Urology Department, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Tatiane Katsue Furuya
- Cancer Institute of Sao Paulo. University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miyuki Uno
- Cancer Institute of Sao Paulo. University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alexis Carrasco
- Cancer Institute of Sao Paulo. University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Laura Sichero
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Luisa Lina Villa
- University of Sao Paulo, Cancer Institute of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Rafael Coelho
- Sao Paulo Cancer Institute ICESP - University of Sao Paulo FMUSP, São Paulo, Brazil
| | - Katia Ramos Moreira Leite
- Laboratory of Medical Research, Urology Department, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Roger Chammas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Secin FP, Coelho R, Monzó Gardiner JI, Salcedo JGC, Puente R, Martínez L, Finkelstein D, Valero R, León A, Angeloni D, Rozanec J, Berger M, Cavazzola LT, Faria EF, Machado RD, Lott F, Campos F, Morales Montor JG, Moreno CS, Barrios HD. Robotic surgery in public hospitals of Latin-America: a castle of sand? World J Urol 2018; 36:595-601. [PMID: 29459996 DOI: 10.1007/s00345-018-2227-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION There is no information about the evolution of robotic programs in public hospitals of Latin-America. OBJECTIVE To describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date. METHODS We conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25-75 centiles (IQR) were estimated. RESULTS Since 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs. CONCLUSION Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.
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Affiliation(s)
| | | | | | | | | | - Levin Martínez
- Hospital de Clínicas, Facultad de Medicina - Universidad de la República, Montevideo, Uruguay
| | - Diana Finkelstein
- Hospital de Trauma Federico Abete, Malvinas Argentinas, Buenos Aires, Argentina
| | - Rair Valero
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Antonio León
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Daniel Angeloni
- Hospital Escuela de Agudos Dr. Ramón Madariaga, Misiones, Argentina
| | - José Rozanec
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Milton Berger
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | | | - Felipe Lott
- Brazilian National Cancer Institute, INCA, Rio do Janeiro, Brazil
| | - Franz Campos
- Brazilian National Cancer Institute, INCA, Rio do Janeiro, Brazil
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Paul G, Aranha M, Fogliato F, Lorenzini F, Coelho R, Von Linsingen R, Stunitz L. O-13 Venous Priapism with More than 36 Hours of Evolution - Description of Management and Outcome of 05 Cases Treated in the State of Paraná – Brazil. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Margalha Miranda A, Loureiro H, Ferreira S, Coelho R, Anacleto V. An older people's disease in a child – a case report of obstructive sleep apnea and arterial hypertension treated by continuous positive airway pressure. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coelho R, Descalço A, Paixão E, Oliveira L, Silva A, Martins Â, Ferreira R. Obstructive sleep apnea syndrome and facial dysmorphisms in paediatric age. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guillemaut C, Drewelow P, Matthews G, Kukushkin A, Pitts R, Abreu P, Brezinsek S, Brix M, Carman P, Coelho R, Devaux S, Flanagan J, Giroud C, Harting D, Lowry C, Maggi C, Militello F, Perez Von Thun C, Solano E, Widdowson A, Wiesen S, Wischmeier M, Wood D. Main chamber wall plasma loads in JET-ITER-like wall at high radiated fraction. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2017.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Viana PÃCC, Horvat N, Guglielmetti G, Coelho R, Nahas WC, Park R, Bezerra R, Bastos DA, Rodrigues T, Vargas HA. The accuracy of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS v2 in disease upgrading on re-biopsy among patients with low-risk prostate cancer (PCa) on active surveillance (AS): A Brazilian perspective. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5084 Background: The current selection criteria to AS is critical and it becomes even more relevant in Latin America, given the higher proportion of high risk cancers. The objective of this study is to analyze the accuracy of mpMRI using PI-RADS v2 in predicting the risk of upgrading on re-biopsy (UR) in men with low-risk PCa on AS. Methods: In this Institutional Review Board approved prospective study, patients with low-grade PCa selected for AS at our institution underwent mpMRI at least 6 weeks after the baseline 12-core random prostate biopsy (BSB), from March 2014 to March 2016. One blinded abdominal radiologist evaluated the exams regarding presence of dominant lesion and assigned the PI-RADS v2 score. MRI-target transrectal ultrasound-guided re-biopsies were performed in all patients within 6-12 months after the BSB. Standardized 12-core biopsy was performed and additional cores were taken from suspicious areas on mpMRI. Results: One hundred and nine patients were included, 93 (85.3%) patients had a dominant lesion on MRI. mpMRI were classified as PI-RADS 1, 2 or 3 in 67 (61.5%) patients, and as PI-RADS 4 or 5 in 42 (38.5%) patients. UR occurred in 42 (38.5%) patients. Out of these, 39 (92.8%) had radical prostatectomy, 6 (15.4%) T2a, 24 (61.5%) T2b, and 9 (23.1%) T3a. The diagnostic performance of mpMRI for PCa upgrading after re-biopsy was summarized in table 1. Patients assigned as PI-RADS 4 or 5 presented a significantly higher risk for UR compared with patients with PI-RADS 1, 2 or 3 (73.8% vs 16.4%, p < 0.001). Logistic regression analyses demonstrated that PI-RADS 4 or 5 remained a significant predictor of UR (OR: 37.366, p < 0.0001). Conclusions: We demonstrated in our population that mpMRI using PI-RADS v2 is a significant predictor for upgrading on re-biopsy in patients on AS and could be used to guide TRUS biopsy, increasing the accuracy of current clinical criteria for AS. [Table: see text]
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Affiliation(s)
| | | | | | - Rafael Coelho
- Sao Paulo Cancer Institute ICESP - University of Sao Paulo FMUSP, São Paulo, Brazil
| | | | - Rubens Park
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - Diogo Assed Bastos
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
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Lestingi JFP, Guglielmetti G, Pontes Jr J, Mitre AI, Sarkis A, Bastos DA, Riechelmann R, Mattedi RL, Cordeiro M, Coelho R, Srougi M, Nahas WC. Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5018 Background: The role of extended pelvic lymph node dissection (ePLND) in treating prostate cancer (PCa) patients remains controversial, mainly by the lack of RCTs. Methods: Patients with D'Amico intermediate or high risk PCa, absence of bone metastasis and no previous treatment were prospectively computer randomised to undergo extended or limited PLND (1:1) during radical prostatectomy. Limited PLND (lPLND) included the obturator chain bilaterally; ePLND involved bilaterally chains: obturator, external-, internal-, common-iliac and pre-sacral. Surgical specimens and each chain were analyzed separately, according to College of American Pathologists. All patients signed a free and informed consent and local ethics committee approved the study. The primary endpoint was biochemical recurrence-free survival, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01812902. Results: Since May 2012 until August 2016, 291 patients were randomly assigned, 145 to ePLND and 146 to lPLND. Preoperative data were comparable between groups. Median follow-up was 35.2 months. EPLND increased significantly operative time (54 minutes), estimated blood loss (100 mL), length of hospital stays (1 day) [p≤0.001], transfusion rate [p = 0.05] and postoperative complications according to Clavien scale [p = 0.03]. There was no difference in Pathologic Gleason grade, T stage or positive surgical margin. On ePLND and lPLND groups, 59.3% and 61.7% were staged ≥ pT3a, respectively. EPLND and lPLND yielded median (mean) 17 (19.8) and 3 (4.1) nodes, respectively (p < 0.001). EPLND showed 6.3 times more lymph node metastases (p < 0.001) and only it was able to show positive nodes in intermediate risk. There were no difference in biochemical recurrence (PSA ≥ 0.2 ng/mL) using Kaplan-Meyer method (p = 0.4), Radiotherapy, Androgen Deprivation Therapy, bone metastases or death. Conclusions: Extended lymphadenectomy in intermediate- and high-risk prostate cancer patients is associated with better tumor staging, increased morbidity and no oncological benefits in this initial short follow-up time. Clinical trial information: NCT01812902.
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Affiliation(s)
| | | | - Jose Pontes Jr
- Laboratory of Medical Research, Urology Department, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Alvaro Sarkis
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
| | - Diogo Assed Bastos
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
| | - Rachel Riechelmann
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
| | - Romulo Loss Mattedi
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
| | - Mauricio Cordeiro
- Sao Paulo State Cancer Institute - University of Sao Paulo, São Paulo, Brazil
| | - Rafael Coelho
- Sao Paulo Cancer Institute ICESP - University of Sao Paulo FMUSP, São Paulo, Brazil
| | | | - William Carlos Nahas
- Sao Paulo Cancer Institute ICESP - University of Sao Paulo FMUSP, São Paulo, Brazil
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