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Results of river-lake disconnection and also eutrophication about river mollusc assemblages throughout floodplain ponds: Loss in congeneric types brings about modifications in equally construction composition as well as taxonomic relatedness.
34 min, 95% CI -4.98 - 17.65, p = 0.27) while shorter hospital stay was reported for RIRS (WMD = -2.15 days,95% CI -3.04 - -1.25, = less then 0.00001). We reported moreover lower Hb drop (WMD = -0.83 g/dl, 95% CI -1.20 - -0.45, p= less then 0.00001) and complications rate in favours of RIRS (RR = 0.88, 95% CI 0.71 - 1.09, p=0.23). CONCLUSIONS RIRS is challenging PCNL for the treatment of large renal stones over 2cm, becoming a safe and effective alternative with a comparable stone free rate, lower complication rate and lower hospitalization time. It is, however, of the uttermost importance to share the treatment decision with the patient due to the possibility of requiring multiple RIRS session to completely clear larger stone burdens.BACKGROUND To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. METHODS Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson comorbidity index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence- free survival (RFS) rates, complication rates and global renal function. RESULTS A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0- 79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4 ± 3.5% and the 24-month RFS was 31.7 ± 9.4%. Lower RFS rates were found in high grade tumor patients (22.2 ± 13.9%) compared to low grade tumor patients (35.6 ± 12.3%) (p=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (p=0.018 and p=0.005, respectively). CONCLUSIONS Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow- up is necessary due to the high risk of disease recurrence.INTRODUCTION To systematically review the effect of additional drug therapy as metaphylaxis in patients with cystinuria. EVIDENCE ACQUISITION A literature search of three databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA-guidelines enclosing articles published up to May 2019. A total of 1117 articles were screened. Thirty-four publications met the inclusion criteria for this review. EVIDENCE SYNTHESIS Male-female ratio in the studied cohorts was 49,9% - 50.1%. The majority of studies showed a positive effect in reducing stone events and/or urinary cystine excretion. D-Penicillamine showed success in 13/14 (92%) studies, whereas Tiopronin-treatment showed a reduction in all (8/8; 100%) studies. All studies on Captopril (4/4) showed a decrease, however not all significant. The same is true for studies on Thiols in combination with Captopril (2/2). Furthermore, Tiopronin showed less side effects compared to D-penicillamine, respectively 30% and 37%. Captopril showed the least adverse events, with one event in nine patients. CONCLUSIONS The evidence on benefit of additional drug therapy in patients with cystinuria is scarce. All studied medications showed an effect on stone event and urinary cystine excretion, when used in addition to hyperhydration, alkalization and a diet low on methionine. Based on this systematic review, no drug can be preferred over another. An important aspect in the choice of drug is the risk of side effects. Therefore, the choice of additional drug should be personalized for every patient where the risk of side effects should be taken into consideration.BACKGROUND Evidence about the clinical benefits of Hyperbaric Oxygen Therapy (HBOT) in patients with Fournier's Gangrene (FG) is controversial and inconclusive. We aimed to compare the mortality related to FG between patients undergoing surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. METHODS We performed a retrospective multi-institutional observational case-control study. All patients admitted with diagnosis of FG from June 2009 to June 2019 were included into the study. Patients received surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. Factors associated with FG related mortality were assessed with uni- and multivariate analyses. The main outcome measure was FG related mortality. RESULTS A total of 161 patients with diagnosis of FG were identified. Mean FG Severity Index was 8.6 ± 4.5. All patients had broad-spectrum parenteral antibiotic therapy. An aggressive debridement was performed in 139 (86.3%) patients. A total of 72 patients (44.7%) underwent HBOT. Mortality due to FG was observed in 32 (36.0%) of patients who do not underwent HBOT and in 14 (19.4%) of patients who underwent HBOT (p=0.01). At the multivariate analysis, surgical debridement and HBOT were independent predictors of lower mortality while higher FG Severity Index was independent predictor of higher mortality. CONCLUSIONS HBOT and surgical debridement are independent predictors of reduced FG related mortality.BACKGROUND Aim of our study was to analyze adverse events (AEs) associated with Radium 223 using real life data from Eudra-Vigilance (EV) database. METHODS EV database is the system for managing and analyzing information on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area (EEA). We recorded number of AEs for Radium 223 per category and severity from 2013 to May 2019. We recorded AEs per age group (85 years) treated with Radium 223 were at increased risk of cardiac, infectious, and metabolism disorders when compared to younger patients ( less then 65). However, we have no information on the number of patients under treatment in the EV database. CONCLUSIONS EV database highlights several AEs which are not reported in registry studies as well as different AEs profiles according to age. Clinicians should consider these data when treating patients with Radium 223.INTRODUCTION Our aim is to compare feasibility and safety of open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for the treatment of bladder cancer through network meta-analysis. EVIDENCE ACQUISITION Eligible articles were identified from electronic databases including PubMed/Medline, Embase, the Cochrane Library and Web of Science up to August 2019 with no language limitations. Studies selection, quality assessment, data extraction and analysis were accomplished by two independent reviewers (DCF and AL) using Cochrane Collaboration's tools. EVIDENCE SYNTHESIS After screening 2528 articles, 27 studies were included in the final meta-analysis. In the network meta-analysis, both RARC (MD83.09, 95%CI 61.06 to 105.11) and LRC (MD 49.68, 95%CI 21.75 to 77.62) showed a longer operative time compared with ORC. Besides, RARC had a longer operative time than LRC (MD 33.40, 95%CI 1.35 to 65.45). RARC (MD-591.86, 95%CI -879.46 to - 304.27) and LRC (MD -435.2med by experienced surgeons in selected patients. Notably, RARC may be more suitable for RC with extracorporeal urinary diversion. Larger well-designed trials are still needed to confirm these findings due to the observational nature of most studies.INTRODUCTION Metastasis directed therapy (MDT) is increasingly being implemented in recurring prostate cancer (PCa), although its role in PCa management has yet been fully defined. Aim of the current systematic review is to analyze current knowledge of MDT in the setting of recurrent PCa and highlight future trials which will continue to shed a light on a controversial aspect of current PCa management. EVIDENCE ACQUISITION The National Library of Medicine Database was searched for relevant articles published between January 2014 and August 2019. A wide search was performed including the combination of following words ((metastasis AND directed AND therapy) AND prostate AND cancer). The selection procedure followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles. EVIDENCE SYNTHESIS Biologic studies support the use of MDT in oligometastatic PCa. Modern imaging techniques as PSMA PET/CT, Fuciclovine PET/CT and whole body MRI are fundamental to implement such an approach given the high diagnostic yield at low PSA values. The majority of data available on MDT concerns retrospective trials, although three prospective randomized trials (STOMP, ORIOLE and POPSTAR) have assessed the safety and feasibility of MDT. Overall, it appears that MDT delays significantly PCa progression and time to systemic therapy. CONCLUSIONS MDT is highly appealing given its potential to delay disease progression and adverse events of systemic therapy. Nonetheless, data remains immature to recommend MDT on a large scale and the selection criteria for patients have yet been defined. https://www.selleckchem.com/products/akba.html Today, MDT should be administered within a clinical trial and results of future research are eagerly awaited.BACKGROUND To examine the predictive value of neutrophil-to-lymphocyte ratio in localized prostate cancer for surgical pathology and recurrence in patients treated by radical prostatectomy. METHODS We evaluated 1 258 patients treated by radical prostatectomy at San Raffaele Hospital between 2011 and 2017 and assessed the association between preoperative neutrophil-to-lymphocyte ratio and surgical pathology (advanced stage, grade group ≥4, nodal involvement, grade discordance between biopsy and surgical pathology) and biochemical recurrence. RESULTS The preoperative neutrophil-to-lymphocyte ratio was not significantly associated with advanced stage (≥T3), International Society of Urological Pathology (ISUP) grade (≥4) or discordance. At multivariable analysis, patients with higher neutrophil-to-lymphocyte ratio had lower risk of nodal involvement at final pathology (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.64, 0.92; P=0.005). The preoperative level of neutrophil-to-lymphocyte ratio was associated with biochemical recurrence on univariate analysis (OR 0.81, 95% CI 0.68, 0.96; P=0.017). Such a relationship was not significant at multivariable analysis adjusting for tumor severity (OR 0.93, 95% CI 0.79, 1.09; P=0.4). CONCLUSIONS Neutrophil-to-lymphocyte ratio does not have clinical utility for the prediction of adverse pathology and biochemical recurrence. Further research should focus on its value for predicting regional lymph node metastasis.INTRODUCTION In recent years, technological advances and new approaches have been developed for the treatment of Benign prostatic obstruction (BPO) in order to reduce complications like bleeding, retrograde ejaculation and risk of infection while obtaining an adequate disobstruction. The most recent surgical approach introduced is the Aquablation system (PROCEPT BioRobotics, Redwood Shores, CA, USA). This intervention is a robotically guided system that uses high-velocity water jets in order to ablate prostatic tissue, with real-time ultrasound guidance. The aim of this review is to summarize the current evidence on Aquablation and its results, compared to the reported outcomes of the gold standard treatment, the transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic review of the Literature was performed in June 2019 using Medline (via PubMed), Embase (via Ovid), and Cochrane databases. The studies that compared the Aquablation to the standard TURP were included. Moreover, a critical review of the single arm studies was conducted.
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