The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology

PURPOSE

Although targeted biopsies (TBx) are associated with improved disease assessment, concerns have been raised regarding the risk of prostate cancer (PCa) overgrading due to more accurate biopsy core deployment in the index lesion.

METHODS

We identified 1672 patients treated with radical prostatectomy (RP) with a positive mpMRI and ISUP ≥ 2 PCa detected via systematic biopsy (SBx) plus TBx. We compared downgrading rates at RP (ISUP 4-5, 3, and 2 at biopsy, to a lower ISUP) for PCa detected via SBx only (group 1), via TBx only (group 2), and eventually for PCa detected with the same ISUP 2-5 at both SBx and TBx (group 3), using multivariable logistic regression models (MVA).

RESULTS

Overall, 12 vs 14 vs 6% (n = 176 vs 227 vs 96) downgrading rates were recorded in group 1 vs group 2 vs group 3, respectively (p < 0.001). At MVA, group 2 was more likely to be downgraded (OR 1.26, p = 0.04), as compared to group 1. Conversely, group 3 was less likely to be downgraded at RP (OR 0.42, p < 0.001).

CONCLUSIONS

Downgrading rates are highest when PCa is present in TBx only and, especially when the highest grade PCa is diagnosed by TBx cores only. Conversely, downgrading rates are lowest when PCa is identified with the same ISUP through both SBx and TBx. The presence of clinically significant disease at SBx + TBx may indicate a more reliable assessment of the disease at the time of biopsy potentially reducing the risk of downgrading at final pathology.

Twinning as a risk factor for neonatal acute intestinal diseases: a case-control study

Introduction

Acute intestinal diseases (AID), including necrotizing enterocolitis and spontaneous intestinal perforation, are a group of conditions that typically present in preterm infants, and are associated with an elevated mortality and morbidity rate. The risk factors for these diseases remain largely unknown. The aim of the study is to identify the correlation between twinning and the development of AID.

Methods

A single-center retrospective case-control study was conducted. We recruited all infants with a diagnosis of AID, confirmed by anatomopathology, recovered in NICU between 2010 and 2020. Considering the rarity of the outcome, 4 matched controls for each subject were randomly chosen from the overall population of newborns. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using a conditional logistic regression model and a multivariate model by the creation of a Directed Acyclic Graph (www.dagitty.net).

Results

The study population resulted in 65 cases and 260 controls. The two groups present similar median gestational age and mean birthweight in grams. The cases have a higher frequency of neonatal pathology (defined as at least one of patent ductus arteriosus, early or late sepsis, severe respiratory distress) (84.6% vs. 51.9%), medically assisted procreation (33.8% vs. 18.8%) and periventricular leukomalacia (10.8% vs. 2.7%), and a lower frequency of steroids prophylaxis (67.7% vs. 86.9%). About 50% of cases needed surgery. The OR for the direct effect were difference from one using logistic regression booth without and with repeated measures statements: from 1.14 to 4.21 (p = .019) and from 1.16 to 4.29 (p = .016), respectively.

Conclusions

Our study suggests that twinning may be a risk factor for the development of AID. Due to the small number of cases observed, further studies on larger populations are needed.

Propofol versus sodium thiopentone for the treatment of status epilepticus and refractory status epilepticus in dogs

AIMS

To compare the effect on mortality and length of hospital stay of propofol with that of sodium thiopentone for the management of dogs with status epilepticus (SE) and refractory status epilepticus (RSE).

METHODS

In this cohort study, medical records of a veterinary referral clinic in Argentina were retrospectively searched for dogs that were hospitalised and required induction of therapeutic coma (TC) with either propofol or sodium thiopentone for the management of SE or RSE of any cause. A logistic regression model was performed to evaluate the association between the type of anaesthetic used and in-hospital mortality adjusting for the type of epilepsy (idiopathic, structural, or reactive). Kaplan-Meier estimated survival curves for the length of hospital stay by the type of anaesthetic drug were compared using the log-rank test (deaths were considered censored events). Cox proportional hazards regression was used to estimate hazard ratios for time to hospital discharge, unadjusted and adjusted for type of epilepsy.

RESULTS

A total of 24 dogs with SE were included in the study: eight treated with propofol and 16 treated with sodium thiopentone. Four dogs treated with propofol (proportion = 0.50; 95% CI = 0.15-0.84), and eight treated with sodium thiopentone (proportion = 0.50; 95% CI = 0.50-0.74) died during hospitalisation. The median hospitalisation time was 43 (IQR 24-56) hours for dogs that were treated with propofol and 72 (IQR 64-96) hours for dogs that were treated with sodium thiopentone. There was no evidence of a difference in the median duration of TC in dogs treated with propofol (12 (IQR 8-24) hours) or with sodium thiopentone (12 (IQR 7.5-20) hours; p = 0.946). In the logistic regression model, no evidence of association between the anaesthetic protocol for the management of RSE and in-hospital mortality, adjusted for the type of epilepsy, was found (OR 1.09 (95% CI = 0.17-6.87); p = 0.925). Cox regression analysis revealed a difference in the time to hospital discharge, adjusted by the type of epilepsy, between treatment groups (HR = 0.05 (95% CI = 0.01-0.54); p = 0.013).

CONCLUSIONS AND CLINICAL RELEVANCE

The time spent in hospital before discharge was longer in dogs with RSE treated with sodium thiopentone compared to those treated with propofol. However, as the sample size was very small, the results obtained in the present study should be analysed with caution. Further studies including a greater number of dogs are required.

Vulnerability to acute psychosocial stress in subjects with eating disorders and history of childhood trauma: experimental evidence of a “Maltreated Ecophenotype”

Introduction

Subjects with eating disorders (ED) show a high prevalence of childhood trauma.

Objectives

Aim of the study is to evaluate the emotional, biological and behavioral responses to an experimental acute psychosocial stress in subjects with ED with or without childhood maltreatment. Secondary aim is to evaluate the effects of different traumatic experiences (physical and emotional).

Methods

48 women with ED completed the Childhood Trauma Questionnaire (CTQ). 29 participants (14 with Anorexia Nervosa [AN] and 15 with Bulimia Nervosa [BN]) reported an history of childhood maltreatment, while 19 (11 with AN and 8 with BN) did not. Cortisol levels, anxiety and hunger perceptions have been assessed in all participants throughout the Trier Social Stress Test (TSST) as well as body dissatisfaction after stress exposure.

Results

Subjects with childhood trauma showed higher emotional reactivity and body dissatisfaction and lower hunger throughout the TSST than those without childhood trauma. Higher cortisol levels were observed in patients with AN, regardless of the presence of childhood trauma, and in those with BN and history of emotional trauma. Emotional trauma was the childhood trauma explaining most of the observed differences.

Conclusions

Childhood trauma, especially emotional one, can lead to vulnerability to interpersonal stress in individuals with ED. The present study is the first that supports the “maltreated ecophenotype” hypothesis in subjects with ED through an experimental task and the evaluation of multiple levels of response. These data may provide new prospectives on the pathogenetic mechanisms of ED and novel therapeutic implications.

Disclosure

No significant relationships.

Porcine coronary arteries: immunohistochemical profile of TNF-alpha, IL-1beta, TGF-beta1 and ICAM-1

BACKGROUND

In our study we used immunohistochemical technique to demonstrate the presence of the cytokines tumour necrosis factor alpha (TNF-α), interleukin 1beta (IL-1β), transforming growth factor beta1 (TGF-β1) and intercellular adhesion molecule-1 (ICAM-1) in porcine coronaries even in physiological conditions.

MATERIALS AND METHODS

Inflammatory cytokines are polypeptide mediators which act as a communication signal between immune system cells and other types of cellsin different organs and tissues, both in human and pig coronary circulation.

RESULTS

Our results show that pro-inflammatory cytokines TNF-α, IL-1β, TGF-β1 and ICAM-1 are also present in the medium tunica of the coronary arteries under physiological conditions. These results may be compared with those found in coronary atherosclerosis, where the increase in TNF-α has a dramatic effect on the function of the left ventricle, and the high value of IL-1 correlates directly with the extent of myocardial necrosis. In our study we observe the damage and activation of endothelial cells; this induces endothelial dysfunction by accumulation and oxidation of low density lipoproteins (LDL). The formation of oxidized LDL could play a central role in the amplification of the inflammatory response causing an increased expression of pro-inflammatory cytokines which promotes leukocyte recruitment in the intimal layer. These leukocytes, after the adhesion to the endothelium, penetrate the intimate tunic.

CONCLUSIONS

Therefore inflammatory processes promote the onset and evolution of atheroma and the development of thrombotic complications.

Controlled Periodic Illumination Enhances Hydrogen Production by over 50% on Pt/TiO2

Efficient solar water photosplitting is plagued by large overpotentials of the HER and OER. Even with a noble metal catalyst, the hydrogen evolution reaction can be limited by the strong M-H bonding over some metals, such as Pt, Pd, and Rh, inhibiting hydrogen desorption. H absorption is regulated by the potential at the metal nanoparticles. Through controlled periodic illumination of a Pt/TiO2 suspension, we hypothesized a fast variation of the photopotential that induced catalytic surface resonance on the metal, resulting in more than a 50% increase of the efficiency at frequencies higher than 80 Hz.