Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy.

INTRODUCTION: Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. OBJECTIVE: Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). MATERIAL AND METHODS: A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan-Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. RESULTS: Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate-poor prognostic groups. CONCLUSION: The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT.

Elaboración de un índice pronóstico inmunonutricional en pacientes con cáncer de vejiga músculo-infiltrante candidatos a cistectomía radical / Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy

Introducción El tumor vesical músculo-infiltrante (TVMI) tiene una supervivencia libre de recidiva (SLR) del 50% a los cinco años, la quimioterapia neoadyuvante (QTN) ha aumentado la misma un 8%, pero no está claro qué pacientes se pueden beneficiar en mayor grado de la misma. Objetivo Evaluar el valor pronóstico del estado inmunológico-nutricional en los pacientes con TVMI candidatos a cistectomía, y desarrollar un score que permita identificar precistectomía a los pacientes con peor pronóstico (pT3-4 y/o pN0-1). Material y método Se realizó un análisis retrospectivo de 284 pacientes con TVMI tratados con cistectomía radical. Se revisó la analítica preoperatoria y se calcularon índices inmunonutricionales. El método de Kaplan-Meier se utilizó para el cálculo de la SLR. Para el análisis multivariante se utilizó la regresión de Cox. Resultados Mediante análisis univariante se observó una relación estadísticamente significativa con el índice leucocito/linfocito (p = 0,0001), el índice neutrófilo/linfocito (p = 0,02) el índice pronóstico nutricional (p = 0,002), y el ratio plaqueta/linfocito (p = 0,002). En análisis multivariante, el ratio leucocito/linfocito (p = 0,002) y el IPN (p = 0,04) se comportaron como factores pronósticos independientes de disminución de SLR, y se elaboró con ello un score pronóstico que divide a los pacientes en tres grupos pronósticos. El 80% de los pacientes con tumores pT3-4 y/o pN0-1 se encontraban en los grupos de pronóstico medio-malo. Conclusión La incorporación en la práctica clínica de un score inmunonutricional precistectomía ayudaría a seleccionar a un grupo de pacientes con estadio patológico más desfavorable y peor SLR. Creemos que estos pacientes podrían beneficiarse en mayor medida de una QTN (AU)

Introduction Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. Objective Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). Material and methods A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan–Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. Results Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate–poor prognostic groups. Conclusion The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT (AU)

Manejo quirúrgico de tumores en riñón en herradura. Revisión de la literatura y análisis de 2 casos / Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases

Introducción: El riñón en herradura es una anomalía congénita poco frecuente en la población general que combina ectopia renal, malrotación y alteraciones en la vascularización. El tumor que más frecuentemente se desarrolla en estos casos es el carcinoma de células renales (50%).Una de sus características a destacar es la gran variabilidad en su anatomía, sobre todo a nivel vascular.Material y métodosPresentamos 2 casos de pacientes con diagnóstico de tumor renal en riñones en herradura, ambos tratados con nefrectomía parcial laparoscópica, llevados a cabo en nuestro servicio; y realizamos una revisión de la literatura actual.DiscusiónLas indicaciones de tratamiento quirúrgico en tumores en esta enfermedad son las mismas que en los riñones anatómicamente normales. Tradicionalmente, el tratamiento ha sido la cirugía abierta, siendo la heminefrectomía la cirugía de elección. En la actualidad se tiende a defender la cirugía conservadora de nefronas, y el abordaje laparoscópico ha adquirido más importancia progresivamente.ConclusiónEs fundamental realizar un estudio de imagen minucioso para una correcta planificación quirúrgica. (AU)

Introduction: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%).One of its main characteristics is great anatomical variation, especially in terms of vascular structures.Material and methodsWe present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature.DiscussionIndications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance.ConclusionA thorough imaging study is essential for proper surgical planning. (AU)

Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases.

INTRODUCTION: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%). One of its main characteristics is great anatomical variation, especially in terms of vascular structures. MATERIAL AND METHODS: We present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature. DISCUSSION: Indications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance. CONCLUSION: A thorough imaging study is essential for proper surgical planning.

Trait-anxiety dependence of movement time performance in a bimodal choice task in subjects exposed to moderate anxiogenic conditions.

Recent studies have provided insight into the interdependence between state-anxiety, trait-anxiety and motor performances. In the present study, we investigated in very low trait-anxiety (VLTA) and normal trait-anxiety (NTA) subjects, the effects of moderate state-anxiety induced by the video-recorded Stroop color word interference test, on reaction time and movement time in bimodal choice response time task providing either visual or auditory modality. We found that in anxiogenic condition, movement time performances were improved in visual modality in NTA subjects, and in auditory modality in VLTA subjects. Our results show that depending on their trait-anxiety level, individuals exposed to anxiogenic condition would allocate attentional resources towards a specific relevant modality. Such attentional resources would influence movement time, but not reaction time.

Detection of polychlorinated biphenyls and dioxins in Belgian cattle and estimation of the maximal potential exposure in humans through diets of bovine origin.

The methodology used to detect a polychlorinated biphenyl (PCB)/dioxin contamination in a Belgian cattle population that was not exposed to the PCB/dioxin incident in 1999 is presented. This population is directly or indirectly destined for human consumption. The methodology consisted in the systematic sampling of all calf-fattening stations and groups of cattle destined for export, and in the random sampling of slaughter cattle. This approach is compared to the method described in directive 96/23/CE from the European Council. When PCB concentrations exceeded the tolerance level of 0.2 micro g/g body fat (seven congeners with numbers 28, 52, 101, 118, 138, 153, and 180), dioxins (seventeen 2,3,7,8-substituted congeners of PCDD and PCDF) were also determined. The prevalence of Belgian slaughter cattle with PCB concentrations above this cutoff was 0.3% (95% confidence interval: 0.01-1.50%). Results indicate that the incidence of contamination was minimal, with environmental origin and common in all industrial countries. The maximal potential exposure of an adult human consumer to dioxins through diet of bovine origin is estimated in two worst-case scenarios. The first one corresponds to the consumption of contaminated food products by a small number of consumers during a long period (local consumption) and the second simulates the consumption of contaminated products by a large number of consumers during a short period (supermarket purchase). The theoretical maximum daily intake of dioxins in adults was respectively 374 and 123 pg TEQ/d. The estimated maximum increase of dioxin body burden corresponds to 7 pg TEQ/g fat in the local consumption scheme and 0.07 pg TEQ/g fat in the supermarket consumption scheme.

Role of frontal cortex in memory for duration: an event-related potential study in humans.

Event-related potentials were recorded in order to determine how brain activity is lateralized during the encoding and the recognition of visual durations (700 and 2500 ms ranges). It is assumed in the Hemispheric Encoding Retrieval Asymmetry model that the encoding of words, faces and odours involves left frontal areas whereas their recognition involves right frontal areas. The present results indicate that, for temporal information, the hemispheric bias is different: a negativity developed over right frontal electrodes for both encoding and recognition, and for both duration ranges. Thus, the involvement of right frontal areas appears critical for time perception. Conversely to what was expected, contingent negative variation during recognition was large over both left and right frontal electrodes. These results suggest that the involvement of both hemispheres is necessary for recognition of temporal information.

Timed active avoidance learning in lurcher mutant mice.

Lurcher mutant mice (+/Lc) which exhibit a massive loss of neurons in the cerebellar cortex and in the inferior olivary nuclei were subjected to an active avoidance learning task; the animals' avoidance response must occur within a small time window after a short or a long delay. The control mice needed a mean of 8.3 sessions of 10 trials (short delay group) and of 11.8 sessions (long delay group) and showed good retention after a 24 h interval. When subjected to the same number of sessions, the +/Lc mice were unable to learn the timing task. However, a subgroup of lurcher mutants was able to learn after a high number of sessions (25.4 sessions as a mean). There was no intergroup difference in the standard version of one-way active avoidance. These results indicate that the cerebellar cortex is involved in time processing during active avoidance. The cerebellum may be part of a loop including the cerebral cortex known to be involved in time perception. An alternative explanation is that the cerebellar mutant animals had persevering tendencies acquired during performance of the one-way avoidance task.