Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma.

OBJECTIVE: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI). MATERIALS AND METHODS: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications. RESULTS: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR. CONCLUSIONS: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.

Access to medically-assisted procreation: the withdrawal of paternal consent in the maze of law n. 40/2004.

Abstract: The law (No.40/2004) stipulates that consent to Medically Assisted Procreation (MAP) remains irrevocable post ovum fertilization. Cryo-preservation introduces complexities, enabling embryo implantation requests after a couple's separation and the dissolution of the original parenthood plan. Constitutional Court Ruling No.161 in 2023 affirmed that the prohibition of revoking consent to MAP aligns with the Italian Constitution and the jurisprudence of the European Court of Human Rights. This delicate equilibrium of conflicting interests upholds human freedom, allowing consent revocation prior to ovocyte fertilization. Permitting revocation until implantation could inflict more significant harm: the infertile woman can in fact miss the opportunity to become a mother, impacting her psychophysical well-being and freedom of self-determination. Moreover, the embryo loses the chance to live, remaining in cryopreservation, which violates its dignity. Addressing this issue requires thorough communication by medical profession-als to inform couples about the limitations on consent revocation. An element of objectivity in terms of standards and evidence-based guidelines, from which norms must originate, is of utmost importance. Relying on broadly shared rules, especially at the international level, is vital in light of the unremitting scientific advances in MAP, as in other areas of medicine, which will open up new opportunities for which current legal/regulatory frameworks are inadequate.

Evaluación del impacto de la obesidad en los resultados del trasplante renal / Does obesity really affect renal transplantation outcomes?

Introducción El trasplante renal es el tratamiento de elección para pacientes con enfermedad renal crónica (ERC) estadio 5. Alrededor de 60% de los pacientes con ERC presentan sobrepeso u obesidad en el momento del trasplante de riñón, y la obesidad postrasplante se da en 50% de los pacientes, con un aumento de peso de 10% en el primer año y un alto riesgo de mortalidad cardiovascular. La obesidad se asocia a un mayor riesgo de retraso de la función del injerto (RFI), rechazo agudo, complicaciones quirúrgicas, pérdida del injerto y mortalidad. El objetivo de este estudio es evaluar la evolución clínica de los pacientes obesos y con sobrepeso receptores de un trasplante renal, en términos de las complicaciones a corto y largo plazo asociadas a un mayor índice de masa corporal (IMC). Material y métodos Se realizó un estudio descriptivo, observacional y transversal con 104 pacientes sometidos a trasplante de riñón o páncreas-riñón entre marzo de 2017 y diciembre de 2020, con seguimiento hasta abril de 2021. Para el análisis comparativo, los pacientes se agruparon según el IMC. Resultados La edad media fue de 56,65 años, 60,6% varones y 39,4% mujeres. Los pacientes con sobrepeso experimentaron cirugías más prolongadas, más dehiscencia de la herida quirúrgica, RFI, hernias, proteinuria y un requerimiento mayor de biopsias renales. Por otro lado, los pacientes obesos presentaron más RFI, mayor número de biopsias renales requeridas, proteinuria, desarrollo de diabetes mellitus y fibrilación auricular, y necesitaron estancias hospitalarias más prolongadas. Conclusiones A pesar de la alta prevalencia de comorbilidad en la población con sobrepeso y/u obesidad, no se observó un empeoramiento en la supervivencia del paciente y/o del injerto. Sin embargo, es necesario un seguimiento más prolongado. (AU)

Introduction Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI. Material and methods A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI. Results Mean age was of 56.65 years, 60.6% male and 39.4% female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays. Conclusions Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed. (AU)

Compressive stress triggers fibroblasts spreading over cancer cells to generate carcinoma in situ organization.

At the early stage of tumor progression, fibroblasts are located at the outer edges of the tumor, forming an encasing layer around it. In this work, we have developed a 3D in vitro model where fibroblasts' layout resembles the structure seen in carcinoma in situ. We use a microfluidic encapsulation technology to co-culture fibroblasts and cancer cells within hollow, permeable, and elastic alginate shells. We find that in the absence of spatial constraint, fibroblasts and cancer cells do not mix but segregate into distinct aggregates composed of individual cell types. However, upon confinement, fibroblasts enwrap cancer cell spheroid. Using a combination of biophysical methods and live imaging, we find that buildup of compressive stress is required to induce fibroblasts spreading over the aggregates of tumor cells. We propose that compressive stress generated by the tumor growth might be a mechanism that prompts fibroblasts to form a capsule around the tumor.

Consequences of COVID-19 restrictions on adolescent mental health and drug abuse dynamics.

The COVID-19 pandemic has hit elderly people the hardest in terms of severity and mortality. However, it is also evident that children and adolescents have been significantly impacted and experienced major disruptions in their lives. The psychological, mental, and developmental repercussions have been major and have led to a reshaping of drug abuse dynamics and substance addiction. The authors have outlined a narrative review of the major issues affecting adolescents and their mental well-being by clarifying the lingering effects and pandemic aftermath, especially on drug abuse, developmental aspects, and behavioral addiction. The unique traits of adolescent risk factors have been outlined, in order to identify areas to be prioritized for future strategies. Possible repercussions on juvenile crime linked to social estrangedness and disrupted interactions have been briefly explored as well. All such aspects are highly meaningful and relevant from a medicolegal perspective as well. The looming mental health crisis involving youngsters will have to be confronted by fine-tuning and optimizing mental health care services, building on current experiences, raising awareness, and eliminating the stigma that often comes with mental issues. Healthcare systems should look at the current scenario as an opportunity to improve care delivery to eliminate access inequalities and stigmatization of mental issues and raise awareness for the benefit and well-being of all. Similarly, law enforcement, lawmakers, and the judiciary will have to account for such factors, too, as will economic policy-makers. In that regard, a set of defining criteria has been framed in order to provide a degree of objectivity when meeting the unique challenges of the pandemic for youth mental health, in a comprehensive and tailored fashion.

Is there such a thing as an indispensable skills profile to be a good doctor? "Life skills" as essential capabilities in the medicoforensic professions.

Abstract: This writing aims to convey the essential nature and features of a cultural tool based on a set of skills and capabilities generally referred to as "life skills", which allow for the proper management (in the medical and medical-forensic professional realms) of daily situations in an effective and rewarding fashion. Such a process is based on individual tools such as communication, problem solving, stress management, self-control, the ability to make timely decisions, empathy, creativity and the opportunity to work in a multidisciplinary setting. Life skills include everything the professional should rely on in order to minimize the risks of a professional error, through the acquisition of knowledge and behavioral traits which constitute the fundamental, experience-based starting point. The chief objective of this commentary is to outline the scope of a straightforward discussion by specifically defining such skills; that in turn will make it possible to identify all the technical issues to address during the medical-diagnostic assessment, also from a medico-legal perspective, in order to frame the residual life skills and evaluate the possibilities of recovery and any disabilities, based on observation and interactions with each patient aimed at weighing their psychophysical performance.

Litiasis en receptores de trasplante renal: revisión sistemática / Kidney stones in renal transplant recipients: A systematic review

Introducción La litiasis en el receptor del injerto renal puede ser una enfermedad peligrosa cuyo riesgo potencial es el deterioro de la función renal. Adquisición de la evidencia Se realizó una búsqueda sistemática de la literatura hasta febrero del 2023. El objetivo primario era evaluar la incidencia de litiasis en receptores de trasplante renal (TR). El secundario era valorar el momento de formación, la localización y la composición de la litiasis, las opciones de tratamiento disponibles y la incidencia de la pérdida del injerto. Síntesis de la evidencia Un total de 41 estudios no aleatorizados compuestos por 699 pacientes cumplieron los criterios de inclusión. La edad en el momento del diagnóstico de la litiasis oscilaba entre 29 y 53 años. La incidencia de urolitiasis se encontraba entre 0,1 y 6,3%, siendo diagnosticada generalmente a los 12 meses del TR. La mayoría de las litiasis detectadas se localizaron en los cálices o en la pelvis. La composición más frecuente fue la de oxalato cálcico. Se consideraron diferentes estrategias de tratamiento como vigilancia activa, ureteroscopia, abordaje percutáneo/combinado o cirugía abierta. Del total de pacientes, 15,73% fueron tratados con litotricia extracorpórea por ondas de choque (LEOCh) y 26,75% se sometieron a litotricia endoscópica o extracción quirúrgica. De estos sujetos, 18,03% se abordaron mediante nefrolitotomía percutánea, mientras que 3,14% se sometieron a un manejo combinado. Se realizó litotomía quirúrgica en 5,01% de los casos. La tasa libre de litiasis (TLL) global se situó en torno a 80%. Conclusiones La litiasis en el TR es una patología poco frecuente que suele diagnosticarse al año de la cirugía. Su localización más común son los cálices y la pelvis renal, y en la mayoría de los casos está compuesta de oxalato cálcico. Todos los tratamientos activos han demostrado resultados satisfactorios en términos de TLL, ... . (AU)

Introduction Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. Evidence acquisition A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. Evidence synthesis A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1 to 6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. Conclusions Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences. (AU)

Radial head prosthesis disassembly: case report and medico-legal implications.

BACKGROUND: The aim of the treatment of radial head comminuted fractures is the restoration of anatomical normalcy to avoid the risk of several complications such as joint instability. Among the options for the treatment of such fractures, it is worth mentioning osteosynthesis, resection of the radial head or prosthetic replacement. In the presence of comminution or severe dislocation of the fracture's fragments, as in our patient's type III Mason fracture, prosthesis implantation is the treatment of choice. CASE REPORT: This clinical case reports a 22-year-old volleyball player, who during training suffered a comminuted fracture of the radial head, type III according to Mason's classification. A prosthesis was implanted. The post-operative course took place regularly. However, approximately three months after surgery, the patient experienced sudden pain and functional limitation following a normal elbow extension movement, so much so that he required medical attention in our emergency room. Following all the appropriate clinical-instrumental tests, a complete dissociation of the bipolar prosthesis of the radial head was found. CONCLUSIONS: Our clinical case shows the disassembly of a bipolar radial head prosthesis, a rather rare complication. From a medicolegal perspective, the patients should be aware of the increased risk of requiring further surgery after radial head replacement. When patients are thoroughly informed, they can cooperate and comply with indications more effectively, thus taking an active role in recovery management.

Does obesity really affect renal transplantation outcomes?

INTRODUCTION: Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI. RESULTS: Mean age was of 56.65 years, 60.6% male and 39.4 % female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays. CONCLUSIONS: Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed.

Kidney stones in renal transplant recipients: A systematic review.

INTRODUCTION: Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. EVIDENCE ACQUISITION: A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. EVIDENCE SYNTHESIS: A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. CONCLUSIONS: Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.

The posterior interosseus artery flap (piaf) in reconstructive surgery of the hand: strategies of use and medico-legal implications.

Background and aim: The fascio-cutaneous posterior interosseus artery flap (PIAF) is used in hand reconstruction, especially to repair skin or tissue defects such as burn injuries, open fractures, gunshot wounds or traumatic amputations. The aim of this study is to examine the anatomical features of this flap, to describe the surgical harvesting technique and the difficulties associated with the dissection. Methods: From January 2016 to January 2022, we performed PIAF in 10 patients (3 women and 7 men) with a mean age of 28 years (range 22-44). This flap is taken from the back of the forearm, between the extensor carpi ulnaris (ECU) muscle and the extensor digitorum common (EDC) muscle. Results: We analyzed retrospectively our patients indicating the failures of this reconstructive surgery, the complications that have arisen and the results using DASH score with the related clinical and medico-legal implications. Conclusions: Due to its location and structure, PIAF is one of the most versatile fascio-cutaneous flaps in upper limb reconstructive surgery and can be used to reconstruct parts of the hand, wrist, or elbow, allowing to restore limb function and improve the quality of life of patients even if there could be some medico-legal implications.

Beneficial effects of music in the healing process of traumatic injuries: perceptual control of suffering and possible abatement of disability conditions.

Abstract: Numerous scientific studies report that listening to music can beneficially affect physical and mental health, and even expedite the healing process of traumatic conditions. One of the most noteworthy positive effects of music lies in its ability to control stress and anxiety by lowering heart rate, blood pressure and blood cortisol levels. Furthermore, music can help improve mood especially in traumatized people who are faced with a wide range of negative emotions, reducing symptoms of depression and stimulating the production of dopamine in the brain, favorably inducing sleep quality, thanks to the their relaxing action. Listening to music can stimulate brain activity and improve short-term memory and concentration, having positive effects on the healing process of traumatic pathologies. Therefore, music should be considered a complementary treatment option for people facing treatment for traumatic pathologies, also stimulating the production of endorphins in the brain and intervening on pain control, resulting in positive effects on the quality of life of the traumatized. Furthermore, music can help people express their emotions and communicate with others, providing a way to connect with the world and share similar experiences, reducing social isolation and improving emotional well-being.

Fresh vs. frozen embryo transfer in assisted reproductive techniques: a single center retrospective cohort study and ethical-legal implications.

OBJECTIVE: Several studies have shown higher pregnancy rates and better perinatal outcomes with frozen embryo transfers than with fresh techniques, with better results in patients with polycystic ovary syndrome (PCOS) but with a higher rate of pregnancy complications such as preeclampsia. This retrospective cohort study aims to compare the cumulative live birth rates, maternal and neonatal complications of fresh embryo transfers (ET) and frozen-embryo transfers (FET) in infertile women who underwent assisted reproduction techniques (ART) at the Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, Palermo, Italy. In addition, the authors have focused on the legislative and ethical complexities which such a procedure entails. PATIENTS AND METHODS: Out of 475 women undergoing in vitro fertilization programs from January 2017 to January 2021, 128 were enrolled; 70 patients underwent ET, and 58 patients FET. The main outcome measure was live birth rates. Secondary outcomes were clinical pregnancy, ongoing pregnancy, pregnancy loss, low birth weight (LBW), ectopic pregnancy, and obstetrical and perinatal complications. RESULTS: The cumulative live birth rates were similar between the fresh transfer (95.7%) and frozen transfer (93.1%). Biochemical pregnancy rates, clinical pregnancy, ongoing pregnancy, and pregnancy loss were similar between the groups. CONCLUSIONS: Obstetrical outcomes were not statistically different between the two groups; a higher preterm delivery rate was reported in the FET group. ET birth weights were notably lower for singletons compared to the freeze-all strategy. ET patients also had higher LBW rates, with a 2.5-fold higher rate compared to FET. No significant differences were found in cumulative live birth rates between ET and FET, which is consistent with earlier studies. FET protocols are linked to higher neonatal birth weight and lower risk of LBW than fresh ET. The ethical and legal quandaries inherent in such techniques, as technology moves on and outpaces current legislative frameworks, cannot be discounted.

Monteggia fracture associated with ipsilateral intercondylar distal humeral fracture with posterior interosseous nerve palsy: case report, medico-legal implications, and methodological assessment analysis.

BACKGROUND: The Monteggia fracture, defined as a fracture of the proximal third of the ulnar shaft associated with an anterior or posterior dislocation of the proximal radial epiphysis, is a serious injury accounting for 0.7% of all elbow fractures and dislocations in adults. For adult patients, good results can only be obtained through early diagnosis and adequate surgical treatment. Monteggia fracture-dislocations associated with distal humeral fracture are extremely rare injuries in adults and there are few cases described in the literature. Medico-legal implications arising from such conditions have a host of complexities that cannot be discounted. CASE REPORT: This case report revolves around a patient affected by a type I Monteggia fracture-dislocation, according to the Bado classification, associated with an ipsilateral intercondylar distal humeral fracture. To our knowledge, this combination of lesions has never been reported before in adult patients. A positive result was obtained due to early diagnosis, achievement of anatomical reduction, and optimal stabilization with internal fixation which made it possible to achieve early functional recovery. CONCLUSIONS: Monteggia fracture-dislocations associated with ipsilateral intercondylar distal humeral fracture are extremely rare in adults. In the case herein reported, a favorable outcome was obtained due to early diagnosis, achievement of anatomical reduction and management with internal fixation with plate and screws, as well as early functional training. Misdiagnosis makes such lesions risky in terms of potentially delayed treatment, increasing the need for surgical interventions and the possibility of high-risk complications and disabling sequelae, with possible medico-legal implications. In the case of unrecognized injuries under urgent circumstances, the injuries may become chronic, making the treatment more complex. The ultimate outcomes of a misdiagnosed Monteggia lesion can lead to very serious functional and aesthetic damage.

COVID-19 and its aftermath, new drivers of infertility?

Abstract: Law 40/2004, the Italian piece of legislation governing access to assisted reproductive technologies (ART), is relatively young, compared to the number of years that have passed since the first attempts at ART in the world. Still, such a law has undergone several revisions in recent years, mostly by court rulings, and such changes are indeed necessary in light of the constant evolution in ART innovations. Then, the COVID-19 pandemic struck on a global scale, disrupting virtually all aspects of social and economic life. COVID-19's impact on fertility has to do, although it is not limited to, the distribution and function of ACE2 in the female reproductive system: such receptors are in fact expressed extensively in the ovaries, uterus, vagina and placenta. We point out that overcoming the "demographic winter" Italy has been going through, compounded by the pandemic, will require major adjustments in the way we ensure access to ART services in an equitable, sustainable and affordable fashion for all who wish to fulfill their reproductive potential and have been prevented to do so by legal, regulatory and financial factors.

Cistectomía radical asistida por robot vs. cistectomía radical abierta: revisión sistemática de ensayos controlados aleatorizados / Robot-assisted vs. open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials

Introducción En la última década se han puesto en marcha varios ensayos controlados aleatorizados (ECA) con el objetivo de evaluar la seguridad quirúrgica y la eficacia oncológica de la cistectomía radical asistida por robot (CRAR) frente a la cistectomía radical abierta (CRA) en pacientes con cáncer de vejiga. El objetivo del estudio fue realizar una revisión sistemática y un metaanálisis de ECA para comparar los resultados perioperatorios y oncológicos de ambas. Métodos Se realizó una búsqueda bibliográfica hasta julio de 2022 en las bases de datos PubMed/Medline, Embase y Web of Science. Se siguieron las directrices de la declaración PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) para identificar los estudios elegibles. Los criterios de evaluación fueron los resultados intraoperatorios, postoperatorios y oncológicos de la CRAR frente a la CRA. Resultados Un total de 8ECA con 1.024 pacientes cumplieron los criterios de inclusión. La CRAR se asoció con un tiempo quirúrgico mayor (media de 92,34 min, IC 95%: 83,83-100,84; p<0,001) y una tasa de transfusión de sangre menor (odds ratio [OR] 0,43; IC 95%: 0,30-0,61; p<0,001). No se observaron diferencias en cuanto a las complicaciones globales (p=0,28) ni graves (p=0,57) a los 90 días, la duración de la estancia hospitalaria (p=0,18), la recuperación de la función intestinal (p=0,67), la calidad de vida relacionada con la salud (p=0,86), la recurrencia (p=0,77) ni la progresión (p=0,49) de la enfermedad entre los 2abordajes. La principal limitación reside en el bajo número de pacientes incluidos en el 50% de los ECA revisados. Conclusiones Este estudio respalda la no inferioridad de la CRAR respecto a la CRA en términos de seguridad quirúrgica y resultados oncológicos. El beneficio de tasas reducidas de transfusión sanguínea obtenido con la CRAR debe sopesarse con relación a los costes derivados del procedimiento (AU)

Introduction Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs. open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs. ORC. Methods A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs. ORC. Results A total of 8RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI: 83.83-100.84, P<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI: 0.30-0.61, P<0.001). No differences emerged in terms of 90-day overall (P=0.28) and major (P=0.57) complications, length of stay (P=0.18), bowel recovery (P=0.67), health-related quality of life (P=0.86), disease recurrence (P=0.77) and progression (P=0.49) between the 2approaches. The main limitation is represented by the low number of patients included in half of RCTs included. Conclusions This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure (AU)

Bilateral femur fracture as the first manifestation of multiple myeloma: a case report.

Abstract: The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.

Assessment of intrarenal temperature dynamics when using holmium and thulium: YAG lasers in an ex vivo porcine kidney model.

AIM: To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. MATERIALS AND METHODS: Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10 min. RESULTS: Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273 µm (10 W to 50 W) (p ≤ 0.02) and 550 µm (10 W) fiber (p = 0.04). With Ho:YAG there was a significant increase when using 273 µm (at 10 W and 20 W) (p ≤ 0.03) and 365 µm (10 W) fibers (p = 0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20 W and 40 W) (p < 0.05). The thermal camera recorded a mean increase of 8 °C in the UPJ while the remaining areas of the kidney did not undergo significant changes. CONCLUSIONS: Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney.

Evaluación de la dinámica de la temperatura intrarrenal con el uso de láseres holmio y tulio YAG en un modelo exvivo de riñón porcino / Assessment of intrarenal temperature dynamics when using holmium and thulium: YAG lasers in an ex vivo porcine kidney model

Objetivo Medir la dinámica de la temperatura en la superficie renal y dentro de la vía urinaria al usar los láseres Ho:YAG y Tm:YAG para la ablación tisular. Materiales y métodos Se utilizaron riñones porcinos. Ambos tipos de láseres con diferentes configuraciones y tamaños de fibras se usaron a través de un ureteroscopio flexible. La temperatura en la superficie renal fue registrada mediante una cámara termográfica mientras que la intrarrenal fue medida a través de dos termómetros, el primero en la unión pieloureteral y el segundo en el cáliz elegido para el uso del láser. La temperatura fue determinada a los 0,5-1-3-5 y 10 minutos. Resultado Los registros en la unión pieloureteral y en el cáliz revelaron incrementos significativos al usar el Tm:YAG con la fibra de 273μm (10W a 50W) (p≤0,02) y de 550μm (10W) (p=0,04). Con el Ho:YAG se registró un incremento significativo al usar fibras de 273μm (a 10W y 20W) (p≤0,03) y de 365μm (10W) (p=0,04). Respecto al tamaño de las fibras, hubo una diferencia significativa al usar el Tm:YAG (a 20W y 40W) (p<0,05). La cámara termográfica registró un incremento medio de 8°C en la unión pieloureteral mientras que el resto del riñón no sufrió cambios significativos. Conclusione Los cambios de temperatura fueron mayores al usar el láser Ho:YAG respecto al Tm:YAG a configuraciones de poder similares para la ablación tisular. El mayor incremento de temperatura fue registrado en la unión pieloureteral desde donde el calor se disipaba al resto del riñón (AU)

Aim To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. Materials and methods Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10minutes. Results Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273μm (10W to 50W) (p≤0.02) and 550μm (10W) fiber (p=0.04). With Ho:YAG there was a significant increase when using 273μm (at 10W and 20W) (p≤0.03) and 365μm (10W) fibers (p=0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20W and 40W) (p<0.05). The thermal camera recorded a mean increase of 8°C in the UPJ while the remaining areas of the kidney did not undergo significant changes. Conclusions Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney (AU)

The core notion of euthanasia in its primordial beginnings.

Abstract: This article provides a brief review of the history of euthanasia, which has always been an ethical, social, legal and medical issue. Euthanasia, meaning "good death" refers to the practice of ending a life to relieve pain and distress. The term was already known in ancient Greece, from the time of Plato, who advocated the suppression of those who were not healthy "of body and soul". Completely different was the thinking of Hippocrates, who mentioned it in his oath, laying the foundation for modern medical ethics based on absolute respect for the person and human life. Recognizing the growing interest in the topic, this writing succinctly outlines the historical evolution of the concept of euthanasia limited to its origins.