Trends in genitourinary cancer mortality in the United States: analysis of the CDC-WONDER database 1999-2020.

Introduction: Sociodemographic disparities in genitourinary cancer-related mortality have been insufficiently studied, particularly across multiple cancer types. This study aimed to investigate gender, racial, and geographic disparities in mortality rates for the most common genitourinary cancers in the United States. Methods: Mortality data for prostate, bladder, kidney, and testicular cancers were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database between 1999 and 2020. Age-adjusted mortality rates (AAMRs) were analyzed by year, gender, race, urban-rural status, and geographic region using a significance level of p < 0.05. Results: Overall, AAMRs for prostate, bladder, and kidney cancer declined significantly, while testicular cancer-related mortality remained stable. Bladder and kidney cancer AAMRs were 3-4 times higher in males than females. Prostate cancer mortality was highest in black individuals/African Americans and began increasing after 2015. Bladder cancer mortality decreased significantly in White individuals, Black individuals, African Americans, and Asians/Pacific Islanders but remained stable in American Indian/Alaska Natives. Kidney cancer-related mortality was highest in White individuals but declined significantly in other races. Testicular cancer mortality increased significantly in White individuals but remained stable in Black individuals and African Americans. Genitourinary cancer mortality decreased in metropolitan areas but either increased (bladder and testicular cancer) or remained stable (kidney cancer) in non-metropolitan areas. Prostate and kidney cancer mortality was highest in the Midwest, bladder cancer in the South, and testicular cancer in the West. Discussion: Significant sociodemographic disparities exist in the mortality trends of genitourinary cancers in the United States. These findings highlight the need for targeted interventions and further research to address these disparities and improve outcomes for all populations affected by genitourinary cancers.

Emerging role of exosomal microRNA in liver cancer in the era of precision medicine; potential and challenges.

Exosomal microRNAs (miRNAs) have great potential in the fight against hepatocellular carcinoma (HCC), the fourth most common cause of cancer-related death worldwide. In this study, we explored the various applications of these small molecules while analyzing their complex roles in tumor development, metastasis, and changes in the tumor microenvironment. We also discussed the complex interactions that exist between exosomal miRNAs and other non-coding RNAs such as circular RNAs, and show how these interactions coordinate important biochemical pathways that propel the development of HCC. The possibility of targeting exosomal miRNAs for therapeutic intervention is paramount, even beyond their mechanistic significance. We also highlighted their growing potential as cutting-edge biomarkers that could lead to tailored treatment plans by enabling early identification, precise prognosis, and real-time treatment response monitoring. This thorough analysis revealed an intricate network of exosomal miRNAs lead to HCC progression. Finally, strategies for purification and isolation of exosomes and advanced biosensing techniques for detection of exosomal miRNAs are also discussed. Overall, this comprehensive review sheds light on the complex web of exosomal miRNAs in HCC, offering valuable insights for future advancements in diagnosis, prognosis, and ultimately, improved outcomes for patients battling this deadly disease.

Pediatric Anesthesia Exposure: Decoding Its Neurodevelopmental Implications and Navigating the Nuances.

General anesthesia is fundamental in pediatric medical interventions, but its potential neurodevelopmental impact on children has raised concerns, necessitating a thorough investigation. This systematic review aimed to assess the association between pediatric anesthesia exposure and neurodevelopmental outcomes, focusing on dosage effects and identifying high-risk groups. The study involved an extensive literature search across PubMed, Medline, and Google Scholar, selecting 40 relevant studies from an initial pool of 2,000, based on inclusion criteria that focused on children under 18 years exposed to anesthesia, excluding those with major comorbidities or perioperative physiological insults. It was observed that while a single exposure to anesthesia had minimal impact on general neurodevelopment, repeated or prolonged exposures posed greater concerns. Despite these findings, the study identified gaps in certain areas like adaptive behavior and sensory cognition due to limited data. The conclusion drawn is that although the evidence on anesthesia-induced neurotoxicity in children remains inconclusive, the implications of pediatric anesthesia exposure are significant enough to warrant careful consideration by healthcare professionals, who should balance the procedural benefits against the risks. This study also calls for future research to standardize methodologies and employ consistent, validated neurodevelopmental measurement tools.

Using machine learning models to predict synchronous genitourinary cancers among gastrointestinal stromal tumor patients.

Objectives: Gastrointestinal stromal tumors (GISTs) can occur synchronously with other neoplasms, including the genitourinary (GU) system. Machine learning (ML) may be a valuable tool in predicting synchronous GU tumors in GIST patients, and thus improving prognosis. This study aims to evaluate the use of ML algorithms to predict synchronous GU tumors among GIST patients in a specialist research center in Saudi Arabia. Materials and Methods: We analyzed data from all patients with histopathologically confirmed GIST at our facility from 2003 to 2020. Patient files were reviewed for the presence of renal cell carcinoma, adrenal tumors, or other GU cancers. Three supervised ML algorithms were used: logistic regression, XGBoost Regressor, and random forests (RFs). A set of variables, including independent attributes, was entered into the models. Results: A total of 170 patients were included in the study, with 58.8% (n = 100) being male. The median age was 57 (range: 9-91) years. The majority of GISTs were gastric (60%, n = 102) with a spindle cell histology. The most common stage at diagnosis was T2 (27.6%, n = 47) and N0 (20%, n = 34). Six patients (3.5%) had synchronous GU tumors. The RF model achieved the highest accuracy with 97.1%. Conclusion: Our study suggests that the RF model is an effective tool for predicting synchronous GU tumors in GIST patients. Larger multicenter studies, utilizing more powerful algorithms such as deep learning and other artificial intelligence subsets, are necessary to further refine and improve these predictions.

Utilization of the emergency department by kidney transplant recipients: a retrospective cohort study from a high-volume transplant center.

This study aims to assess the trends of emergency department (ED) visits among kidney transplant recipients in a high-volume transplant centre. Methods: This retrospective cohort study targeted patients who underwent renal transplantation at a high-volume transplant centre from 2016 to 2020. The main outcomes of the study were ED visits within 30 days, 31-90 days, 91-180 days, and 181-365 days of transplantation. Results: This study included 348 patients. The median (interquartile range) age of patients was 45.0 years (30.8, 58.2). Over half of the patients were male (57.2%). There was a total of 743 ED visits during the first year after discharge. 19% (n=66) were considered high-frequency users. High-volume ED users tended to be admitted more frequently as compared to those with low frequencies of ED visits (65.2% vs. 31.2%, respectively, P<0.001). Conclusion: As evident by the large number of ED visits, suitable coordination of management through the ED remains a pivotal component of post-transplant care. Strategies addressing prevention of complications of surgical procedures or medical care and infection control are aspects with potential for enhancement.

Classical Seminoma With Secondary Undescended Testis in an Elderly Patient: An Incidental Finding With a Penile Fracture.

Cryptorchidism is a common condition among children; however, it is rare in adults and is associated with an increased risk of malignancy. The development of secondary undescended testes is recognized as a complication following inguinal surgeries such as hernia repair and orchidopexy. Herein, we describe the case of a 64-year-old male with a known past surgical history of right indirect inguinal hernia repair complaining of penile swelling. The patient was diagnosed with a penile fracture, and a genital examination further revealed a right undescended testis. The patient underwent penile fracture repair and right orchiectomy. Histopathology examinations showed classic seminoma. These findings show that the position of each testis should always be documented before, during, and after inguinal hernia repair due to the increased risk of undescended testis. Histopathological confirmation is necessary for such patients so that malignancy can be identified in its early stages and cured subsequently.

Duodenal transection following a seat belt injury: A case report.

INTRODUCTION AND IMPORTANCE: The rare presentation of duodenal injuries has led to a lack of guidelines for managing and diagnosing such cases. In most duodenal injuries, intramural hematoma and perforation are seen; however, complete resection of the duodenum is rare, which is seen in our case. CASE PRESENTATION: We report a rare case of a 6-year-old boy who suffered from a complete isolated duodenal transection at the pylorus and a 90% transection at D3 and D4 following a seat-belt injury. The surgeon performed a primary anastomosis for the first part of the duodenum with pyloric exclusion. Then, primary repair with controlled fistula for the second transection at D3 and D4 and a gastrojejunostomy were performed. After further management, the patient was discharged with no further complaints. CLINICAL DISCUSSION: Due to the retroperitoneal location of the duodenum, it is challenging to diagnose a duodenal injury. CT scan with contrast is considered the best diagnostic tool in the case of a duodenal injury. Treatment of duodenal injuries depends on the type of injury and the present level of damage. It is imperative to differentiate between a duodenal hematoma, a duodenal perforation, or a duodenal transection as the management for each complication differs. CONCLUSION: No official guidelines have been set in the case of management or diagnosis of duodenal transection. Based on our experience with this patient and similar literature, guidelines for managing and diagnosing duodenal transection should be set, and further studies on the matter are warranted.

Obesity-related kidney disease: Beyond hypertension and insulin-resistance.

Chronic kidney disease (CKD) causes considerable morbidity, mortality, and health expenditures worldwide. Obesity is a significant risk factor for CKD development, partially explained by the high prevalence of diabetes mellitus and hypertension in obese patients. However, adipocytes also possess potent endocrine functions, secreting a myriad of cytokines and adipokines that contribute to insulin resistance and induce a chronic low-grade inflammatory state thereby damaging the kidney. CKD development itself is associated with various metabolic alterations that exacerbate adipose tissue dysfunction and insulin resistance. This adipose-renal axis is a major focus of current research, given the rising incidence of CKD and obesity. Cellular senescence is a biologic hallmark of aging, and age is another significant risk factor for obesity and CKD. An elevated senescent cell burden in adipose tissue predicts renal dysfunction in animal models, and senotherapies may alleviate these phenotypes. In this review, we discuss the direct mechanisms by which adipose tissue contributes to CKD development, emphasizing the potential clinical importance of such pathways in augmenting the care of CKD.

Adult T-cell leukemia/lymphoma in the Middle East: first report of two cases from Lebanon.

BACKGROUND: Adult T-cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disorder caused by human T-cell leukemia virus type I (HTLV-I). HTLV-I is endemic in southern Japan, the Caribbean, Central and South America, certain areas of Africa, and the southeastern United States. In the Middle East, North East Iran, particularly the region of Mashhad, has been recognized as an endemic region. CASE REPORTS: In this report, the first two cases of ATL diagnosed in Lebanon are described. The first patient of Lebanese origin presented with acute ATL. The second patient of Romanian origin developed acute ATL in early relapse after autologous transplantation for ATL. Both patients had lymphocytosis, severe hypercalcemia, and CD25+ T-cell immunophenotype on peripheral blood. In both patients, HTLV-I serology was positive by enzyme-linked immunosorbent assay and confirmed by Western blot and HTLV-I oncoprotein Tax expression was documented in the leukemic cells. Upon screening, seven direct family members of the first patient were HTLV-I positive; four of them were regular blood donors. CONCLUSIONS: Screening blood donors for HTLV-I seropositivity is not currently performed in Lebanon. A large screening study in Lebanon is needed to confirm whether South Lebanon is a new endemic region for HTLV-I infection and to recommend mandatory screening of blood donors for HTLV-I infection.

Poststress motionlike artifacts caused by the use of a dual-head gamma camera for (201)Tl myocardial SPECT.

UNLABELLED: When performing (201)Tl myocardial SPECT using a dual-head gamma camera on patients after exercise stress, we have observed in some a sudden increase in the counting rate between the 16th and 17th images. This increase provoked motionlike artifacts, which increased the number of false-positive findings. The aim of our study was to determine possible causes for this leap in activity. METHODS: We performed myocardial SPECT using a dual-head gamma camera on 110 patients after exercise stress: in 38 patients approximately 5 min after injection (group 1), in 43 patients approximately 14 min after injection (group 2), and in 29 patients twice, at approximately 5 and 20 min after injection (group 3). We also performed dynamic data acquisition for 10 min on 18 patients after exercise stress. We compared activity in the heart region in image series obtained after exercise stress and at rest. RESULTS: Daily quality control tests eliminated the possibility of any malfunctions of the gamma camera. Careful image analysis showed no visible patient motion. Our results showed that upward creep of the heart could not be a cause of the described phenomenon. After exercise stress, a > or = 5% activity leap in the heart region on the 16th and 17th frames was more frequent in group 1 than in group 2. Two consecutive acquisitions after exercise stress showed that the leap was >5% in 24 patients (83%) and 12 patients (41%) at the first and second acquisitions, respectively (group 3). In all patients, the leap was <5% at rest. Dynamic studies showed that the activity in the heart region steadily decreased in all patients after exercise stress. We suggest that decreasing (201)Tl concentrations in myocardium or blood could be a major reason for the described artifacts. CONCLUSION: We proposed that the pharmacokinetics of (201)Tl-chloride be evaluated within a short time after injection in humans after exercise stress. Now, in our department, we have begun acquisition approximately 12 min after (201)Tl administration, and the above-mentioned phenomenon has not appeared. However, to avoid the artifacts caused by early redistribution of (201)Tl, acquisition must not begin too late.