Urinary microbiota and prostatic diseases: the key for the lock? A systematic review

BACKGROUND

Urinary microbiota is implicated in many diseases of the urinary tract. The aim of this study was to perform a systematic review of the role of urinary microbiota in prostatic diseases.

METHODS

A PubMed/Medline search was undergone from inception through June 2022 for studies investigating urinary microbiota alterations in prostatic diseases, subdivided into benign prostatic hyperplasia (BPH), prostate cancer (PCa), and chronic prostatitis (CP). Study selection followed the PRISMA statement. Phylum, family, genus and species of each bacterium in cancer patients and controls were recorded. Quality of included studies was evaluated using the Critical Appraisal Skills Program (CASP) checklist for non-randomized studies.

RESULTS

A total of 16 studies (4 studies on BPH, 9 studies on PCa and 3 studies on CP) comprising 1486 patients were included in our final analysis. Patients with BPH had a different urinary microbial composition, with a certain pattern proven to be associated with a higher lower urinary tract symptoms severity. Regarding PCa, some bacterial phyla/genera/classes/species were more abundant in PCa and others predicted a higher grade disease. In patients with CP, a different microbiota composition and a higher diversity were found, with the symptom severity being influenced mainly by microbiota composition, favoring aerobic microorganisms.

CONCLUSION

Urinary microbiota is implicated in prostatic diseases, especially in BPH, PCa and CP. However, given the relative heterogeneity among published studies, this implication suggests better delineation is needed. Further studies are needed to confirm these findings.

Prognostic role of neutrophil-to-lymphocyte ratio (NLR) in urological tumors: an umbrella review of evidence from systematic reviews and meta-analyses

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) has been studied as a biomarker for cancer prognosis, predicting survival in many tumors. The aim of this umbrella review was to combine the results from all systematic reviews and meta-analyses related to the prognostic role of the NLR in patients with urological tumors.

METHODS

A PubMed, Scopus, Embase and Cochrane search was undergone from inception through September 2020 for systematic reviews and meta-analyses investigating the prognostic value of NLR in urological tumors, subdivided into prostate cancer, renal cell carcinoma, urothelial bladder and upper tract carcinomas PROSPERO (CRD42020216310).

RESULTS

The results have shown, with a high level of evidence, that an elevated NLR predicts worse overall survival (OS), progression-free survival (PFS) and relapse-free survival (RFS) in prostate cancer, worse OS, PFS and RFS in renal cell carcinoma, worse OS, PFS, RFS and cancer-specific survival (CSS) in muscle invasive bladder cancer, worse PFS and RFS in non-muscle invasive bladder cancer, and worse OS, PFS, RFS and CSS in urothelial upper tract carcinoma.

CONCLUSION

NLR has a significant prognostic value in urological tumors and should be included in prognostic scores of these cancers.

What is the most reliable radiographic method to evaluate the longitudinal foot arch? Application in subjects with Adolescent Idiopathic Scoliosis

BACKGROUND

The foot arch is known to be altered in subjects with postural malalignment. Foot arch morphology can be studied simultaneously with body's balance by measuring foot radiographic parameters on full-body biplanar x-rays. There is no consensus on which is the most reliable method to use to draw the foot axes. The aim was to determine the most reliable methods to draw the main foot axes and apply these findings in order to study the difference of foot parameters between AIS and control subjects.

HYPOTHESES

(1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; (2) foot longitudinal arch parameters differ between AIS and controls.

METHODS

Ninety AIS patients and 36 controls have undergone full body biplanar X-rays from which 3D spino-pelvic and postural parameters were collected for each patient. Six radiological foot angles were evaluated on the 2D lateral radiographs: calcaneal pitch (CPA), talar declination (TDA), first metatarsal declination (FMDA), talo-calcaneal (TCA), calcaneal first metatarsal (CFMA) and Meary. Angles were calculated based on three major axes of the foot: talar, calcaneal, and first metatarsal. Two to three methods were used to draw each axis and the reliability of each method was assessed (three operators, 2-times each). Then, differences of the foot parameters between AIS and controls, and determinants of these differences among 3D spino-pelvic and postural parameters were evaluated.

RESULTS

The most reliable methods for drawing the three axes of the foot were those using distant and clear anatomical landmarks on talus, calcaneum and first metatarsal and used for the subsequent analysis. The AIS group showed a significantly lower TDA (22° vs. 24°, p=0.014) and CFMA (141° vs. 144°, p=0.045), and higher FMDA (18° vs. 15°, p=0.008) and Meary's angle (-5° vs. -9°, p=0.005) when compared to controls. Differences were found to be determined mainly by the center of auditory meatus sagittal plumbline.

DISCUSSION

This is the first study to evaluate the most reliable method to draw foot axes on the lateral radiograph of biplanar X-rays in order to assess radiological foot arch parameters. AIS patients were shown to have more elevated foot arch compared to controls.

COVID-19 and the male susceptibility: the role of ACE2, TMPRSS2 and the androgen receptor

COVID-19 is the pandemic that hit the world starting December 2019. Recent studies and international statistics have shown an increased prevalence, morbidity as well as mortality of this disease in male patients compared to female patients. The aim of this brief communication is to describe the pathophysiology of this sex-discrepancy, based on the infectivity mechanism of the coronavirus including the Angiotensin-Converting Enzyme 2 (ACE2), the Type II transmembrane Serine Protease (TMPRSS2), and the androgen receptor. This could help understand the susceptibility of urological patients, especially those receiving androgen deprivation therapy for prostate cancer, and testosterone replacement therapy.

Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis

PURPOSE

To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment.

METHODS

Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°-110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center-edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters.

RESULTS

Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R2: 0.08-0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12.

CONCLUSIONS

Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.

The role of asymptomatic screening in the detection of recurrent ovarian cancer

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The pelvic exam was a useful tool in the detection of ovarian recurrence.

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CA-125 use was not associated with better survival or rate of secondary cytoreductive surgery.

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Providers should carefully consider modalities for asymptomatic ovarian recurrence monitoring.

Objective

To investigate the utility of asymptomatic screening, including CA-125, imaging, and pelvic exam, in the diagnosis and management of recurrent ovarian cancer.

Methods

Women with ovarian cancer whose cancer recurred after remission were categorized by first method that their provider suspected disease recurrence: CA-125, imaging, symptoms, or physical exam. Differences in clinicopathologic, primary treatment characteristics, and outcomes data including secondary cytoreductive surgery (SCS) outcome and overall survival (OS) were collected.

Results

102 patients were identified at our institution from 2003 to 2015. 20 recurrences were detected by symptoms, while 62 recurrences were diagnosed first by asymptomatic rise in CA-125, 5 by pelvic exam, and 15 by imaging in the absence of known exam abnormality or rise in CA-125.

Mean time to recurrence was 18.9 months, and median survival was 45.8 months. These did not vary by recurrence detection method (all p > 0.4). Patients whose disease was detected by CA-125 were less likely to undergo SCS than those detected by other means (21.7% vs. 35.0%, p = 0.007). In addition to the 5 patients whose recurrence was detected primarily by pelvic exam, an additional 10 (total n = 15) patients had an abnormal pelvic exam at time of diagnosis of recurrence.

Discussion

Recurrence detection method was not associated with differing rates of survival or optimal SCS, however those patients detected by CA-125 were less likely to undergo SCS. The pelvic exam was a useful tool for detecting a significant proportion of recurrences.

Is the apical vertebra the most rotated vertebra in the scoliotic curve?

OBJECTIVE

The aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment.

METHODS

A total of 158 patients with AIS (Cobb angle range 20°-101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed.

RESULTS

The distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001).

CONCLUSIONS

This study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.

Seroprevalence of peste des petits ruminants and bluetongue in goat population of Meghalaya, India

Aim:

This study aimed to determine the seroprevalence of peste des petits ruminants (PPR) and bluetongue (BT) in goats’ population in the state of Meghalaya of Northeast India.

Materials and Methods:

The serosurveillance study was done from the random sampling (n=598) of blood collected from five districts (Ri-Bhoi, East Khasi Hills, West Khasi Hills, Jaintia Hills and West Garo Hills) of Meghalaya. The presence of antibodies against PPR and BT in the samples was detected by indirect enzyme-linked immunosorbent assay (ELISA) method for PPR and competitive ELISA for BT.

Results:

The results showed the overall seropositivity of PPR and BT at 7.19% and 60.20%, respectively. West Garo Hills recorded the highest seroprevalence of both PPR (9.81%) and BT (68%) and 3.6% of the samples tested positive for both PPR and BT.

Conclusion:

The random survey results indicating the presence of PPR and BT have specific implication in epidemiological perspectives since it highlights the prevalence under natural situations, where the subclinical, inapparent, or non-lethal or recovery of infection was suspected in unvaccinated animals. It also warrants further studies to suggest appropriate control measures to prevent the spread of infection.

Detection of classical swine fever virus E2 gene in cattle serum samples from cattle herds of Meghalaya

The present study focused on the detection and genetic characterisation of 5' untranslated region (5'UTR) and E2 gene of classical swine fever virus (CSFV, family Flaviviridae, genus Pestivirus) from bovine population of the northeastern region of India. A total of 134 cattle serum samples were collected from organised cattle farms and were screened for CSFV antigen with a commercial antigen capture enzyme linked immunosorbent assay (Ag-ELISA) and reverse transcription-polymerase chain reaction (RT-PCR). A total of 10 samples were positive for CSFV antigen by ELISA, while all of them were positive in PCR for 5'UTR region. Full length E2 region of CSFV were successfully amplified from two positive samples and used for subsequent phylogenetic analysis and determination of protein 3D structure which showed similarity with reported CSFV isolate from Assam of sub-genogroup 2.1, with minor variations in protein structure.

Solvent Effect on the Electronic Polarizability of Benzonitrile

In this study, the static and dynamic electronic polarizability of benzonitrile is reported. This property was determined using refraction index measurements of neat benzonitrile and CCl4, THF, C6H12 and CH3CN diluted solutions. The real refractive index of pure benzonitrile was obtained by refractometry, FTIR transmission spectroscopy and Kramers-Kr¨onig transform. These results indicate that the vibrational contribution to the visible refraction is very small, and the electronic polarizabilities calculated with these values agree with reported values. In binary mixtures, the polarizability of benzonitrile was obtained with the refractometric method proposed by Singer and Garito at five frequencies to obtain the dispersion curve. The local field effects were tested within the Onsager and Lorentz local field approach. The static properties in each solvent was obtained by extrapolation of the Cauchy-type dispersion curve to zero frequency, which gave a monotonic increased as a function of the squared frequency. The polarizabilities obtained in this work agree well with theoretical and experimental data, reported by other authors. The static and dynamic electronic polarizability of benzonitrile was found to be little affected by the dielectric nature of the solvent, and the electric deformability is similar to that of the benzene molecule. The effect of the replacement of the C-H group by N in 4-cyano-pyridine and benzonitrile molecules is discussed.

Influence of residual disease and extreme drug resistance assays on outcome in patients with epithelial ovarian cancer

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Background: Extreme drug resistance (EDR) assays have been used as tools in identifying those agents that are least likely to be of clinical benefit in the treatment of epithelial ovarian cancer (EOC). We sought to examine the effect of obtaining EDR assays on the outcome of patients with EOC in the primary and recurrent setting. Methods: We conducted a retrospective review of demographic, pathologic, EDR assay and outcome data from 377 patients with EOC who had an assay sent at the time of their diagnosis or at recurrence. Univariate followed by multivariate analyses using Cox proportional hazards method were performed to identify and estimate the impact of independent prognostic factors on time to progression (TTP), overall survival (OS) and survival after recurrence (RS). Results: Increasing age was associated with a worse OS and RS (HR = 1.34; 95% CI, 1.14–1.58 and HR = 1.14; 95% CI, 1.00–1.31, for each decade increase in age respectively). Compared with patients with microscopic residual disease, patients who were left with 0.1 to 1.0 cm and >1.0 cm residual disease had an increased risk of recurrence (HR=1.94; 95% CI, 1.33 to 2.84 and HR=3.61; 95% CI; 2.07 to 6.39, respectively) and death (HR = 1.59; 95% CI, 1.03 to 2.45; and HR = 2.14; 95% CI, 1.09 to 4.20, respectively). For patients who recurred, those who did not undergo secondary cytoreductive surgery and patients who were left with >1.0 cm residual had an increased risk of death compared to patients with microscopic residual (HR = 2.13; 95% CI, 1.28 to 3.54; and HR = 2.84; 95% CI, 1.71 to 4.71, respectively). EDR assay results for single agents or combinations did not independently predict patient outcomes. Conclusions: The amount of residual disease continues to be an important prognostic factor, especially when all macroscopic disease is removed both in the primary and recurrent setting. Increasing age is also an independent predictor of OS and RS. EDR assay results do not independently predict or alter the outcomes of patients with EOC who are treated with the current standard of care including optimal cytoreductive surgery followed by platinum and taxane combination chemotherapy in either the primary or recurrent setting.

No significant financial relationships to disclose.

Determinants of outcome in elderly patients with positive sentinel lymph nodes

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Background: Older women are less likely to receive standard of care treatment for breast cancer. This undertreatment may be linked to the perception that elderly patients (pts) may not tolerate or derive benefit from treatment that is often viewed as “too toxic.” Methods: From July 1997 to July 2003, 1,470 pts with invasive cancer with positive sentinel lymph nodes (PSLN) by intraoperative frozen section or final pathologic exam by hematoxylin-eosin and/or immunohistochemistry (IHC). We examined sociodemographic, pathologic, and therapeutic variables that affected the outcome of elderly pts ≥70 years old. A comorbidity score was assigned using Adult Comorbidity Evaluation-27 system. Chi-square, Fisher's exact Wilcoxon tests, and multivariate logistic regression analysis were used. Results: The median age was 53 years (range 21–89) and median tumor size 1.6 cm (range 0.1–11). 1,265 (86.1%) pts were <70 years old and 205 (13.9%) pts were ≥70 years old. 183 (12.5%) pts had IHC only PSLN, 1,021 (69.5%) had 1–3 PSLN, and 266 (18%) ≥4 PSLN. Breast conservation therapy (BCT) was performed in 59.7% of pts. Elderly pts were more likely to have moderate to severe comorbidities (46% vs. 11%, p < 0.0001) and BCT (67% vs. 59%, p = 0.026), compared to pts <70 years old. Elderly pts were less likely to undergo completion ALND (73% vs. 89%, p < 0.0001), adjuvant chemotherapy (43% vs. 90%, p < 0.0001) and radiotherapy following BCT (82% vs. 90%) compared to pts <70 years old. The 5-year disease-free survival (DFS) was not significantly different for elderly pts compared to non-elderly pts (87.7% vs. 91.9%, p = 0.21), on the other hand the 5-year overall survival was significantly worse for elderly pts (80.4% vs. 93.2%, p < 0.0001), a difference that was mainly due to a significantly higher 5-year cumulative incidence of death due to other causes (13.2% vs. 1.9%, p < 0.0001). On multivariate analysis, ER or PR positive status, IHC only PSLN and T1 tumors were the only factors independently associated with improved odds of 5-year DFS. Conclusions: Tumor rather than patient factors were the primary determinants of breast cancer outcomes in our cohort of node positive breast cancer pts. Elderly breast cancer pts with an estimated life expectancy beyond 5 years should receive the same standard of care therapy as their younger counterparts.

No significant financial relationships to disclose.

Adverse effects of pesticides residues on biochemical markers in pakistani tobacco farmers

Tobacco is an important cash crop of Pakistan and tremendous amount of irrational pesticides are being used to control insect growth. The frequency of plasma pesticide residues above acceptable daily intake (ADI) and its correlation with biochemical markers for assessment of adverse health effects in the tobacco farmers at district Sawabi, Pakistan was determined. Total 109 adult males consisting of 55 tobacco farmers exposed to pesticides and 54 controls were included. Pesticides residues in blood were analyzed on HPLC and GC-NPD. Plasma butyrylcholinesterase (BChE) was analyzed by Ellman's method. Biochemical markers including serum calcium, phosphorus, urea, creatinine, bilirubin and liver enzymes were measured on Selectra-E auto analyzer. The tobacco farmers had multiple pesticides residues above ADI in their blood consisting of 35 (63%) methomyl; 31 (56%) thiodicarb; 34(62%) cypermethrin; 27 (49%) Imidacloprid; 18 (32%) Methamidophos and 15 (27%) endosulfan. BChE activity was significantly decreased in the pesticides exposed farmers as compared to controls (P<0.001). Plasma biochemical markers including ALT, AST, CK, LDH and phosphate were significantly raised in the pesticides exposed farmers as compared to control group (P<0.001). Total pesticides residues revealed a significant positive correlation with AST (r=0.42), LDH(r= 0.47), ALT (r=0.20) and phosphorus (r=0.51). Excessive exposure to pesticide caused cytotoxic changes in the hepatic and renal biochemical markers which were positively correlated with pesticide residue. Hence these biomarkers might be used in addition to BChE activity for monitoring of adverse effects of pesticides on the health of farm workers.