Ahmad Matarneh, Sundus Sardar, Abdelrauof Akkari
et al.
Objectives Renal replacement therapy (RRT) is vital for managing acute kidney injury (AKI), with continuous renal replacement therapy (CRRT) and intermittent hemodialysis (iHD) as primary modalities. CRRT is preferred for critically ill patients due to gradual fluid and solute removal, whereas iHD is used for stable patients. Outcomes among AKI patients requiring RRT vary widely, with some recovering kidney function while others progress to end-stage renal disease (ESRD). This study evaluates the risk of dialysis dependence and ESRD within 90 days among AKI patients receiving RRT.Methods Retrospective cohort study analyzed inpatient admissions from the MarketScan database (2005–2021) with an AKI diagnosis requiring RRT, identified using ICD-10 codes. Logistic regression compared CRRT and iHD groups, adjusting for age, sex, length of stay, and calendar year.Results Compared to iHD, CRRT was associated with 67% lower odds of dialysis dependence at discharge (OR = 0.33; 95% CI: 0.28–0.39) and 80% lower odds at 90 days (OR = 0.20; 95% CI: 0.16–0.27). Patients receiving both iHD and CRRT had higher odds of dialysis dependence at discharge (OR = 1.41; 95% CI: 1.27–1.57) but 46% lower odds at 90 days (OR = 0.54; 95% CI: 0.45–0.64). CRRT also reduced the risk of ESRD within 90 days by 88% (OR = 0.12; 95% CI: 0.10–0.14).Conclusion Our study demonstrates that compared to iHD, CRRT is associated with a significantly lower risk of dialysis dependence and progression to ESRD in patients with AKI. CRRT may prevent further kidney injury and promote improved renal recovery.
Alejandro Rendón-Molina, Viridiana Gorbea-Chávez, Verónica Granados-Martínez
et al.
Pelvic organ prolapse (POP) is common among aging women and frequently requires surgical intervention. Concerns about increased surgical risk in elderly patients often lead to conservative treatment. However, evidence from low- and middle-income countries, including Latin America, remains scarce. The objective of this study is to compare perioperative and 1-year postoperative complications between women aged ≥60 and <60 undergoing pelvic reconstructive surgery in a tertiary center. A nested case-control study within a retrospective cohort was conducted, including women who underwent POP surgery. Two age groups were analyzed: <60 years and ≥60 years. Complication rates were compared using chi-square, Fisher’s exact test, and odds ratios with 95% confidence intervals. Among 231 patients, 79 were aged ≥60 years. Perioperative complications occurred in 10.4% of older vs. 22.1% of younger women. Respectively, 1-year complications were 12.9% vs. 17.2%. De novo urgency was more frequent in older women (25.3%, p=0.02). No major complications were observed. POP surgery in women aged ≥60 appears safe. Findings support surgical management in elderly patients based on functional rather than chronological age.
Panupong Hansrivijit, Janinne Ortega-Montiel, Deborah J. Wexler
et al.
Rationale & Objective: Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for type 2 diabetes (T2D) and obesity. However, the real-world utilization of tirzepatide remains unexplored, particularly in patients with chronic kidney disease (CKD), where the prevalence of T2D and obesity is high. This study aimed to describe the utilization trends of tirzepatide, glucose-lowering medications (GLMs), and anti-obesity medications (AOMs) in patients with CKD, with and without T2D. Study Design: A population-based, observational cohort study. Setting & Participants: Patients with CKD, with and without T2D, were identified from a large US health insurance claims database (from January 1, 2022 to September 30, 2023). Exposures: Tirzepatide, other GLMs, and AOMs. Outcomes: Medication utilization trends and patient characteristics. Any users were defined as those with prescription claims, and incident users as those with no previous dispensing within 365 days. Analytical Approach: Longitudinal trends were assessed by 1-month intervals from January 1, 2022 to September 30, 2023. Results: Among 455,047 patients with CKD and T2D, tirzepatide any users increased to 4.8% in September 2023, while incident users rose from 0.8% to 8.6%. Sodium glucose cotransporter-2 inhibitors remained the most initiated GLM. Tirzepatide initiators had higher rates of obesity (32.5%), and morbid obesity (44.1%) when compared with other GLMs. Among 5,978 patients with CKD without diabetes, weekly semaglutide ≤2 mg was the most initiated AOM, followed by tirzepatide. Incident users of tirzepatide rose from 0.6% in June 2022 to 23.5% in September 2023. Clinical characteristics were similar between semaglutide ≤2 mg versus tirzepatide initiators. Limitations: The study period ended before tirzepatide’s approval for weight management (November 2023). Conclusions: Our study indicates rapidly shifting trends in tirzepatide uptake among patients with CKD both with and without diabetes. The uptake of tirzepatide is expected to increase further. Future studies on the comparative effectiveness and safety of tirzepatide in patients with CKD are warranted. Plain Language Summary: Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for glycemic control and weight management, but its utilization in the real-world settings among patients with chronic kidney disease (CKD) is unknown, where the prevalence of type 2 diabetes and obesity is high. In this study, we examined the utilization trends of tirzepatide, other glucose-lowering medications, and anti-obesity medications (AOMs) from January 1, 2022 to September 30, 2023 using a large US health insurance database. We found that the use of tirzepatide has been rapidly rising as a GLM and AOM among patients with CKD and is expected to increase further. Future studies on the effectiveness and safety of tirzepatide against other glucose-lowering medications or AOMs in patients with CKD are needed.
Objective: This study aims to determine the effect of tamsulosin administration on alteration in PSA levels in BPH patients in Padang. Material & Methods: This study employed an analytical method with a prospective cohort design. The research was conducted at M. Djamil General Hospital, BMC Hospital, Hermina Hospital, and Semen Padang Hospital in August - December 2022. Sampling was carried out by consecutive sampling. Results: At the end of the study, there were 23 patients with BPH. The mean age was 67.5 ± 7.7, which most of them having good education. Patients were mostly self-employed. The highest IPSS score is the severe stage. The PSA levels before and after tamsulosin administration were 1.7 ± 0.9 ng/ml and 1.6 ± 0.8 ng/ml, respectively. Bivariate analysis showed that tamsulosin administration affects PSA levels in benign prostatic hyperplasia patients in Padang. Conclusion: There is an effect of tamsulosin administration on PSA levels.
Keywords: Benign prostatic hyperplasia, tamsulosin, prostate-specific antigen.
Background Ureteral stricture (US) is a pathological stenosis in the urinary tract characterized by increased collagen synthesis and inflammation. Autophagy activation has been shown to ameliorate tissue fibrosis and protect against fibrotic diseases. Verapamil has beneficial therapeutic benefits on fibrotic disorders. The pharmacological effects of verapamil on fibroblast autophagy in US and the underlying mechanism need to be investigated further.Methods US patients were recruited to isolate scar tissues, hematoxylin-eosin (HE) and Masson trichrome staining were performed to analyze histopathological changes. The US animal model was established and administered with verapamil (0.05 mg/kg) in the drinking water. Transforming growth factor (TGF)-β1 was adopted to facilitate collagen synthesis in fibroblasts. The mRNA and protein expressions were examined by qRT-PCR, western blot, immunofluorescence and immunohistochemistry. ELISA was adopted to measure interleukin (IL)-1β and IL-6 levels. Molecular interaction experiments like dual luciferase reporter and chromatin immunoprecipitation (ChIP) assays were performed to analyze the interaction between signal transducers and activators of transcription 3 (STAT3) and RNA polymerase II associated factor 1 (PAF1).Results Herein, our results revealed that verapamil activated TGF-β1-treated fibroblast autophagy and inhibited inflammation and fibrosis by repressing Ca2+⁄calmodulin-dependent protein kinase II (CaMK II) δ-mediated STAT3 activation. Our following tests revealed that STAT3 activated PAF1 transcription. PAF1 upregulation abrogated the regulatory effect of verapamil on fibroblast autophagy and fibrosis during US progression. Finally, verapamil mitigated US in vivo by activating fibroblast autophagy.Conclusion Taken together, verapamil activated TGF-β1-treated fibroblast autophagy and inhibited fibrosis by repressing the CaMK IIδ/STAT3/PAF1 axis.
Anubhav Narwal, Kalpana Kumari, Seema Kaushal
et al.
Background: Epithelial-mesenchymal transition (EMT) plays an important role in bladder carcinoma (BC) invasiveness and metastasis. Studies have shown that muscle-invasive BC (MIBC) and non-MIBC (NMIBC) are different at the molecular level owing to different EMT-related programming. Recent studies suggest that dysregulation of specific miRNAs is linked to EMT in BC. With this background, we aimed to study the immunoexpression of EMT-markers and its correlation with miRNA-200c expression in a series of MIBCs and NMIBCs.
Materials and Methods: Quantitative real-time-polymerase chain reaction for the quantification of miR-200c expression was performed on 50 cases of urinary BC obtained from transurethral resection of bladder tumor (TURBT), cystectomy specimens, and ten peritumoral bladder tissue. Immunohistochemistry for ZEB1, ZEB2, TWIST, E-cadherin, and β-catenin was performed on tumor and peritumoral bladder tissue.
Results: Thirty-five TURBT and 15 cystectomy specimens were assessed. Among MIBC, loss of expression of E-cadherin (72.3%), β-catenin (66.7%), and ZEB1, ZEB2, and TWIST2 immunoreactivity was noted in 53.3%, 86.7%, and 73.3% of cases, respectively. Among NMIBC, loss of expression of E-cadherin (22.5%), β-catenin (17.1%) and ZEB1, ZEB2, and TWIST immunoreactivity was noted in 11.5%, 51.4%, and 91.4% of cases, respectively. Upregulation of miRNA-200c was noted in cases with retained E-cadherin and negative TWIST expression. Downregulation of miRNA-200c expression was noted in all the cases showing loss of E-cadherin, β-catenin, and in cases immunoreactive for ZEB1, ZEB2, and TWIST in MIBC. Downregulation of miRNA-200c expression was also noted in cases of MIBC with retained β-catenin and those immunonegative for ZEB1 and ZEB2. A similar trend was noted in NMIBC. Median miRNA-200c expression was low in both high-grade and low-grade NMIBC compared to peritumoral bladder tissue and was not statistically significant.
Conclusion: This study for the first time explores the relation of miR200C with E-cadherin, b-catenin, and its direct transcriptional regulators, namely Zeb1, Zeb2, and Twist in the same cohort of BC. We observed that miRNA-200c is downregulated in both MIBC and NMIBC. We identified novel expression of TWIST in cases of BC showing downregulation of miR200Cs suggesting that it is one of the protein targets of altered miRNA-200c expression contributing to EMT and can serve as a promising diagnostic marker and therapeutic target. Loss of E-cadherin and ZEB1 immunoexpression in high-grade NMIBC suggests an aggressive clinical behavior. However, ZEB2 heterogeneous expression in BC limits its diagnostic and prognostic utility.
Introduction Mammary‐type myofibroblastoma is a rare benign tumor, mainly arising along the embryonal mammary ridge. We report a rare case of mammary‐type myofibroblastoma of the perineum. Case presentation A 37‐year‐old Japanese man presented with a 20 mm, progressively‐growing painless mass in the right perineum. Computed tomography showed a subcutaneous tumor with a strong contrast effect. Upon total resection, pathology showed a spindle‐cell tumor positive for desmin but negative for CD34. Further immunohistochemistry showed loss of Rb expression, leading to differential diagnosis. We could not evaluate the exact rarity of the perineal location due to categorization in past reports. Conclusion Due to the similarities between mammary and anogenital tissue, we suggest that tallying perineal and vulvar areas separately from the embryonic mammary ridge sites may be beneficial in gaining insight into the pathophysiology of this tumor.
Nicola Santoni, Lorna Cottrell, Jennifer Elizabeth Talia Jones
et al.
Nephrogenic adenoma is a rare benign urinary tract lesion. There are pediatric cases that have been managed with intravesical sodium hyaluronate, but there are no published adult cases. We present the first case of an adult successfully treated with intravesical sodium hyaluronate without resection. A 77-year-old man was investigated with cystoscopy for lower urinary tract symptoms (LUTS) unresponsive to medical therapy. This revealed multifocal flat black bladder lesions. Biopsy showed the lesions to be nephrogenic adenoma. His LUTS were treated with 6 weeks of intravesical sodium hyaluronate. He returned 6 weeks later for resection of his bladder lesions. However, resection was abandoned as the bladder lesions had entirely resolved. The resolution of the bladder lesions following intravesical sodium hyaluronate was unexpected but does agree with existing literature. The two reported pediatric cases also suggest that intravesical sodium hyaluronate is therapeutic for nephrogenic adenoma.
Angela Maria Pellegrino, Luigi Annicchiarico Petruzzelli, Eleonora Riccio
et al.
Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease characterized by the presence of renal cysts. Over time the expanding cysts lead to progressive renal failure. The use of tolvaptan, a V2-receptor antagonist, was recently approved in ADPKD patients. It was demonstrated that tolvaptan get slower decline in Kidney function compared with placebo. Idiosyncratic hepatic toxicity was described in patients receiving tolvaptan, with elevations in aminotransferases levels. We describe the first case reported in the literature in which hepatic toxicity is caused by the association of amoxicillin/clavulanic acid and tolvaptan. Case presentation A 41 years old woman with diagnosis of ADPKD had been in treatment with tolvaptan for 16 weeks when an elevation of liver enzyme levels was detected. She had taken autonomously amoxicillin/clavulanic acid (in doses of 825/175 mg twice a day for 7 days) about 5 weeks before. The timing of the event and the kind of hepatocellular injury could be attributed to the concomitance of medication of tolvaptan and amoxicillin/clavulanic acid. Conclusion We highlight the need to careful monitor hepatic enzyme levels in order to recognize early hepatic side effects in ADPKD patients in treatment with tolvaptan and amoxicillin/clavulanic acid.
Even in the era of novel targeted agents, switching to a second-line nonsteroidal antiandrogen (NSAA) is still widely used in treating metastatic castration-resistant prostate cancer (mCRPC), especially in undeveloped countries. However, whether prior treatment with a second-line NSAA would impact the efficacy of abiraterone acetate (Abi) remains uncertain. In the current study, 87 mCRPC patients treated with Abi were analyzed. Among them, 21 were treated with a second-line NSAA (from bicalutamide to flutamide) before receiving abiraterone, while the remaining 66 received Abi directly. Therapeutic efficacy of Abi was compared between those with and without prior second-line NSAA using Kaplan–Meier curves, log-rank test, and Cox regression models. The therapeutic efficacy of Abi was similar between those with or without the prior switching treatment of flutamide, in terms of either prostate-specific antigen progression-free survival (PSA-PFS, 5.5 vs 5.6 months, P = 0.967), radiographic progression-free survival (rPFS, 12.8 vs 13.4 months, P = 0.508), overall survival (OS, not reached vs 30.6 months, P = 0.606), or PSA-response rate (71.4% [15/21] vs 60.6% [40/66], P = 0.370). This is the first time that the impact of prior switching of treatment to a second-line NSAA on the efficacy of Abi in mCRPC patients has been addressed. Our data support that, use of prior sequential bicalutamide and flutamide does not seem to preclude response to abiraterone, although larger cohort studies and, ideally, a randomized controlled trial are needed. These findings will facilitate doctors' decision-making in the treatment of mCRPC patients, especially for those with previous experience of switching NSAA second-line treatments in the clinic.
ZusammenfassungUrologische Malignome sind relativ häufig und nehmen mit zunehmendem Lebensalter zu. Der demografische Wandel führt dazu, dass bei immer mehr Patienten mit entzündlich-rheumatischen Erkrankungen urogenitale Tumoren koinzident sind oder unter antirheumatischer Therapie auftreten. Die Basistherapie rheumatischer Erkrankungen muss in dieses Fällen individuell sorgfältig abgewogen werden, obwohl die begrenzte Evidenz für die meisten Situationen gegen eine massive Risikoerhöhung durch konventionelle und/oder biologische Basistherapeutika spricht. Paraneoplastische Phänomene auch im Bewegungsapparat können durch urogenitale Malignome ausgelöst werden. Mit den sich abzeichnenden Umwälzungen der medikamentösen Tumortherapie durch die Immunonkologie ergeben sich darüber hinaus neue Herausforderungen für die interdisziplinäre Kooperation von Uroonkologen und Rheumatologen. In dieser Übersichtsarbeit werden unter Berücksichtigung der aktuellen deutschen und europäischen Leitlinien die Diagnostik, Standardbehandlung und Nachsorge urologischer Malignome skizziert. Wir beschreiben Kernaspekte, die von Urologen und Rheumatologen beachtet werden sollten. Durch persönliche Absprache, regelmäßigen Erfahrungsaustausch und Einbeziehung von Rheumatologen in interdisziplinäre Tumorboards sollte zukünftig eine bessere Behandlung unserer gemeinsamen Patienten möglich werden.AbstractGenitourinary neoplasms are relatively common and the frequency increases with age. Due to demographic changes more patients with inflammatory rheumatic diseases will have concomitant genitourinary tumors or they will develop them under antirheumatic therapy. In such cases, disease-modifying antirheumatic drugs (DMARD) and immunosuppressive therapy have to be carefully balanced on an individual basis. Based on the limited evidence available large increases in the risks from conventional and/or biological DMARDs for patients with genitourinary malignancies appear to be unlikely for most situations. In addition to these more common situations paraneoplastic symptoms in the musculoskeletal system can occur due to genitourinary malignancies. Moreover, novel drugs with immunostimulating activity for some genitourinary tumors may provoke autoimmune symptoms and thus present new challenges for interdisciplinary cooperation between rheumatologists and uro-oncologists. In this review, the diagnostic procedures, therapies and follow-up of cancers in the field of urology are delineated according to the current German and European guidelines. We describe the core issues that both urologists and rheumatologists should bear in mind. Direct communication, routine exchange and involvement of rheumatologists in interdisciplinary tumor boards should improve future treatment quality of our joint patients.