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1.
An Acad Bras Cienc ; 94(suppl 3): e20220041, 2022.
Article in English | MEDLINE | ID: mdl-36197366

ABSTRACT

The interaction between animal movement and roads is pervasive, but little is known of the effects of the land-use patterns in roadside landscapes on roadkill events. Here, we compared wildlife roadkill along two road stretches that cross landscapes with different land-use patterns, including the presence of protected areas in Central Brazil. Sampling was conducted in 2017 and 2018 in two seasons (dry and rainy). We expected roadkill events to be more frequent bordering the protected area. Roadkill occurred more frequently in the rainy season in the unprotected landscape. Birds were most frequently recorded in the unprotected (44%, n = 76) than in the protected landscape (37%, n = 48). The least recorded group in the unprotected landscape was Squamata (11%, n = 18), while mammals were less detected in the protected landscape (14%, n = 18). Classes 'agriculture' and 'savanna' were related to amphibian roadkill numbers. For Squamata, we observed the effect of the presence of forests in the protected landscape. Bird roadkill was affected by protection level, while the presence of pasture and the level of protection explained mammal roadkill. Differences in roadkill patterns reinforce the need for long-term management of this source of mortality for the Cerrado fauna.


Subject(s)
Animals, Wild , Mammals , Animals , Birds , Brazil , Ecosystem , Forests
2.
Cancers (Basel) ; 12(3)2020 Mar 05.
Article in English | MEDLINE | ID: mdl-32150972

ABSTRACT

: Introduction: Animal models are interesting tools to improve our knowledge of the pathophysiological processes underlying kidney cancer development. Recent advances have been made in the understanding of the genetic founding events underlying clear cell renal carcinoma. The aim of this paper was to review and discuss the characteristics of all the induced animal models of renal carcinogenesis that have been described in the scientific literature to date and to see if and how they could regain some use in the light of the latest discoveries. Methods: The authors reviewed all the papers available in PubMed regarding induced animal models of renal carcinogenesis. From this perspective, the keywords "induced", "animal model", and "renal cancer" were used in PubMed's search engine. Another search was done using the keywords "induced", "animal model", and "kidney cancer". PRISMA recommendations were used to develop the literature review. Results: Seventy-eight studies were included in this review. Results were presented depending on the mechanisms used to induce carcinogenesis in each model: induction by carcinogens, hormones, viral induction, or induction by other agents. Discussion focused on the possibility to rethink these different induced animal models and use them to answer new research questions. Conclusion: Many induced animal models have been developed in the past to study renal cancer. While these models seemed unable to yield new knowledge, the latest advances in the understanding of the genetics behind renal carcinogenesis could well bring the models back to the forefront.

3.
Urol Oncol ; 38(4): 174-183, 2020 04.
Article in English | MEDLINE | ID: mdl-31761611

ABSTRACT

Introduction and Objectives The animal models for renal carcinogenesis have allowed researchers to better understand the physiopathological, genetic, molecular, and immunological mechanisms underlying the development of human renal cancers from the induction of precancerous lesions to the metastatic process. Our study aimed to review and discuss the characteristics of all the spontaneous animal models of renal carcinogenesis described in scientific literature to date and see how they could address future challenges in the field of personalized medicine. Methods and Materials We reviewed all the papers on PubMed which focus on spontaneous animal models of renal carcinogenesis. To do so, we used the keywords "spontaneous" AND "animal model" AND "renal cancer" in the PubMed search engine. We also conducted a search using the keywords "spontaneous" AND "animal model" AND "kidney cancer." PRISMA recommendations were used for the literature review. Results A total of 213 publications were found on PubMed with the keywords "spontaneous" AND "animal model" AND "kidney cancer." 219 publications were found on PubMed with the keywords "spontaneous" AND "animal model" AND "renal cancer." After pooling these 2 searches and removing the duplicate publications, 233 publications remained. Among these, 220 full-text articles were assessed for eligibility; 160 were removed because they were irrelevant to our topic, and the remaining 60 studies were included in our qualitative synthesis. Conclusions Many spontaneous animal models have been developed to study renal cancer. So far, these models have enabled the understanding of pathophysiological mechanisms underlying renal cancer. Though less appropriate than patient xenografts from the perspective of personalized medicine, we believe animal models can help medical professionals better understand the hows and whys of the genetic events underlying the intratumoral heterogeneity and spatial distribution of metastatic subclones.


Subject(s)
Carcinoma, Renal Cell/epidemiology , Kidney Neoplasms/epidemiology , Aged , Animals , Carcinoma, Renal Cell/physiopathology , Female , Humans , Kidney Neoplasms/physiopathology , Male , Models, Animal
4.
Braz J Psychiatry ; 38(1): 61-4, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27111701

ABSTRACT

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of "limited guardianship," applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer's disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.


Subject(s)
Alzheimer Disease/psychology , Legal Guardians/legislation & jurisprudence , Alzheimer Disease/classification , Brazil , Civil Rights/legislation & jurisprudence , Decision Making , Humans , Mental Competency/legislation & jurisprudence
5.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 38(1): 61-64, Jan.-Mar. 2016.
Article in English | LILACS | ID: lil-776492

ABSTRACT

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of “limited guardianship,” applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer’s disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.


Subject(s)
Humans , Alzheimer Disease/psychology , Legal Guardians/legislation & jurisprudence , Brazil , Civil Rights/legislation & jurisprudence , Mental Competency/legislation & jurisprudence , Decision Making , Alzheimer Disease/classification
6.
Encephale ; 42(2): 138-43, 2016 Apr.
Article in French | MEDLINE | ID: mdl-26806140

ABSTRACT

AIM: The aim of this study was to explore the links between pubertal maturation, physical self-esteem and sexuality in adolescence, differentiating between boys and girls. METHOD: The sample was comprised of 312 French secondary school children (seventh and ninth grades); 52.6 % (n=164) of whom were girls. Participants answered three self-evaluation questionnaires: the scale of sexuality (interests, emotions, relationships: IERS) in prime adolescence (12 to 15 years); (b) the self-administered rating scale for pubertal development and (c) the Physical Self-Description Questionnaire (PSDQ). RESULTS: Pubertal maturation was associated with higher scores on "Flirting with the aim of having sexual relations" and "Going out with someone", and a drop in overall and physical self-esteem, mainly in socially valued domains, namely "Body fat" for girls, and "Strength" and "Health" for boys. Overall physical self-esteem was associated with "Going out with someone" and "Flirting with the aim of having sexual relations" in boys. DISCUSSION: Physical changes at puberty induce two distinct trends in adolescents: sexual exploration and discovery (genitalized body), and self-depreciation (social body).


Subject(s)
Puberty/psychology , Self Concept , Sexual Maturation , Sexuality/psychology , Sexuality/statistics & numerical data , Adolescent , Body Image , Child , Emotions , Female , France/epidemiology , Humans , Male , Muscle Strength , Sexual Behavior , Surveys and Questionnaires
7.
Expert Opin Investig Drugs ; 24(7): 913-27, 2015.
Article in English | MEDLINE | ID: mdl-26098435

ABSTRACT

INTRODUCTION: Bladder cancer represents 7% of all new cancers diagnosed in the USA in 2015. Furthermore, the mortality of metastatic bladder cancer has not decreased substantially in the last four decades. Angiogenesis is known to play a major role in the pathogenesis of bladder cancer. AREAS COVERED: The following article provides an overview of the first results of agents targeting the VEGF pathway in the treatment of metastatic bladder cancer. EXPERT OPINION: Despite a few clinical trials providing preliminary encouraging results, the overall outcomes of the first published trials have been rather disappointing. In some instances, especially the case of trials which have investigated the use of new targeted agents as a single agent, no significant improvement in outcomes was seen, or was not sustained. In other cases, such as with combination trials, intolerable adverse effects have compromised the trials, due to overlapping toxicity between the targeted agent and chemotherapeutic agent(s). Further trials are warranted possibly combining different targeted agents or the use of sequential therapy. A better selection of the patient population may also be a key factor to improve patient outcomes, as many predictive factors of response seem to have already been identified.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Urinary Bladder Neoplasms/drug therapy , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Animals , Antibodies, Monoclonal/therapeutic use , Humans , Neovascularization, Pathologic/drug therapy , Receptors, Vascular Endothelial Growth Factor/immunology , Urinary Bladder Neoplasms/pathology , Vascular Endothelial Growth Factor A/immunology
8.
Nitric Oxide ; 49: 26-39, 2015 Sep 15.
Article in English | MEDLINE | ID: mdl-26068241

ABSTRACT

Clear cell renal cell carcinoma (ccRCC) is characterized by Von Hippel-Lindau (VHL)-deficiency, resulting in pseudohypoxic, angiogenic and glycolytic tumours. Hydrogen sulfide (H2S) is an endogenously-produced gasotransmitter that accumulates under hypoxia and has been shown to be pro-angiogenic and cytoprotective in cancer. It was hypothesized that H2S levels are elevated in VHL-deficient ccRCC, contributing to survival, metabolism and angiogenesis. Using the H2S-specific probe MeRhoAz, it was found that H2S levels were higher in VHL-deficient ccRCC cell lines compared to cells with wild-type VHL. Inhibition of H2S-producing enzymes could reduce the proliferation, metabolism and survival of ccRCC cell lines, as determined by live-cell imaging, XTT/ATP assay, and flow cytometry respectively. Using the chorioallantoic membrane angiogenesis model, it was found that systemic inhibition of endogenous H2S production was able to decrease vascularization of VHL-deficient ccRCC xenografts. Endogenous H2S production is an attractive new target in ccRCC due to its involvement in multiple aspects of disease.


Subject(s)
Carcinoma, Renal Cell/metabolism , Hydrogen Sulfide/antagonists & inhibitors , Hydrogen Sulfide/metabolism , Animals , Cell Line, Tumor , Cell Proliferation/drug effects , Cell Survival/drug effects , Chick Embryo , Humans , Hydrogen Sulfide/pharmacology , Neovascularization, Pathologic/metabolism , Xenograft Model Antitumor Assays
9.
Expert Opin Investig Drugs ; 23(11): 1553-62, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25284004

ABSTRACT

INTRODUCTION: Bladder cancer (BC) is the third and fifth cancer in men in terms of incidence and mortality in the US. Overexpression and mutations of fibroblast growth factor receptor 3 (FGFR3) are frequently found in BC and can represent a very interesting therapeutic target. Different FGFR3-targeted strategies have been investigated through in vitro and in vivo settings, including FGFR3 tyrosine kinase inhibitors such as dovitinib . AREAS COVERED: The authors review the data that provide a scientific rationale for FGFR3-targeted therapy in BC. They also provide an evaluation of the currently available in vitro and in vivo data on the use of dovitinib in BC patients. EXPERT OPINION: The development and progression of BC rely on a very complex signaling network that involves many different receptors aside from FGFR3 and VEGFR2. The involved signaling network can also be very different from one BC to the other, and can also evolve through time in the same patient. Inhibiting only one single target may thus not be sufficient to achieve a complete downstream oncogenic signaling blockage. Additionally, in vitro data on the use of neutralizing monoclonal antibodies targeting FGFR3 show that it can be a more efficient strategy to reach the same goal, with the potential advantage of less toxicity.


Subject(s)
Benzimidazoles/therapeutic use , Carcinoma, Transitional Cell/drug therapy , Quinolones/therapeutic use , Urinary Bladder Neoplasms/drug therapy , Animals , Antineoplastic Agents/pharmacology , Antineoplastic Agents/therapeutic use , Benzimidazoles/pharmacology , Carcinoma, Transitional Cell/genetics , Carcinoma, Transitional Cell/pathology , Disease Progression , Humans , Molecular Targeted Therapy , Quinolones/pharmacology , Receptor, Fibroblast Growth Factor, Type 3/genetics , Urinary Bladder Neoplasms/genetics , Urinary Bladder Neoplasms/pathology
10.
J Sex Med ; 11(9): 2302-7, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24902614

ABSTRACT

INTRODUCTION: Clomiphene citrate (CC) is as an effective treatment for men with hypogonadism (HG). Identifying the ideal candidate for this strategy has to date largely relied upon a patient's interest in preservation of testicular volume and spermatogenesis. AIM: This analysis was undertaken to define if predictors existed of robust elevation in serum testosterone (T) levels in response to CC. METHODS: Seventy-six men with a diagnosis of HG (two separate early morning total T levels <300 ng/dL) opting for CC therapy constituted the study population. Demographic, comorbidity data, and physical and laboratory characteristics were recorded. Laboratory tests were conducted 4 weeks after commencement and every 6 months thereafter. Multivariable analysis was conducted to define if predictors of biochemical response could be identified. Parameters included in the model were patient age, mean testicular volume, varicocele presence, and baseline total T, free T, and luteinizing hormone (LH) levels. MAIN OUTCOME MEASURE: Successful biochemical response to CC, defined as an increase of ≥200 ng/dL in total T level at ≥6 months after commencing CC, was the main outcome measure. RESULTS: Mean age was 46 ± 22 years. Mean pretreatment testicular volume was 16 ± 8 mL. Mean baseline T and LH levels were 179 ± 72 ng/dL and 7.2 ± 5.6 IU/mL, respectively. Mean total T on CC was 467 ± 190 ng/dL. Forty-seven patients (62%) met the responder definition, with a mean increase in total T levels of 302 ± 76 (204-464) ng/dL. In CC responders, the mean LH rise was 5.6 ± 3.1 IU/mL. On multivariable analysis, factors predictive of CC response included: mean testicular volume (adjusted [adj.] r = 0.32, P < 0.01), mean testicular volume ≥14 mL (hazard ratio [HR] 2.2, P < 0.01), LH level (adj. r = 0.48, P < 0.001), and LH level ≤6 IU/mL (HR 3.5, P < 0.001). CONCLUSION: These data indicate that two thirds of men with HG meet a robust responder definition and that pretreatment testicular volume and LH levels (in continuous and dichotomized fashions) are predictors of response.


Subject(s)
Clomiphene/therapeutic use , Hypogonadism/drug therapy , Adult , Aged , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
11.
J Sex Med ; 11(8): 2119-24, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24903070

ABSTRACT

INTRODUCTION: Optimal oncologic control of higher stage prostate cancers often requires sacrificing the neurovascular bundles (NVB) with subsequent postoperative erectile dysfunction (ED), which can be treated with interposition graft using sural nerve. AIMS: To examine the long term outcome of sural nerve grafting (SNG) during radical retropubic prostatectomy (RRP) performed by a single surgeon. METHODS: Sixty-six patients with clinically localized prostate cancer and preoperative International Index of Erectile Function (IIEF) score >20 who underwent RRP were included. NVB excision was performed if the risk of side-specific extra-capsular extension (ECE) was >25% on Ohori' nomogram. SNG was harvested by a plastic surgeon, contemporaneously as the urologic surgeon was performing RRP. IIEF questionnaire was used pre- and postoperatively and at follow-up. MAIN OUTCOME MEASURES: Postoperative IIEF score at three years of men undergoing RRP with SNG. Recovery of potency was defined as postoperative IIEF-EF domain score >22. RESULTS: There were 43 (65%) unilateral SNG and 23 (35%) bilateral SNG. Mean surgical time was 164 minutes (71 to 221 minutes).The mean preoperative IIEF score was 23.4+1.6. With a mean follow-up of 35 months, 19 (28.8%) patients had IIEF score >22. The IIEF-EF scores for those who had unilateral SNG and bilateral SNG were 12.9+4.9 and 14.8+5.3 respectively. History of diabetes (P=0.001) and age (P=0.007) negatively correlated with recovery of EF. 60% patients used PDE5i and showed a significantly higher EF recovery (43% vs. 17%, P=0.009). CONCLUSIONS: SNG can potentially improve EF recovery for potent men with higher stage prostate cancer undergoing RP. The contemporaneous, multidisciplinary approach provides a good quality graft and expedited the procedure without interrupting the work-flow.


Subject(s)
Erectile Dysfunction/surgery , Penile Erection/physiology , Sural Nerve/transplantation , Adult , Aged , Erectile Dysfunction/physiopathology , Humans , Male , Middle Aged , Operative Time , Postoperative Care , Prospective Studies , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/physiopathology , Prostatic Neoplasms/surgery , Recovery of Function , Treatment Outcome
12.
Can Urol Assoc J ; 8(3-4): E199-203, 2014.
Article in English | MEDLINE | ID: mdl-24678366

ABSTRACT

Schwannomas are benign nerve sheath tumours most often associated with the cranial nerves and the peripheral nerve system of the neck and extremities. Pelvic schwannomas are rare, with only about 25 cases reported. We report the case of a 34-year-old man referred for worsening pain of 10 years duration involving the right testicle and right penile shaft. Magnetic resonance imaging discovered a well-circumscribed pelvic tumour of 3.2 × 2.8 × 3.2 cm. Considering the possible complications involved in exposing the pudendal nerve during surgical resection, we performed an extensive literature search to aid preoperative planning. The most commonly described surgical approach for pelvic schwannomas has been open median laparotomy with transperitoneal dissection. To our knowledge, pudendal schwannomas have never been described in the literature. However, after considering the location and characteristics of the tumour, we chose laparoscopy because it offers the advantages of better visualization of anatomical structures with minimal invasiveness and faster recovery. At the 3-week follow-up, the patient described a significant decrease in pain and normal neurological and urological examinations.

13.
Eur Urol ; 65(1): 20-5, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23619390

ABSTRACT

BACKGROUND: The presence of lymph node metastasis (LNM) at radical prostatectomy (RP) is associated with poor outcome, and optimal treatment remains undefined. An understanding of the natural history of node-positive prostate cancer (PCa) and identifying prognostic factors is needed. OBJECTIVE: To assess outcomes for patients with LNM treated with RP and lymph node dissection (LND) alone. DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010. INTERVENTION: RP and extended LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Our primary aim was to model overall survival, PCa-specific survival, metastasis-free progression, and freedom from biochemical recurrence (BCR). We used univariate Cox proportional hazard regression models for survival outcomes. Multivariable Cox proportional hazard regression models were used for freedom from metastasis and freedom from BCR, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesical invasion, surgical margin status, and number of positive nodes as predictors. RESULTS AND LIMITATIONS: Sixty-four patients with LNM died, 37 from disease. Seventy patients developed metastasis, and 201 experienced BCR. The predicted 10-yr overall survival and cancer-specific survival were 60% (95% confidence interval [CI], 49-69) and 72% (95% CI, 61-80), respectively. The 10-yr probability of freedom from distant metastasis and freedom from BCR were 65% (95% CI, 56-73) and 28% (95% CI, 21-36), respectively. Higher pathologic Gleason score (>7 compared with ≤ 7; hazard ratio [HR]: 2.23; 95% CI, 1.64-3.04; p < 0.0001) and three or more positive lymph nodes (HR: 2.61; 95% CI, 1.81-3.76; p < 0.0001) were significantly associated with increased risk of BCR on multivariable analysis. The retrospective nature and single-center source of data are study limitations. CONCLUSIONS: A considerable subset of men with LNM remained free of disease 10 yr after RP and extended LND alone. Patients with pathologic Gleason score <8 and low nodal metastatic burden represent a favorable group. Our data confirm prior findings and support a plea for risk subclassification for patients with LNM.


Subject(s)
Prostatectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Aged , Androgen Antagonists , Chemotherapy, Adjuvant , Disease-Free Survival , Humans , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Prostatectomy/methods , Retrospective Studies , Time Factors , Treatment Outcome
15.
J Sex Med ; 10(7): 1861-6, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23253943

ABSTRACT

INTRODUCTION: Erection hardness has been shown to correlate with increased self-confidence, sexual satisfaction, and improvement in psychosocial factors such as sexual and overall relationship. It is estimated that one-third of men using phosphodiesterase type 5 inhibitors (PDE5) cease use of medication after one prescription and one-half cease use by 6 months. AIM: This study was undertaken to explore the link between erection hardness and treatment adherence. METHODS: Men presenting with erectile dysfunction (ED) who were candidates for PDE5 therapy constituted the study population. They were assessed at the baseline regarding their erectile function (EF) and rigidity using autoquestionnaires. Patients then received regular follow-up using the same assessment tools and were also asked about continued use of PDE5. The final patient assessment was conducted at a time point no sooner than 12 months after commencing PDE5. Multivariable analysis was conducted to define predictors of continued PDE5 use. MAIN OUTCOME MEASURES: Patients were assessed using the International Index of Erectile Function (IIEF) questionnaire and the Erection Hardness Score (EHS). Adherence was defined as continued use of PDE5 at least once per month. RESULTS: One hundred eighty-six men were analyzed. The mean age and the duration of ED were 61 ± 22 and 2.2 ± 2.9 years, respectively. Sixty-three percent were married or partnered. The mean partner age was 52 ± 8 years. Of the 186 patients, 32% had one vascular comorbidity, 34% had two vascular comorbidities, 26% had three vascular comorbidities, and 6% had ≥ 4 vascular comorbidities. All patients were treated with sildenafil and were sexually active. The mean time to end-of-treatment (EOT) interview and repeat completion of questionnaires was 17 ± 4 months. At the baseline, 26% were EHS 3 (mild ED), 42% were EHS 2 (moderate ED), and 32% were EHS 1 (severe ED). The mean baseline EF domain score was 14 ± 10, and at the EOT, it was 22 ± 5 (P < 0.01). At the follow-up interview, 4% were EHS 1, 12% were EHS 2, 28% were EHS 3, and 56% were EHS 4. Overall, 67% of the men continued to use PDE5 at follow-up. The distribution of patients continuing to use PDE5 after commencement was 15% of those achieving EHS 1, 30% for EHS 2, 66% for EHS 3, and 82% for EHS 4. Based on logistic regression analysis, the factors predictive of continued PDE5 use were being partnered, partner age, frequency of sexual activity, a shift of ≥ 2 points on the EHS, and reaching level 4 on the EHS scale. CONCLUSION: There is an excellent relationship between erection hardness and adherence to PDE5 treatment. Driving men to greater erectile rigidity appears to translate into lower dropout rates.


Subject(s)
Erectile Dysfunction/drug therapy , Medication Adherence , Penile Erection/drug effects , Phosphodiesterase 5 Inhibitors/therapeutic use , Piperazines/therapeutic use , Sulfones/therapeutic use , Adult , Aged , Erectile Dysfunction/psychology , Humans , Male , Middle Aged , Penile Erection/psychology , Personal Satisfaction , Purines/therapeutic use , Self Concept , Sexual Behavior , Sexual Partners , Sildenafil Citrate , Surveys and Questionnaires
16.
BJU Int ; 110(11 Pt B): E570-3, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22726451

ABSTRACT

UNLABELLED: What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3-4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process. OBJECTIVE: • To compare clinical, pathological and outcome features of renal cell carcinomas (RCCs) arising in patients with chronic renal failure (CRF) with or without renal transplantation. PATIENTS AND METHODS: • In all, 24 French University Departments of Urology and Kidney Transplantation participated in this retrospective study comparing RCCs arising in patients with CRF according to their dialysis or transplantation status at the time of diagnosis. • Information about age, sex, symptoms, duration of CRF, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. • Qualitative and quantitative variables were compared by using chi-square and Student statistical analysis. Survival was assessed by Kaplan-Meier and Cox methods. RESULTS: • Data on 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). • Transplanted and not transplanted patients accounted for 213 (70.3%) and 90 cases (29.7%), respectively. • In transplant recipients, RCC was diagnosed at a younger age [mean (sd) 53 (11) vs 61 (14) years, P < 0.001), the mean tumour size was smaller [3.4 (2.3) vs 4.2 (3.1) cm, P= 0.02), pT1a stage (75 vs 60%, P= 0.009) and papillary histological subtype (44 vs 22%, P < 0.001) were more frequent than in their dialysis-only counterparts. • Nodal (1 vs 6%, P= 0.03) and distant metastases rates (0 vs 5%, P < 0.001) were significantly increased in patients who had not had a transplant. However, Fürhman grading, symptoms, tumour multifocality or bilaterality, presence of acquired cystic kidney disease, were not significantly different between the groups. • Estimated 5-year survival rates were 97% and 77% for transplanted and not transplanted patients, respectively (P < 0.001). In univariate analysis, presence of symptoms (P= 0.008), poor performance status (P= 0.04), large tumour size, advanced TNM stage (P < 0.001), high Führman grade (P= 0.005) and absence of transplantation (P < 0.001) were all adverse prognostic factors. In multivariate analysis, only T stage remained an independent predictor for cancer-related death (P < 0.001). CONCLUSION: • RCC arising in native kidneys of transplant patients seems to exhibit many favourable clinical, pathological and outcome features compared with those diagnosed in dialysis-only patients. Further research is needed to determine whether it is due to particular molecular pathways or to biases in relation to mode of diagnosis.


Subject(s)
Carcinoma, Renal Cell/epidemiology , Kidney Failure, Chronic/complications , Kidney Neoplasms/epidemiology , Kidney Transplantation , Renal Dialysis , Carcinoma, Renal Cell/etiology , Carcinoma, Renal Cell/pathology , Female , France/epidemiology , Humans , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Kidney Neoplasms/etiology , Kidney Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging/methods , Prevalence , Prognosis , Retrospective Studies , Risk Factors , Survival Rate/trends
17.
Asian J Androl ; 14(2): 198-203, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22231298

ABSTRACT

Many patients with prostate cancer for whom androgen deprivation therapy (ADT) is indicated are young and desire to remain sexually active. In such patients, the side effects of androgen therapy on sexual function can be a source of serious reduction in overall quality of life. Providing the appropriate treatment options in this patient population is therefore essential. Nevertheless, treating such patients is challenging and an understanding of the underlying mechanisms of sexual physiology and pathophysiology is crucial to optimal patient care. In this paper, we reviewed what was known regarding the effects of ADT on sexual function in animal models and we also provided a detailed review on the effects of ADT on sexual health in humans and its treatment.


Subject(s)
Androgen Antagonists/adverse effects , Androgen Antagonists/therapeutic use , Prostatic Neoplasms/drug therapy , Sexual Dysfunction, Physiological/epidemiology , Androgen Antagonists/pharmacology , Animals , Cricetinae , Humans , Male , Models, Animal , Quality of Life , Rats , Risk Factors , Sexual Behavior, Animal/drug effects , Sexual Behavior, Animal/physiology
18.
BJU Int ; 110(1): 112-6, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22093870

ABSTRACT

UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Erectile dysfunction is a recognized complication of radical prostatectomy. Androgen deprivation therapy adversely impacts sexual function. Our study shows that the preoperative use of androgen deprivation therapy significantly reduces erectile function recovery after radical prostatectomy. The underneath pathophysiological mechanisms for this to occur are reviewed. OBJECTIVE: To define the impact of androgen deprivation therapy (ADT), undergone before radical prostatectomy (RP), on erectile function (EF) recovery. MATERIAL AND METHODS: A total of 38 consecutive patients presenting to a sexual medicine clinic after undergoing RP who had received ADT before RP (ADT+ group) were compared with a contemporary, age and comorbidity-matched cohort of 94 patients who did not receive ADT (ADT- group) before undergoing RP. Medical records were reviewed for demographics, comorbidity profiles and duration of ADT exposure. All the patients underwent Doppler penile ultrasonography within 6 months of RP and were administered the International Index of Erectile Function (IIEF) questionnaire. All the patients underwent evaluation of EF recovery. We analysed the incidence of venous leak (VL), mean IIEF EF domain score and proportion of men with EF domain scores ≥ 24 at 18 months after RP. RESULTS: The mean age, comorbidity profiles, median Gleason score, median pre-treatment PSA level, and mean time to evaluation after RP were similar between the two groups. The median duration of ADT exposure in the ADT+ group was 3 months. The incidence of VL within 6 months of surgery was 60% for the ADT+ and 20% for the ADT- group (P < 0.001). Likewise, the IIEF EF domain scores and proportion of men with EF domain scores ≥ 24 at 18 months were significantly lower in the ADT+ group, even when controlled for nerve-sparing status. CONCLUSION: Our data suggest that preoperative use of ADT adversely impacts EF outcomes and should therefore be avoided in the absence of robust data suggesting any oncological benefit.


Subject(s)
Androgen Antagonists/adverse effects , Antineoplastic Agents, Hormonal/therapeutic use , Erectile Dysfunction/etiology , Phosphodiesterase 5 Inhibitors/adverse effects , Prostatectomy , Prostatic Neoplasms/surgery , Aged , Androgen Antagonists/therapeutic use , Combined Modality Therapy , Humans , Leuprolide/therapeutic use , Male , Middle Aged , Preoperative Care , Prostatectomy/adverse effects
19.
Arch Pediatr ; 11(2): 85-92, 2004 Feb.
Article in French | MEDLINE | ID: mdl-14761728

ABSTRACT

AIM: This study was conducted on a sample of 644 pupils between the ages of five and ten years at school in the Orléans-Tours education authority with the aim of studying the nocturnal sleep duration and timetable of young children according to age and socio-economic environment. METHOD: In order to find out about children's sleeping habits (duration, time of going to bed and getting up, and weekly variations) a standard grid was used to carry out a cross-sectional survey in the children's families. This was filled in each day from Monday to Sunday during the same school week for all the children. RESULTS: Sleep duration decreased with age from maternelle to CM2 (nursery to last year of primary education). Data relating to sleep duration from CE2 (third year of primary school - 8-year-old -) showed differences according to whether the school belonged to an Educational Priority Zone (EPZ) or not. It was noticed that between five- and ten-year-old children from EPZ lost 62 minutes of sleep, whereas those not from EPZ only lost 29 minutes. These results would suggest that in addition to developmental factors, environmental factors also play a role in sleep duration. The differences observed were due to later bed times for children from EPZ. Weekly variations in sleep were generally very similar for all the children. At the weekend all the children tended to go to bed later, however this was more noticeable Saturday night for children not living in EPZ. Children slept the longest on Tuesday night due to the fact they got up later Wednesday morning (Wednesday is a day off in the majority of French schools). However, children from the age of nine (CM1 - forth year of primary education -) in EPZ did not benefit from this recuperation time, as they went to bed later but still got up early the next morning. CONCLUSION: This study showed that in addition to the physiological and developmental factors that influence children's sleep, the socio-economic context also plays a role. These results as a whole highlight the importance that practitioners and families should pay to maintaining a regularity in the child's routine and in the amount of sleep necessary at each age.


Subject(s)
Sleep , Age Factors , Child , Child, Preschool , Cross-Sectional Studies , Humans , Socioeconomic Factors , Time Factors
20.
Chronobiol Int ; 16(4): 491-503, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10442242

ABSTRACT

The present study attempts to determine whether diurnal variations in memory performance like the ones observed by Folkard et al. (1977) are independent of the testing day (Monday or Thursday) and the type of material (story or word list). In the experiment, 103 pupils aged 10 and 11 had to listen to a story and learn a list of 14 nouns at 09:00 or 15:00 on Monday or Thursday. Immediately after presentation of the information and then again 1 week later the pupils had to answer questions about the story and recall the list of nouns. The results showed that the type of task had no effect on memory performance, but immediate and delayed recall scores were dependent on both the time and the day the information was presented. Moreover, memory performance was also affected by the time at which the delayed recall test took place. On Monday and especially on Thursday, better performance was obtained at 09:00. This data only partially confirms the findings of Folkard et al.


Subject(s)
Circadian Rhythm/physiology , Memory/physiology , Periodicity , Child , Female , Humans , Male , Memory, Short-Term/physiology , Mental Recall/physiology
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