Long non-coding RNAs and renal cell carcinoma

BACKGROUND

To provide an overview of the importance of long non-coding RNAs (lncRNAs) in the pathogenesis of renal cell carcinoma and their utility as bio-markers for dia-gnosis, prognosis and prediction of treatment response.

MATERIALS AND METHODS

A literature search in the Pubmed and Web of Science databases using the keywords variations of “long non-coding RNA” (“lncRNA”, “long noncoding RNA”, “long non-coding RNA”) and “renal cell carcinoma” (“renal cancer”, “renal cell carcinoma”, “kidney cancer”) was performed. The results related to the pathogenesis, dia-gnosis, prognosis and use as therapeutic targets were separated.

RESULTS

Long non-coding RNAs regulate gene expression at different levels. They act both as oncogenes and tumor suppressors. The mechanism of their action has not been fully elucidated, but they are actively involved in the regulation of hypoxia inducible factors pathway, epithelial-mesenchymal transition, cell proliferation, cell cycle regulation, apoptosis, local invasion and development of metastases. Aberrant expression in tumor tissue compared to healthy parenchyma and the correlation of expression levels with clinical-pathological features allow the potential use of many lncRNAs as bio-markers for early detection and prognosis of the disease, including the response to targeted therapy. In vitro assays indicate the potential use of lncRNAs as therapeutic targets.

CONCLUSION

Our knowledge of long non-coding RNAs in relation to renal cell carcinoma is increasing rapidly. At present, some of them can be considered as promising bio-markers. Further research is needed before they can be introduced into routine clinical practice.

Fast and accurate compensation of signal offset for T2 mapping

OBJECTIVE

T₂ maps are more vendor independent than other MRI protocols. Multi-echo spin-echo signal decays to a non-zero offset due to imperfect refocusing pulses and Rician noise, causing T₂ overestimation by the vendor's 2-parameter algorithm. The accuracy of the T₂ estimate is improved, if the non-zero offset is estimated as a third parameter. Three-parameter Levenberg-Marquardt (LM) T₂ estimation takes several minutes to calculate, and it is sensitive to initial values. We aimed for a 3-parameter fitting algorithm that was comparably accurate, yet substantially faster.

METHODS

Our approach gains speed by converting the 3-parameter minimisation problem into an empirically unimodal univariate problem, which is quickly minimised using the golden section line search (GS).

RESULTS

To enable comparison, we propose a novel noise-masking algorithm. For clinical data, the agreement between the GS and the LM fit is excellent, yet the GS algorithm is two orders of magnitude faster. For synthetic data, the accuracy of the GS algorithm is on par with that of the LM fit, and the GS algorithm is significantly faster. The GS algorithm requires no parametrisation or initialisation by the user.

DISCUSSION

The new GS T₂ mapping algorithm offers a fast and much more accurate off-the-shelf replacement for the inaccurate 2-parameter fit in the vendor's software.

Mantle cell lymphoma diagnosed from radical prostatectomy for prostate adenocarcinoma: a case report

We present a case of 64 - year - old man with mantle cell lymphoma (MCL) diagnosed in radical prostatectomy for adenocarcinoma. Lymphoma of the prostate, either primary or secondary, is a rare entity. The prognosis of lymphoma involving the prostate is usually poor. The most common form of leukemia/lymphoma involving the prostate is that of chronic lymphocytic leukemia/lymphoma (CLL/SLL). Mantle cell lymphoma of the prostate is an exceedingly rare entity. The association between MCL and urologic cancer was previously described, however the etiologic connection between these two conditions remains unknown. The pathologists should pay attention to all lymphoid infiltrates in the prostate, especially in cases when these are dense.

Worldwide Use of Antiretropulsive Techniques: Observations from the Clinical Research Office of the Endourological Society Ureteroscopy Global Study

INTRODUCTION

Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage.

METHODS

The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use.

RESULTS

Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group.

CONCLUSIONS

When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.

Detection and quantitation of glutamate carboxypeptidase II in human blood

BACKGROUND

Glutamate carboxypeptidase II (GCPII) is a transmembrane enzyme that cleaves N-acetyl-L-aspartyl-L-glutamate (NAAG) in the brain. GCPII is highly expressed in the prostate and prostate cancer and might be associated with prostate cancer progression. Another exopeptidase, plasma glutamate carboxypeptidase (PGCP), was reported to be similar to GCPII and to share its NAAG-hydrolyzing activity.

METHODS

We performed a radioenzymatic assay with [(3) H]NAAG as a substrate to detect and quantify the enzymatic activity of GCPII in plasma. Using a specific antibody raised against native GCPII (2G7), we immunoprecipitated GCPII from human plasma. We also cloned two PGCP constructs, expressed them in insect cells, and tested them for their NAAG-hydrolyzing activity.

RESULTS

We detected GCPII protein in human plasma and found that its concentration ranges between 1.3 and 17.2 ng/ml in volunteers not diagnosed with prostate cancer. Recombinant PGCP was enzymatically active but exhibited no NAAG-hydrolyzing activity.

CONCLUSION

GCPII is present in human blood, and its concentration within a healthy population varies. Recombinant PGCP does not hydrolyze NAAG, suggesting that GCPII alone is responsible for the NAAG-hydrolyzing activity observed in human blood. The potential correlation between GCPII serum levels and the disease status of prostate cancer patients will be further investigated.

[Our experience in using fluorescence in situ hybridization FISH-Uro Vysion in diagnostics of urothelial carcinoma]

Urothelial carcinoma is a disease at high risk of recurrence after the initial therapy (70-80%) and with the tendency to progression accomplishing the recurrence (30%). Long lasting monitoring of patients with urothelial carcinoma is necessary. Cystoscopy and cytology are currently the primary modalities used to detect and monitor urothelial carcinoma. However, cytology has relatively poor sensitivity especially in well differentiated tumors. Cystoscopy is an invasive and relatively expensive method. Therefore, methods improving detection of urothelial carcinoma from urine specimens are employed. Uro Vysion (Vysis) fluorescence in situ hybridization (FISH) for improved detection of urothelial carcinoma was evaluated.

MATERIALS AND METHODS

Bladder tumor progression is accompanied by increased chromosomal instability and aneuploidy of chromosomes 3, 7, 17 and loss of locus 9p21. A total of 124 patients were analyzed at Dpts. of Urology and Pathology, Faculty Hospital in Brno. Cytologically analyzed urine specimens were tested by FISH and simultaneously cystoscopy was employed including biopsy for histological examination.

RESULTS

FISH analysis was positive in 35 cases, including 5 cases with negative biopsy and cytology. Negative FISH result was detected in 24 cases where the malignant status was determined. The sensitivity of FISH in our series was 58.9% and the specificity 88.1%.

CONCLUSIONS

FISH is a relatively simple, speedy and non invasive diagnostic method. It detects the symptoms of malignity on the molecular level, which leads to earlier diagnosis and therapy and, hence, to potential extended survival. FISH makes it possible to take decision in cases of atypical or unclear cytological finding. The FISH method using the Uro Vysion kit appears as a prospective non invasive method capable of early UK detection, with a higher sensitivity than the standard cytology of urine.

[Controversial opinions in the prostate cancer treatment]

Attitude to prostate cancer topics has developed during last several decades explosively. Vast amount of information also brings flood of controversial opinions. Development in spiral upwards could only result from discussion based on evidence. We have not yet been able to achieve a primary prevention of the disease. Much information is promising and doubtlessly represents large potential. As the detection of cases in the early stage increases, the diagnosis of less aggressive or non aggressive forms, that need not to be radically treated, increases as well. We have a chance, though still limited, to differentiate forms of the disease more precisely than whenever before and the precise diagnostics should be included into the daily clinical practice. Surgical techniques have been developed and improved. It is necessary to adopt and use them because it can further improve already relatively good surgical results.

[Long-term results of microsurgical varicocelectomy]

OBJECTIVE

Presentation of microsurgical varicocelectomy (MVE) treatment outcome in infertile males, in males with symptomatic varicocela and in males with hypotrophic testes.

MATERIAL AND METHODOLOGY

From IV/98 to XII/05, a total of 350 patients with varcicocelas were operated in our clinic, using the MVE method. The authors assess the surgical method results in 131 patients. In 90.84% of the patients, the procedure was performed in order to manage infertility, in 7.63% for dyscomfort and in 1.53% due to findings of hypotrophic testes. 82.44% of the patients sufferred from a left-sided varicocela, 6.03% from a bilateral one and 1.53 % from a right-sided varicocela.

RESULTS

Postoperative follow up of spermiograms (Spg), performed at three-month intervals, confirmed significant Spg improvements in 75.57% of the patients, in 13.74% of the cases no change was reported, and in 7.63% the Spg could not be assessed because the patients failed to turn up for a check up, and in 3.05% mild deterioration of the Spg was reported.

CONCLUSION

Microsurgical varicocelectomy is a standard and highly effective treatment method of varicelas, which are indicated for management.

[Long-term experience with MESA, TESE techniques in the University Hospital (FN) in Brno]

Authors evaluated the experience of application MESA, TESE and ICSI techniques during 9 years long cooperation between Department of Urology University Hospital Brno and Institulions of reproductive Medicine University Hospital Brno. 104 surgical procedures were performed during this time period and as result 24 children were born.

[Treatment alternatives of the locally advanced prostate cancer]

Author makes overview on locally advanced prostate cancer. In spite of the effort to make diagnosis in the earliest stage, disease is still pretty often diagnosed in locally advanced stage with significantly higher risk of progression and recurrence. He summarizes current view on available treatment alternatives (radical surgery, radiotherapy, hormonal treatment, chemotherapy) and their possible and proven combinations. Monotherapy is not considered as the optimal alternative, treatment of choices is the multimodal treatment strategy, though some combinations have been already confirmed as inappropriate.

Comparison of cizolirtine citrate and metamizol sodium in the treatment of adult acute renal colic: a randomized, double-blind, clinical pilot study

BACKGROUND

Renal colic causes excruciating pain that provides a good clinical model of acute pain for the development of new analgesics.

OBJECTIVE

The purpose of the study was to compare the analgesic efficacy and tolerability of cizolirtine citrate and metamizol sodium in adult acute renal colic.

METHODS

This Phase II, randomized, double-blind, clinical pilot study was conducted in the emergency departments of 6 general hospitals in the Czech Republic between October 2000 and February 2001. Male and female patients aged 18 to 65 years and presenting with hematuria and moderate to severe pain due to suspected renal colic starting within the 24 hours before presentation were eligible. Patients were randomized to receive a single IV dose of cizolirtine 350 mg or metamizol 2,500 mg, administered by slow infusion over 15 minutes. Both doses were maximal for the respective drugs to attain adequate analgesia. Use of rescue medication with butorphanol was allowed 30 minutes after study drug administration. Pain intensity was assessed at various time points during the following 360 minutes using a 100-mm visual analog scale (VAS) and a verbal categoric scale. In addition, a specific verbal categoric scale was used to rank pain relief. Physical examinations, laboratory tests, and questioning for adverse events addressed drug tolerability.

RESULTS

Sixty-four patients (50 men, 14 women; mean [SD] age, 44.21 [12.29] years; mean [SD] body mass index, 25.97 [3.38] kg/m(2)) were enrolled. Physical examination findings and mean VAS pain intensity scores at baseline (mean [SD], 79.42 [7.89] mm and 82.59 [10.50] mm in the cizolirtine and metamizol groups, respectively) were similar in both groups. After 30 minutes, the mean (SD) scores were 33.84 (25.15) mm and 25.41 (24.51) mm, respectively. This difference was not statistically significant, and the noninferiority of cizolirtine with respect to the comparator could not be established. However, the proportion of patients that showed satisfactory pain relief (ie, decrease of > or = 50% in VAS pain intensity score compared with baseline) at 30 minutes in the cizolirtine group was fairly high (64.5%), which means relevant analgesic activity. Both treatments were well tolerated; 6 adverse events were reported in 5 patients (7.8%), and all were considered as not treatment related.

CONCLUSIONS

Although this limited pilot study did not include an internal measure of sensitivity, relevant pain reduction was shown in the population of patients with suspected renal colic undergoing treatment with cizolirtine, suggesting the presence of analgesic activity. However, the efficacy of cizolirtine was found to be similar to that of metamizol. Treatments were well tolerated.

[Recurrent prostatic carcinoma after curative radiotherapy and radical prostatectomy]

INTRODUCTION

The authors evaluate indication criteria for individual therapeutic modalities of localized and locally advanced prostate cancer (CaP), but especially investigate progression of the disease in relation to CaP classification and other prognostic criteria.

MATERIAL AND METHODS

The paper evaluates 120 patients altogether, treated by curative radiotherapy (RT) and 115 patients who underwent radical retropubic prostatectomy (RAPE). The patients were followed according to age, PSA value, Gleason score and life prognosis. The Partin nomograms were used to evaluate probability of localized disease, locally advanced disease, the involvement of seminal vesicles (gonecysts) and lymphatic nodes. The patients were also stratified according to T-classification, patients after RAPE also according to pT classification.

RESULTS

RAPE: the mean period of observation was 37.9 month (6-114), 90 patients being without relapse (78.3%). A biochemical relapse occurred in 25 patients (21.7%). A local progression was confirmed by histology in 11 patients (44% of patients with progression, 9.6% of all patients after RAPE). RT: the mean period of observation was 26.75 months. A histological verification of the relapse was demonstrated in 14 patients (35.9% of patients with progression, 11.7% of all patients treated with RT).

CONCLUSION

No progression was detected (under comparable period of observation) in patients with lower mean PSA values, a lower Gleason score and a higher probability of localized disease. In contrast, detection of a progression of the disease is significantly higher in patients with higher PSA values, a higher mean value of the Gleason score, higher probability of the locally advance disease or involvement of seminal vesicles. In order to reach good results in the therapy of prostate cancer for long periods of time, the disease must be detected in time and the stage of the disease should be determined exactly with a maximum precision possible. The prognosis in patients with worse "input" parameters is worse from the long-term point of view and these indices should be carefully controlled.

Severe complications following intravesical BCG instillation

In patients with urinary bladder carcinoma, the intravesical BCG instillation is widely used. We present two cases of severe pulmonary afflictions developed during this treatment. The possible mechanisms of etiology are discussed and the classification of the intravesical BCG treatment side effects is suggested.

[Use of erythropoietin in radical prostatectomy]

All patients in the first group tolerated sampling of four transfusion units of autologous blood in the course of two weeks with subsequent erythropoietin administration very well. Erythropoietin was well tolerated, no local nor systemic undesirable side-effects or complications were observed. The mean transferrin and serum iron values remained during sampling of autotransfusions and erythropoietin administration within the range of normal values reported by our laboratory. The ferritin levels were above the norm. On the other hand in patients of the control group it was not possible--due to the decline of haemogram values--to sample in 45% the required amount of autologous blood before operation. For the same reason it was not possible to implement haemodilution as required. In similar blood losses administration of allogenic blood was necessary in 35% patients of the control group whereby in the group of patients with erythropoietin allogenic blood was administered in two cases (10%). Erythropoietin administration can effectively facilitate preoperative sampling of autotransfusion within a relatively short period. By its administration we can prevent a marked decline of red blood cells as a result of sampling of several preserves of autologous blood at a rapid rate. A satisfactory value of the haematocrit before the operation proper moreover makes it possible to collect a larger amount of blood in case of acute isovolaemic haemodilution. This enhances the patient's safety in relation to risks ensuing from administration of allogenic blood.

[A case of high-flow priapism successfully treated with percutaneous selective embolization of the internal pudendal artery]

Relatively rare high-flow priapism is most frequently caused by contusion or direct injury of the cavernous artery with a subsequent uncontrolled inflow of arterial blood into the cavernous bodies. Knowledge of this pathophysiology and the development of intervention radiology made a more selective therapeutic approach possible. The authors present a report on a case of arterial or high-flow priapism which was successfully resolved by a minimally invasive approach--percutaneous superselective transcatheter embolization of the internal pudendal artery.

[Quality of life in incontinent men after implantation of an artificial urinary sphincter]

The authors implanted to a group of 10 patients incontinent after prostate surgery (on account of BPH and adenocarcinoma) an artificial AMS 800 sphincter. After a mean follow-up period of 29 months they evaluate based on a questionnaire the therapeutic effect and its influence on the patients quality of life as well as the adequacy of the approval procedure of indication on the part of the insurance company as it influences the quality of life. The effect of treatment and influence on quality of life is evaluated without exception very highly while the approval process is evaluated negatively. The authors draw attention to the risk of suicide in mentally otherwise sound subjects due to unsatisfactory solution of urinary incontinence. Correctly indicated treatment by an artificial sphincter can achieve very satisfactory results. The approval procedure must combine medical and rational aspects, it must be however revised, incl. the economic aspects of the system of health services.

[Intravesical immunotherapy with BCG vaccine in superficial carcinoma of the urinary bladder]

The authors present their experience with the use of BCG immunotherapy in the treatment of superficial bladder cancer in 42 patients as regards antitumorous effectivity. They compare BCG immunotherapy with intravesical chemotherapy and evaluate exact diagnostics before indication BCG immunotherapy.

Effectiveness of SWL for lower-pole caliceal nephrolithiasis: evaluation of 452 cases

The authors report on the treatment of lower-pole caliceal nephrolithiasis with extracorporeal shockwave lithotripsy (SWL) using the Czech-made Medilit M-5 lithotripter. In 310 patients, they have performed 452 treatments and evaluated the results 3 months after the last session using plain radiographs and ultrasound examination. The effectiveness of treatment and the success rate of SWL decreased with increasing size of stones: with stones >20 mm, it declined to 30%. This poor success rate was attributable not only to the size of the concrement, but also to its location in a lower calix, which is unfavorable for the passage of fragments. For big lower-pole caliceal stones (>20 mm in the longest diameter), the authors recommend percutaneous nephrolithotomy as the primary management method, the effectiveness of which does not depend on the size of the stone. The success rate achieved in treating the lower-pole caliceal lithiasis using the Medilit M-5 machine was 61.3%, similar to that achieved with other lithotripters.

[Initial experience with the MESA and TESE techniques in the treatment of infertile men with azoospermia]

The authors evaluate their initial experience and results of the technique of microsurgical aspiration of epididymal sperm (MESA) and extraction of testicular sperm (TESE) combined with intracytoplasmic sperm injection into the oocyte (ICSI) in men with azoospermia. The above methods were used in 16 patients with repeatedly assessed azoospermia. Epididymal sperm was obtained in six instances, testicular sperm in 10 instances. With epididymal sperm after ICSI 50% fertilization was achieved after ICSI, with testicular sperm 51% fertilization of oocytes.

[Pitfalls in intravesical immunotherapy of superficial carcinoma of the gallbladder with BCG vaccine]

The authors present their experience with the use of BCG immunotherapy in the treatment of superficial carcinoma of the urinary bladder in 30 patients as regards side-effects and tolerance of preparations. In the discussion they deal in particular with the classification and therapy of side-effects.

[Prenatal use of a vesico-amniotic shunt in obstructive uropathy]

Obstructive uropathy was diagnosed in a fetus in the 31st week of gestation. Good renal functioning and a low L/S index (lecithin/sphingomyelin) in amniotic fluid having been found, a vesocoamniotic shunt was inserted percutaneously. Draining through the shunt lasted for three weeks; then the gravidity was terminated due to stent dislocation while the lung maturity was good. After delivery, right kidney afunction, 4th-5th degree reflux and left-sided hydroureter were diagnosed. At the age of one year, nephrectomy on the right, left-sided hydroureter resection and plastic correction of the megaloureter on the right were performed. The child's condition is satisfactory.

[Ureteroscopy--an alternative treatment in ureterolithiasis]

The authors evaluate the results of 315 ureteroscopies performed in 1991-1995 at the Urological Clinic in Brno Bohunice. 290 ureteroscopies were made on account of ureterolithiasis, diagnostic ureteroscopy was performed in 17 patients, in four instances extraction of a foreign body was involved and in four instances during ureteroscopy the stenosis of the ureter was severed. One-stage operations were successful in 226 patients (78%), in 42 patients (14%) after ureteroscopy ESWL had to be made. Ureteroscopy as a two-stage operation was performed in 12 patients (6%), five cases were resolved by open surgery because ureteroscopy failed. The authors evaluate early and late complications, none of which called for nephrectomy. The authors discuss the position of ureteroscopy in ureterolithiasis which is one of the most frequent indications.

[Effective treatment of nephrolithiasis of the lower calix using ESWL (evaluation of 452 procedures)]

The authors present their results with the treatment of nephrolithiasis of the lower calix using the method of extracorporeal lithotripsy with the Czech apparatus Medilit M-5. In 310 patients they made 452 operations and checked the therapeutic results three months after the last session. For checking they used a native nephrogram and examination by ultrasound. With the increasing size of concrements the effectiveness declined and thus also the success of ESWL(in concrements above 20 mm in size it declined to 30%). This is not due only to the size of the concrement but also its site in the lower calix which is unfavourable for the elimination of fragments after ESWL. The authors recommend therefore in large concrements of the lower calix (more than 20 mm in the longitudinal axis) to select as the primary method percutaneous nephrolithotomy which is highly effective in this localization and is independent on the size of the concrement. The general success rate achieved in treatment of lithiasis of the lower renal calix with Medilit M-5 is 61.3% and is comparable with other lithotriptors.

[Implantation of inflatable penile prostheses as an effective alternative surgical treatment for erectile disorders]

The authors present an account of their own experience with results and complications of inflatable penile prostheses implanted in a group of 30 patients with organic erectile dysfunction. They discuss possible complications of this operation as well as the place of penile prostheses in the treatment of erectile dysfunction.

[An unusual case of plastic penile induration]

The presence of calcified plaques is one of the few unequivocal indications for surgery of Peyronie's disease. The mean size of plaques described in the literature is 1.5-2 cm whereby it may vary from 1 mm all along the penis. The authors treated successfully an unusually large calcified plaque 7 x 0.8 cm with excellent postoperative results--restoration of the patient's full sexual activity which was not possible before operation.

[Drug-induced urolithiasis caused by N4-acetylsulfamethoxazole (Biseptol) and oxolinic acid (Desurol)]

The authors describe rare types of drug-induced urolithiasis in two female patients (N4-acetylsulfamethoxazole--a Biseptol metabolite and oxolinic acid--Desurol). To improve the diagnosis of drug induced urolithiasis the authors recommend a combination of microscopic methods and infrared spectroscopy. They findings are documented by photographs and infrared absorption spectra.

[Ureteroscopy in the treatment of ureterolithiasis]

After establishment of endourological methods at our University Urological Department we have treated 36 ureteral stones in 34 patients since January 91 until April 92. Through retrograde (23) and antegrade (13) access we have successfully treated almost all calculi with the exception of one (where we hadn't been able to pass through reimplanted ureteral orificium). We have introduced double J stent in 90% patients after procedure and discharged them 3 days postoperatively on average. We have had no serious complication. Ureteroscopy with stone disintegration possibility has enabled us almost to leave open surgery in those cases, lower morbidity and shorten time spent in the hospital significantly.

Ureteral incarceration in the symptomatology of hydronephrosis

Renal colic symptoms may be caused by an aberrant vascular bundle that intermittently incarcerates the pyeloureteral junction. The authors describe 6 patients who were complaint free except for the period of fits and routine urological examinations showed normal findings. The patients had no subjective complaints after open surgery.