Routine Systematic Prostate Biopsies not Replaced by Magnetic Resonance Imaging-Targeted Biopsy

ABSTRACT Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.

Short- and mid- term impact of tobacco smoking on donor renal function following living kidney donation at a tertiary referral hospital

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Glicoproteína P en leucocitos de sangre periférica de individuos sanos / Glycoprotein P in peripheral blood leukocytes of healthy individual

El objetivo de este trabajo fue estudiar la distribución de la expresión de la Gp-P y su ARNm en sangre periférica de una amplia población de sujetos sanos para identificar probables diferencias individuales. Para ello se estudiaron un total de 126 muestras sanguíneas mediantes inmunofluorescencia directa, por citometría de flujo, con el anticuerpo monoclonal JSB1 conjugado con FITC. Los parámetros a evaluar fueron el número de células positivas (por ciento POS) e incorporación media de fluorescencia específica (IMFE). Posteriormente, se estudió el ARNm del gen MDR1 por RT-PCR. Los resultados mostraron que en aproximadamente el 82 por ciento de los individuos estudiados, la IMFE presentó valores entre 10 y 25 en las tres subpoblaciones celulares de sangre periférica; en los linfocitos y monocitos, se observó además que un grupo de donantes, no superior al 10 por ciento, presentaron valores de IMFE menores de 10 y mayores de 25. Entre los subpoblaciones celulares, el por ciento POS más elevado correspondió a los linfocitos (t de student; p<0.001). Los resultados del estudio de ARNm del gen MDR1 por TR-PCR mostró correlación con los valores obtenidos por citometría del flujo. Se concluye que el estudio de la Glicoproteína P en el leucocitos de sangre periférica en una población de individuos sanos, pone de manifiesto la existencia de variabilidad individual en los niveles de expresión, lo que hace suponer un condicionamiento genético de control de los niveles de expresión basal de la Gp-P