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Crișan D, Avram L, Grapă C, Nemeș A, Coman MV, Beldean-Galea MS, Coman RT, Călinici T, Donca V, Crăciun R. Unveiling Health Inequalities: Exploring Metabolic Dysfunction in Rural Roma Communities. Healthcare (Basel) 2024; 12:816. [PMID: 38667578 PMCID: PMC11050184 DOI: 10.3390/healthcare12080816] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Europe's largest ethnic minority, the Roma, are often confronted with substantial obstacles that result in health disparities. Research indicates that there are elevated rates of both communicable and non-communicable diseases, such as metabolic syndrome (MetS), among Roma communities, often linked to living conditions, limited education, or poverty. This study centers on remote rural Roma settlements in Romania, evaluating the prevalence of metabolic dysfunction, obesity, and liver steatosis while considering socio-economic and lifestyle factors. METHODS Over a period of 36 months, local visits to a total of 25 rural Roma communities were conducted, where a medical team gathered information through a standardized questionnaire and conducted a physical exam on every participant. Liver steatosis was also recorded with the help of a portable wireless ultrasound device. RESULTS Our study included 343 participants, with a predominance of female subjects, representing 72.5% (n = 249) of the patients. The prevalence of obesity, defined by a body mass index (BMI) above 30 kg/m2, was 32.2% (n = 111). Arterial hypertension was found to have a prevalence of 54.1% (n = 185), with de novo hypertension being observed in 19.2% patients (n = 66). Type 2 diabetes mellitus was found in 28.9% patients (n = 99), with 19.5% being de novo cases. The prevalence of hepatic steatosis was 57.2% (n = 111/194). A positive association between metabolic features and at-risk behaviors was found. CONCLUSIONS This study underscores the transition from infectious to metabolic diseases in vulnerable communities and highlights the urgency of targeted public health strategies tailored to the unique needs of rural Roma populations, aiming to mitigate health disparities and promote equitable healthcare access.
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Affiliation(s)
- Dana Crișan
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Lucreția Avram
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Cristiana Grapă
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Andrada Nemeș
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Maria-Virginia Coman
- “Raluca Ripan” Institute for Research in Chemistry, “Babeş-Bolyai” University, 400294 Cluj-Napoca, Romania;
| | | | - Radu-Tudor Coman
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Tudor Călinici
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Valer Donca
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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Buhas BA, Toma V, Beauval JB, Andras I, Couți R, Muntean LAM, Coman RT, Maghiar TA, Știufiuc RI, Lucaciu CM, Crisan N. Label-Free SERS of Urine Components: A Powerful Tool for Discriminating Renal Cell Carcinoma through Multivariate Analysis and Machine Learning Techniques. Int J Mol Sci 2024; 25:3891. [PMID: 38612705 PMCID: PMC11011951 DOI: 10.3390/ijms25073891] [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: 03/02/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
The advent of Surface-Enhanced Raman Scattering (SERS) has enabled the exploration and detection of small molecules, particularly in biological fluids such as serum, blood plasma, urine, saliva, and tears. SERS has been proposed as a simple diagnostic technique for various diseases, including cancer. Renal cell carcinoma (RCC) ranks as the sixth most commonly diagnosed cancer in men and is often asymptomatic, with detection occurring incidentally. The onset of symptoms typically aligns with advanced disease, aggressive histology, and unfavorable prognosis, and therefore new methods for an early diagnosis are needed. In this study, we investigated the utility of label-free SERS in urine, coupled with two multivariate analysis approaches: Principal Component Analysis combined with Linear Discriminant Analysis (PCA-LDA) and Support Vector Machine (SVM), to discriminate between 50 RCC patients and 44 healthy donors. Employing LDA-PCA, we achieved a discrimination accuracy of 100% using 13 principal components, and an 88% accuracy in discriminating between different RCC stages. The SVM approach yielded a training accuracy of 100%, a validation accuracy of 99% for discriminating between RCC and controls, and an 80% accuracy for discriminating between stages. The comparative analysis of raw and normalized SERS spectral data shows that while raw data disclose relative concentration variations in urine metabolites between the two classes, the normalization of spectral data significantly improves the accuracy of discrimination. Moreover, the selection of principal components with markedly distinct scores between the two classes serves to alleviate overfitting risks and reduces the number of components employed for discrimination. We obtained the accuracy of the discrimination between the RCC patients cases and healthy donors of 90% for three PCs and a linear discrimination function, and a 88% accuracy of discrimination between stages using six PCs, mitigating practically the risk of overfitting and increasing the robustness of our analysis. Our findings underscore the potential of label-free SERS of urine in conjunction with chemometrics for non-invasive and early RCC detection.
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Affiliation(s)
- Bogdan Adrian Buhas
- Department of Urology, La Croix du Sud Hospital, 52 Chemin de Ribaute St., 31130 Quint Fonsegrives, France; (B.A.B.); (J.-B.B.)
- Department of Urology, Clinical Municipal Hospital, 11 Tabacarilor St., 400139 Cluj-Napoca, Romania; (I.A.); (N.C.)
- Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii St., 410087 Oradea, Romania; (R.C.); (T.A.M.)
| | - Valentin Toma
- Department of Nanobiophysics, MedFuture Research Center for Advanced Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4-6 Pasteur St., 400337 Cluj-Napoca, Romania;
| | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, 52 Chemin de Ribaute St., 31130 Quint Fonsegrives, France; (B.A.B.); (J.-B.B.)
| | - Iulia Andras
- Department of Urology, Clinical Municipal Hospital, 11 Tabacarilor St., 400139 Cluj-Napoca, Romania; (I.A.); (N.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes St., 400347 Cluj-Napoca, Romania
| | - Răzvan Couți
- Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii St., 410087 Oradea, Romania; (R.C.); (T.A.M.)
| | - Lucia Ana-Maria Muntean
- Department of Medical Education, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes St., 400347 Cluj-Napoca, Romania;
| | - Radu-Tudor Coman
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes St., 400347 Cluj-Napoca, Romania
| | - Teodor Andrei Maghiar
- Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii St., 410087 Oradea, Romania; (R.C.); (T.A.M.)
| | - Rareș-Ionuț Știufiuc
- Department of Nanobiophysics, MedFuture Research Center for Advanced Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4-6 Pasteur St., 400337 Cluj-Napoca, Romania;
- Department of Pharmaceutical Physics–Biophysics, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 6 Pasteur St., 400349 Cluj-Napoca, Romania
- Nanotechnology Laboratory, TRANSCEND Research Center, Regional Institute of Oncology, 700483 Iași, Romania
| | - Constantin Mihai Lucaciu
- Department of Pharmaceutical Physics–Biophysics, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 6 Pasteur St., 400349 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, Clinical Municipal Hospital, 11 Tabacarilor St., 400139 Cluj-Napoca, Romania; (I.A.); (N.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes St., 400347 Cluj-Napoca, Romania
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Herghelegiu MC, Pănescu VA, Bocoș-Bințințan V, Coman RT, Berg V, Lyche JL, Bruzzoniti MC, Beldean-Galea MS. Simultaneous Determination of Steroids and NSAIDs, Using DLLME-SFO Extraction and HPLC Analysis, in Milk and Eggs Collected from Rural Roma Communities in Transylvania, Romania. Molecules 2023; 29:96. [PMID: 38202679 PMCID: PMC10780084 DOI: 10.3390/molecules29010096] [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: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
This research aims to determine five steroids and four non-steroidal anti-inflammatory drugs in milk and egg samples collected from rural Roma communities in Transylvania, Romania. Target compounds were extracted from selected matrices by protein precipitation, followed by extract purification by dispersive liquid-liquid microextraction based on solidification of floating organic droplets. The extraction procedure was optimized using a 24 full factorial experimental design. Good enrichment factors (87.64-122.07 milk; 26.97-38.72 eggs), extraction recovery (74.49-103.76% milk; 75.64-108.60% eggs), and clean-up of the sample were obtained. The method detection limits were 0.74-1.77 µg/L for milk and 2.39-6.02 µg/kg for eggs, while the method quantification limits were 2.29-5.46 µg/L for milk and 7.38-18.65 µg/kg for eggs. The steroid concentration in milk samples was
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Affiliation(s)
- Mihaela Cătălina Herghelegiu
- Faculty of Environmental Science and Engineering, Babeș-Bolyai University, 1 Kogălniceanu Str., 400084 Cluj-Napoca, Romania
| | - Vlad Alexandru Pănescu
- Faculty of Environmental Science and Engineering, Babeș-Bolyai University, 1 Kogălniceanu Str., 400084 Cluj-Napoca, Romania
| | - Victor Bocoș-Bințințan
- Faculty of Environmental Science and Engineering, Babeș-Bolyai University, 1 Kogălniceanu Str., 400084 Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 Babeș Str., 400012 Cluj-Napoca, Romania
| | - Vidar Berg
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1433 Ås-Oslo, Norway
| | - Jan Ludvig Lyche
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1433 Ås-Oslo, Norway
| | | | - Mihail Simion Beldean-Galea
- Faculty of Environmental Science and Engineering, Babeș-Bolyai University, 1 Kogălniceanu Str., 400084 Cluj-Napoca, Romania
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Candrea E, Vargha JL, Todor N, Coman RT, Baican A, Filip A. COVID-19 vaccine acceptance among medical students in Romania. J Physiol Pharmacol 2022; 73. [PMID: 36193970 DOI: 10.26402/jpp.2022.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/30/2022] [Indexed: 06/16/2023]
Abstract
Vaccination against COVID-19 is a highly debated subject that brings confusion due to contradictory information coming from the scientific community and the media. Our aim was to focus on a homogeneous group of students in the healthcare field to assess their intention to vaccinate and the drivers behind this decision. A cross-sectional study was performed in the spring of 2021 in a Medical University in Romania. 725 of the undergraduates that completed an online questionnaire regarding their intention to vaccinate against COVID-19 were included in the study. Univariable analysis and logistic regression were performed on several variables to analyze factors affecting the willingness to vaccinate against COVID-19. In our study sample, 93.1% of students presented a strong intention to vaccinate, out of which the highest proportion belonged to subjects studying general medicine (96%). On logistic regression, we identified the following predictor factors: previous infection with coronavirus, prior vaccination refusal, VAX score, scientifically oriented sources of information and preference for RNA-based technology. Medical students have an increased willingness towards vaccination. Even for them, a highly educated and informed group of subjects, the general attitude towards vaccinations has a strong impact on the choice of COVID-19 vaccination.
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Affiliation(s)
- E Candrea
- Department of Dermatology, University of Medicine and Pharmacy 'I. Hatieganu', Cluj Napoca, Romania.
| | - J L Vargha
- Institute of Contextual Psychological Technologies, Cluj Napoca, Romania
| | - N Todor
- 'Prof.Dr. I. Chiricuta' Oncology Institute, Cluj-Napoca, Romania
| | - R T Coman
- Epidemiology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - A Baican
- Department of Dermatology, University of Medicine and Pharmacy 'I. Hatieganu', Cluj Napoca, Romania
| | - A Filip
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Cata ED, Andras I, Telecan T, Tamas-Szora A, Coman RT, Stanca DV, Coman I, Crisan N. MRI-targeted prostate biopsy: the next step forward! Med Pharm Rep 2021; 94:145-157. [PMID: 34013185 PMCID: PMC8118209 DOI: 10.15386/mpr-1784] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
Aim For decades, the gold standard technique for diagnosing prostate cancer was the 10 to 12 core systematic transrectal or transperineal biopsy, under ultrasound guidance. Over the past years, an increased rate of false negative results and detection of clinically insignificant prostate cancer has been noted, resulting into overdiagnosis and overtreatment. The purpose of the current study was to evaluate the changes in diagnosis and management of prostate cancer brought by MRI-targeted prostate biopsy. Methods A critical review of literature was carried out using the Medline database through a PubMed search, 37 studies meeting the inclusion criteria: prospective studies published in the past 8 years with at least 100 patients per study, which used multiparametric magnetic resonance imaging as guidance for targeted biopsies. Results In-Bore MRI targeted biopsy and Fusion targeted biopsy outperform standard systematic biopsy both in terms of overall and clinically significant prostate cancer detection, and ensure a lower detection rate of insignificant prostate cancer, with fewer cores needed. In-Bore MRI targeted biopsy performs better than Fusion biopsy especially in cases of apical lesions. Conclusion Targeted biopsy is an emerging and developing technique which offers the needed improvements in diagnosing clinically significant prostate cancer and lowers the incidence of insignificant ones, providing a more accurate selection of the patients for active surveillance and focal therapies.
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Affiliation(s)
- Emanuel Darius Cata
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Telecan
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan-Vasile Stanca
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Cata E, Andras I, Ferro M, Kadula P, Leucuta D, Musi G, Matei DV, De Cobelli O, Tamas-Szora A, Caraiani C, Lebovici A, Epure F, Bungardean M, Coman RT, Crisan N. Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting-prospective single center experience after 300 cases in first biopsy setting. Transl Androl Urol 2020; 9:2510-2518. [PMID: 33457225 PMCID: PMC7807351 DOI: 10.21037/tau-20-1001] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy have become an integral part of the diagnosis of prostate cancer (PCa), as recommended by the European Association of Urology Guidelines. The aim of the current study was to evaluate the performance of MRI and MRI-transrectal ultrasound (TRUS) fusion prostate biopsy as first biopsy setting in a tertiary center. Methods A cohort of 300 patients was included in the current analysis. All patients presented with clinical or biochemical suspicion of PCa and harbored at least one suspect lesion on mpMRI. MRI-TRUS fusion prostate biopsy, followed by 12 core systematic prostate biopsy were performed by the same operator using a rigid registration system. Results The mean age of the patients was 64 years (IQR: 58–68.5 years) and the mean PSA was 6.35 ng/mL (IQR: 4.84–9.46 ng/mL). Overall cancer and csPCa diagnosis rates were 47% and 40.66%. Overall PCa/csPCa detection rates were 20.4%/11.1%, 52%/45% and 68.5%/66.7% for PI-RADS lesions 3, 4 and 5 (P<0.001/P<0.0001). Larger lesion diameter and lesion volume were associated with PCa diagnosis (P=0.006 and P=0.001, respectively). MRI-TRUS fusion biopsy missed PCa diagnosis in 37 cases (of whom 48.6% ISUP 1) in comparison with 9 patients missed by systematic biopsy (of whom 11.1% ISUP 1). In terms of csPCa, systematic biopsy missed 77.7% of the tumors located in the anterior and transitional areas. The rate of csPCa was highest when targeted biopsy was associated with systematic biopsy: 86.52% vs. 68.79% for targeted biopsy vs. 80.14% for systematic biopsy, P=0.0004. In 60.6% of cases, systematic biopsy was positive for PCa at the same site as the targeted lesion. Of these patients, eight harbored csPCa and were diagnosed exclusively on systematic biopsy. Conclusions MRI-TRUS fusion prostate biopsy improves the diagnosis of csPCa. The main advantage of an MRI-guided approach is the diagnosis of anterior and transitional area tumors. The best results in terms of csPCa diagnosis are obtained by the combination of MRI-TRUS fusion with systematic biopsy. The systematic biopsy performed during MRI-targeted biopsy could have an important role in overcoming errors of MRI-TRUS fusion systems.
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Affiliation(s)
- Emanuel Cata
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Pierre Kadula
- Urology Department, Municipal Hospital, Cluj Napoca, Romania
| | - Daniel Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | | | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Andrei Lebovici
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Flavia Epure
- Medical Imaging Department, Medisprof Cancer Center, Cluj Napoca, Romania
| | - Maria Bungardean
- Pathology Department, County Emergency Hospital, Cluj Napoca, Romania
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Urology Department, Municipal Hospital, Cluj Napoca, Romania
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Cealan A, Coman RT, Simon V, Andras I, Telecan T, Coman I, Crisan N. Evaluation of the efficacy of Phyllanthus niruri standardized extract combined with magnesium and vitamin B6 for the treatment of patients with uncomplicated nephrolithiasis. Med Pharm Rep 2019; 92:153-157. [PMID: 31086843 PMCID: PMC6510356 DOI: 10.15386/mpr-1246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of our study was to assess the efficacy of Phyllanthus niruri standardized extract, combined with magnesium and B6 vitamin, used to treat uncomplicated nephrolithiasis. Methods We included in the present study 48 patients with uncomplicated nephrolithiasis, with the maximum calculi diameter of up to 15 mm, confirmed by non-contrast-enhanced computer tomography. Each patient followed a three-month therapeutic regimen with the above mentioned combination, with imaging assessment of the calculi after treatment. Results Per patient: The mean age of the patients was 48 years. The median number of calculi was 1 and the mean dimension was 5.5 mm. The stone-free status after treatment was not correlated with gender (p=0.7), side location (p=0.8) or with the number of calculi (p=0.3), but we found a correlation with the location in the upper or middle calyx (54.5% vs 13.8%, p=0.008) and with the maximum diameter (p=0.001).Per stone: 60 calculi were analyzed, 8.3% being located in the upper calyx, 36.7% in the middle and 55% in the lower one. After treatment, 40% were absent, 21.7% showed lower dimensions and 38.3% remained unchanged, with the mean reduction of 1.7 mm. We identified a cut-off value of ≤ 3 mm (AUC 0.9, CI:0.8-0.9, p<0.0001) for the prediction of stone-free status after treatment. Conclusions The current treatment had the highest efficacy in achieving stone-free status for patients with calculi ≤ 3 mm, located in the middle or upper calyx. A higher duration of the treatment might show improved results.
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Affiliation(s)
- Alexandru Cealan
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vasile Simon
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Telecan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Andras I, Crisan D, Cata E, Tamas-Szora A, Caraiani C, Coman RT, Bungardean C, Mirescu C, Coman I, Crisan N. MRI-TRUS fusion guided prostate biopsy - initial experience and assessment of the role of contralateral lobe systematic biopsy. Med Ultrason 2019; 21:37-44. [PMID: 30779829 DOI: 10.11152/mu-1705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS To present our initial experience and results of MRI-TRUS fusion guided prostate biopsy and assess the role of contralateral lobe systematic biopsy. MATERIAL AND METHOD A number of 119 patients with clinical or biochemical suspicion for prostate cancer (PCa) were included. All patients harbored at least one PIRADS score ≥ 3 lesion and underwent MRI-TRUS fusion guided biopsy, as well as a concurrent systematic biopsy. The biopsy was performed by the same operator, using a rigidregistration software system. RESULTS The mean age of the patients was 62.2 years. The mean pre-biopsy PSA was 9.15 ng/dl. The diagnosis rate of MRI-TRUS fusion guided biopsy was 47% for overall PCa and 29.4% for clinically significant (cs) PCa. A higher PIRADS score was significantly associated with the presence of overall and csPCa. MRI-TRUS fusion guided biopsy had a higher percentage of positive biopsy cores (51% vs 29%), higher likelihood of csPCa (OR 5.36, p=0.008) and upgrading (14.8%) in comparison with systematic biopsy but missed 6.7% csPCa. The contralateral lobe systematic biopsy could have been avoided without losing the PCa diagnosis all patients with PIRADS score 5, both in initial and repeat biopsy setting. Anterior and transitional lesions were more likely to be diagnosed only by targeted cores. CONCLUSION MRI-TRUS guided prostate biopsy improves the detection of PCa, but systematic biopsy is still essential. In selected cases (PIRADS 5), contralateral lobe systematic biopsy can safely be avoided. Pre-biopsy mpMRI might reduce the number of biopsy sessions in patients with anterior and transitional lesions.
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Affiliation(s)
- Iulia Andras
- Department of Urology, Iuliu Hatieganu Unviersity of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
| | - Dana Crisan
- Internal Medicine Department, 5th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Internal Medicine Department, Clinical Municipal Hospital Cluj-Napoca, Romania.
| | - Emanuel Cata
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania.
| | | | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | | | - Claudiu Mirescu
- Pathology Department, Clinical Municipal Hospital Cluj-Napoca, Romania.
| | - Ioan Coman
- Department of Urology, Iuliu Hatieganu Unviersity of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
| | - Nicolae Crisan
- Department of Urology, Iuliu Hatieganu Unviersity of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
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Crisan N, Andras I, Telecan T, Szabo A, Popa A, Coman RT, Medan P, Coman I. Retroperitoneal laparoendoscopic single-site approach for renal cyst decortication - first experience and a review of literature. Med Pharm Rep 2018; 91:346-350. [PMID: 30093816 PMCID: PMC6082605 DOI: 10.15386/cjmed-953] [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: 12/22/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/23/2022] Open
Abstract
Laparoendoscopic single-site (LESS) approach has been successfully employed for a number of urologic procedures. The retroperitoneal approach further limits the working space and instrument movement during LESS surgery, but has the advantage of a faster post-operative recovery and lower complications rate. We present our first experience using retroperitoneal LESS approach for a renal cyst decortication in a 40-year-old patient. The operative time was 40 minutes, the blood loss was minimal and we did not encounter significant conflicts between the instruments. The patient was discharged 2 days after the procedure and returned to full normal activity within one week. We consider that the retroperitoneal LESS approach is feasible for upper tract urologic surgery. Pre-bent instruments might further improve surgical gestures and extend the indications for more complex procedures. Nevertheless, the advent of reusable devices is expected to increase the cost-effectiveness of LESS and expand its use.
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Affiliation(s)
- Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy and Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy and Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Teodora Telecan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Szabo
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Andrei Popa
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paul Medan
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy and Clinical Municipal Hospital, Cluj-Napoca, Romania
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Crisan N, Andras I, Grad DL, Telecan T, Coman RT, de Cobelli O, Matei DV, Coman I. Dual Combined Laparoscopic Approach for Renal-Cell Carcinoma with Renal Vein and Level I-II Inferior Vena Cava Thrombus: Our Technique and Initial Results. J Endourol 2018; 32:837-842. [PMID: 29947249 DOI: 10.1089/end.2018.0228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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
OBJECTIVE To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. PATIENTS AND METHODS We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. RESULTS The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. CONCLUSIONS The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.
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Affiliation(s)
- Nicolae Crisan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Iulia Andras
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Doru-Lucian Grad
- 2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Teodora Telecan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- 3 Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | | | - Deliu Victor Matei
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,4 Urology Division, European Institute of Oncology , Milan, Italy
| | - Ioan Coman
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
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11
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Coman RT, Crisan N, Andras I, Nicu B, Bocsan IS. The 3D laparoscopic approach for radical prostatectomy overcomes the hurdles of metabolic syndrome. Med Pharm Rep 2018; 91:245-246. [PMID: 29785167 PMCID: PMC5958994 DOI: 10.15386/cjmed-923] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | | | - Ioan-Stelian Bocsan
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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Coman RT, Crisan N, Andras I, Bud G, Matei DV, DE Cobelli O, Coman I, Bocsan IS. Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (< 50 years vs > 65 years). Med Pharm Rep 2018; 91:92-97. [PMID: 29440957 PMCID: PMC5808275 DOI: 10.15386/cjmed-825] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background and aims To assess the outcomes of robotic radical prostatectomy in two different age subgroups of pre-operatively potent patients: younger than 50 years and older than 65 years. Methods We included in the present study a number of 202 patients with prostate cancer divided into two groups: 99 patients older than 65 years (group 1) and 103 patients younger than 50 years (group 2). Results More than half of the younger patients were low-risk vs 57% of the older patients who were high-risk. Overall positive surgical margins rate was 21.2% in group 1 vs 12.1% in group 2. The early biochemical recurrence at 6 months after radical prostatectomy was 4% in group 1 vs 11.6% in group 2. The continence rate at 6 months was similar between the two groups and was not correlated with the patients’ age (p=0.72), nerve-sparing (p=0.3 for group 1, p=0.92 for group 2) or pathological staging (overall p=0.81, p=0.89 in group 1 and p=0.63 in group 2). We observed a significantly higher rate of potency for patients in group 2 (91.5% vs 47.2%, p<0.0001). The most important factor associated with the regain of potency at 6 months after the procedure was the age of the patient (p<0.0001), independently of the type of nerve-sparing performed. Conclusions Age seems to be the most important predictor of the regain of potency after robotic radical prostatectomy. Patients should be counseled accordingly in order to have realistic expectations about the functional results after robotic-assisted surgery.
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Affiliation(s)
- Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Gabriela Bud
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | | | | | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Ioan-Stelian Bocsan
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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13
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Coman RT, Crisan N, Kadula PA, Bocsan IS, Coman I, Andras I. Neutrophil-to-lymphocyte ratio above 2 - advocate for lymph node dissection in prostate cancer. J BUON 2018; 23:275-276. [PMID: 29552799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Radu-Tudor Coman
- Iuliu Hatieganu University of Medicine and Pharmacy, Dept. of Epidemiology, Cluj-Napoca, Romania
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Crisan N, Andras I, Radu C, Andras D, Coman RT, Tucan P, Pisla D, Crisan D, Coman I. Prostate ultrasound: back in business! Med Ultrason 2017; 19:423-429. [PMID: 29197919 DOI: 10.11152/mu-1147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The use of grey scale prostate ultrasound decreased after the implementation of magnetic resonance imaging (MRI) for the diagnosis and evaluation of prostate cancer. The new developments, such as multiparametric ultrasound and MRI-ultrasound fusion technology, renewed the interest for this imaging method in the assessment of prostate cancer. The purpose of this paper was to review the current role of prostate ultrasound in the setting of these new applications. A thorough reevaluation of the selection criteria of the patients is required to assess which patients would benefit from multiparametric ultrasound, who wouldbenefit from multiparametric MRI or the combination of both to assist prostate biopsy in order to ensure the balance between overdiagnosis and underdiagnosis of prostate cancer.
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Affiliation(s)
- Nicolae Crisan
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Iulia Andras
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Corina Radu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca.
| | - David Andras
- Oncologic Surgery Department, Ion Chiricuta Institute of Oncology, Cluj-Napoca.
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Paul Tucan
- CESTER (Research Center for Industrial Robots Simulation and Testing), Technical University, Cluj-Napoca.
| | - Doina Pisla
- CESTER (Research Center for Industrial Robots Simulation and Testing), Technical University, Cluj-Napoca.
| | - Dana Crisan
- Internal Medicine Department, 5th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca Internal Medicine Department, Clinical Municipal Hospital Cluj-Napoca.
| | - Ioan Coman
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
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Andras I, Crisan N, Vesa S, Rahota R, Romanciuc F, Lazar A, Socaciu C, Matei DV, de Cobelli O, Bocsan IS, Coman RT. Serum metabolomics can predict the outcome of first systematic transrectal prostate biopsy in patients with PSA <10 ng/ml. Future Oncol 2017; 13:1793-1800. [PMID: 28776421 DOI: 10.2217/fon-2017-0078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/31/2023] Open
Abstract
AIM To assess the predictive value of metabolomic analysis for the presence of prostate cancer (PCa) at first systematic biopsy. PATIENTS & METHODS Ninety serum samples from patients with suspicion for PCa were included. Targeted and nontargeted metabolomic analysis was performed. RESULTS Six metabolites were combined into a predictive score. A cutoff value of 0.528 for the metabolomic score showed a good accuracy for the prediction of PCa at biopsy (Area under the curve (AUC): 0.779; p < 0.001). These results were validated in a subgroup of patients, showing similar accuracy (p = 0.1). For patients with prostate specific antigen (PSA) less than 10 ng/ml, the score showed a Se 80.95%, Sp 64.52% for the detection of PCa at biopsy. CONCLUSION Metabolomic analysis can predict the outcome of the first systematic biopsy.
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Affiliation(s)
- Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania.,Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania.,Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Stefan Vesa
- Department of Pharmacology, Toxicology & Clinical Pharmacology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Razvan Rahota
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Florina Romanciuc
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Andrei Lazar
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Carmen Socaciu
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | | | | | - Ioan-Stelian Bocsan
- Department of Epidemiology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Department of Epidemiology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
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Andras I, Crisan N, Gavrilita M, Coman RT, Nyberg V, Coman I. Every setback is a setup for a comeback: 3D laparoscopic radical prostatectomy after robotic radical prostatectomy. J BUON 2017; 22:87-93. [PMID: 28365940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess whether previous experience in robotic surgery has a role in the transition to 3D laparoscopy and influences the perioperative results and short term oncological and functional outcomes of the first patients that undergo laparoscopic radical prostatectomy (LRP). METHODS We analyzed 248 patients that underwent robotic radical prostatectomy (RALP) between 2009-2015 and 98 patients that underwent 3D HD LRP from 2015-present in our department. The procedures were performed by the same two surgeons, who crossed from open to robotic surgery, and afterwards to 3D laparoscopy. RESULTS The patients in the study groups were comparable in terms of age, pre-operative PSA levels, clinical staging and D'Amico risk groups. The operative time was significantly shorter in favor of the laparoscopic approach (a difference of 110 min, p<0.0001). The overall rate of positive surgical margins was similar, with the biggest difference from 40.8% to 25% in pT3 patients in favor of the laparoscopic approach. The mean time to catheter removal was 7 days for RALP and 8 days for LRP. We did not identify any significant difference between the two groups in terms of biochemical recurrence, continence or potency at 3 and 6 months after the procedure. CONCLUSIONS Previous experience in robotic surgery ensured a fast transition to 3D laparoscopic approach for radical prostatectomy, with comparable oncologic and functional outcomes, but with a shorter operative time and reduced costs.
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Affiliation(s)
- Iulia Andras
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Urology, Cluj-Napoca, Romania
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Andras I, Crisan N, Coman RT, Logigan H, Epure F, Stanca DV, Coman I. Oncological results at 2 years after robotic radical prostatectomy - the Romanian experience. Cent European J Urol 2016; 69:48-52. [PMID: 27123326 PMCID: PMC4846716 DOI: 10.5173/ceju.2016.640] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/10/2015] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction To assess the oncological outcomes of robotic radical prostatectomy in a country where there are no on-going national screening programs for prostate cancer. Material and methods Between November 2009 and November 2014, 220 robotic radical prostatectomies were performed at our Robotic Surgery Center. We already have the complete data for the 2-year follow-up of the first 105 patients, who were therefore included in the study group. Pre-operative (age, prostate-specific antigen, body-mass index, prostate volume, clinical staging, biopsy characteristics), post-operative (surgical technique, surgical margin status, lymph node status, pathological stage, Gleason score) and follow-up parameters (biochemical recurrence) were assessed. Results The global rate of positive surgical margins was 34.3%, with rates of 17.2% in stage pT2 and 55.3% in stage pT3. The most frequent localization for positive surgical margins was at the base and apex of the prostate. The positive surgical margins rate was correlated with the pre-operative prostate-specific antigen, clinical and pathological Gleason score, lymph node status and the number of positive biopsy cores. The rate of biochemical recurrence at the 2-year follow-up was 11.8%. The most important predictors for the biochemical recurrence were the positive surgical margins, pathological staging and Gleason score on the prostatectomy specimen. Conclusions Robotic surgery is validated by the oncological results at medium follow-up (2 years) for localized and locally advanced prostate cancer, even in countries where there is no on-going national screening program.
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Affiliation(s)
- Iulia Andras
- Clinical Municipal Hospital, Urology Department, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Nicolae Crisan
- Clinical Municipal Hospital, Urology Department, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Horia Logigan
- Clinical Municipal Hospital, Urology Department, Cluj-Napoca, Romania
| | - Flavia Epure
- Clinical County Hospital, Radiology Department, Cluj-Napoca, Romania
| | - Dan Vasile Stanca
- Clinical Municipal Hospital, Urology Department, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Ioan Coman
- Clinical Municipal Hospital, Urology Department, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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