[Urology]. / Urologie.

Over this last year, urology has progressed both in oncology and reconstructive surgery. Genomic tests have been since quite a few years foreseen as very promising prognostic factors of prostate cancer, however remaining not clearly convincing. At last, the present data available seem to favour their contribution to improve selecting patients for active surveillance. For the same cancer, but at a metastatic stage resistant to androgenic deprivation, therano stics is providing an elegant targeting of disseminated tumor cells using a PSMA radio-active ligand fatal for the latter. Finally, penile urethral strictures appear to convincingly benefit on a long-term basis from a new method to place the substitution tissue which will restore urethral caliber.

C'est entre l'oncologie et la chirurgie reconstructive que l'urologie a poursuivi, en 2021, sa quête de progrès et de mises au point. Voilà plusieurs années que la génomique est attendue comme pourvoyeuse de capacités pronostiques dépassant les facteurs classiques. Plus lentement qu'attendu, la surveillance active du cancer de la prostate apparaît en être la bénéficiaire principale. Ce même cancer, mais au stade métastatique résistant à la déprivation androgénique, profite de la théranostique, qui cible le récepteur du Prostate-Specific Membrane Antigen de la cellule tumorale, avec un ligand radioactif fatal pour cette dernière. Enfin, la chirurgie des sténoses urétrales péniennes se voit enrichie d'une nouvelle manière de placer le tissu de substitution qui agrandira le calibre urétral, conférant à ce type de reconstruction une durabilité et une esthétique probantes.

Non-invasive and high-throughput interrogation of exon-specific isoform expression.

Expression of exon-specific isoforms from alternatively spliced mRNA is a fundamental mechanism that substantially expands the proteome of a cell. However, conventional methods to assess alternative splicing are either consumptive and work-intensive or do not quantify isoform expression longitudinally at the protein level. Here, we therefore developed an exon-specific isoform expression reporter system (EXSISERS), which non-invasively reports the translation of exon-containing isoforms of endogenous genes by scarlessly excising reporter proteins from the nascent polypeptide chain through highly efficient, intein-mediated protein splicing. We applied EXSISERS to quantify the inclusion of the disease-associated exon 10 in microtubule-associated protein tau (MAPT) in patient-derived induced pluripotent stem cells and screened Cas13-based RNA-targeting effectors for isoform specificity. We also coupled cell survival to the inclusion of exon 18b of FOXP1, which is involved in maintaining pluripotency of embryonic stem cells, and confirmed that MBNL1 is a dominant factor for exon 18b exclusion. EXSISERS enables non-disruptive and multimodal monitoring of exon-specific isoform expression with high sensitivity and cellular resolution, and empowers high-throughput screening of exon-specific therapeutic interventions.

A life-threatening small bowel obstruction as onset of an unknown sarcoidosis: A case report.

Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by non-caseating granulomas at the site of disease. A confident diagnosis should be established by the evidence of typical granulomas on biopsy and after exclusion of other conditions. Clinically recognizable Gastrointestinal involvement (GI) occurs in less than 1.6% of patients with sarcoidosis, with data revealing small intestine participation in 0.03% of the cases and few anecdotal reports describe a peritoneal presentation. Clinical manifestations of peritoneal sarcoidosis are abdominal discomfort, bloating, weight loss, epigastric and peri-umbilical pain with or without ascites, bowel obstruction. Treatment depends on symptoms and disease activity. Herein we describe the case of a 42-years-old male patient who developed an acute, life-threatening small bowel obstruction as first manifestation of sarcoidosis. To the best of our knowledge, this is the only report showing such extensive and acute onset of intra-abdominal sarcoidosis in the absence of a previous disease manifestation and without pulmonary involvement.

[Early detection of prostate cancer: a summary of the past 10 years]. / Détection précoce du cancer de la prostate : résumé de ces dix dernières années.

Early detection of prostate cancer remains a controversial subject for the general practitioner. In fact, prostate cancer remains the most frequently diagnosed non skin tumor in men with a proportion of 15 %. However, while prostate specific antigen has massively contributed to its identification at a curable stage for 25 years, it has simultaneously appeared essential not to overtreat a cancer with a significant proportion of indolent tumors. In parallel with this controversial background, the prospective randomized study of the European Randomized Study of Screening for Prostate Cancer, and in particular its Swedish subpopulation, has validated during the last decade the benefit of at least early detection. However, due to the variety of treatment options and the potential side effects of some of them, it is recommended that this detection be performed only in properly informed patients.

La détection précoce du cancer de la prostate reste un sujet d'incertitude pour le praticien généraliste. Le cancer de la prostate est la tumeur non cutanée la plus fréquemment diagnostiquée chez l'homme avec une proportion de 15 %. Bien que l'antigène spécifique de la prostate ait massivement contribué à l'identification à un stade curable depuis 25 ans, il est simultanément indispensable de ne pas surtraiter un cancer dont le taux de tumeurs indolentes est significatif. Dans ce contexte controversé, l'étude prospective randomisée de l'European Randomized Study of Screening for Prostate Cancer, et en particulier sa sous-population suédoise, a validé le bénéfice d'une détection précoce au cours de cette dernière décennie. En raison des options thérapeutiques variées et des potentiels effets secondaires de certaines d'entre elles, il est recommandé de ne pratiquer cette détection que chez les patients dûment informés.

Health-Related Quality of Life in Children With Chronic Illness Compared to Parents: A Systematic Review.

PURPOSE: The purpose of this systematic review is to identify quality-of-life issues that affect participation in age-appropriate activities in chronically ill children, as reported by the children and their families. SUMMARY OF KEY POINTS: Social and emotional functioning scores on the Pediatric Quality of Life Inventory (PedsQL) 4.0 were found to have the greatest frequency of poor agreement between parents and children in 4 of the 6 studies included in this review, suggesting parents and children have wide variation in their assessment in these areas of psychosocial function. CONCLUSIONS: Cumulative evidence appears to indicate that parents of children with chronic illness perceive their children as having a poorer quality of life than the children report for themselves. RECOMMENDATIONS FOR CLINICAL PRACTICE: Identifying differences and commonalities between these reports can guide health care practitioners to specific activities that should be the focus of caring for children; specifically, functional goal development can become more personalized and appropriate.

The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum.

Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques.An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation.Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial. The use of different methods for indexation of ARD may have in part contributed to the heterogeneous findings obtained in the investigations exploring the relationships between ARD and BP. Indeed, the best methods for ARD indexation, as well as the normal values of aortic root size, are still a matter of debate.Several non-hemodynamic factors influence ARD, including age, gender, and anthropometric variables, such as height, weight and their derivatives body surface area (BSA) and body mass index. Of these factors, anthropometric variables have the greatest impact.Several studies documented an association between ARD enlargement, assessed by echocardiography, and some indices of hypertensive target organ damage such as left ventricular hypertrophy, diastolic dysfunction, and carotid intima-media thickening. Recently, we found that ARD, expressed either as absolute values or normalized for BSA (ARD/BSA) or height (ARD/H), was significantly greater in hypertensive subjects with chronic kidney disease (CKD) when compared to their counterparts with normal renal function. Moreover, at univariate analyses estimated glomerular filtration rate (eGFR) showed significant inverse correlations with ARD not indexed and with ARD/BSA and ARD/H. Taking into account the effect of age, sex, duration of hypertension and other potentially confounding factors, in multiple regression analyses, only the association of GFR with ARD/H and that between GFR and ARD/BSA remained statistically significant. The receiver-operating characteristic curve analysis revealed that an estimated GFR of about 50 ml/min/1.73 m2 represents the better threshold to distinguish hypertensive patients with dilated aortic root from those with a normal one.Some population-based studies showed that an enlarged ARD might predict an adverse prognosis, even in absence of aneurysmatic alterations.In the Cardiovascular Health Study, a dilated aortic root was independently associated with an increased risk for stroke, cardiovascular and total mortality in both sexes and with incident congestive heart failure only in men. The relationship between ARD and heart failure has been observed also in the Framingham Heart Study. More recently, the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study demonstrated an independent relationship of ARD/H with incident cardiovascular morbidity and mortality.Although the relationship between BP and aortic root size is still a matter of debate, increasing evidence seems to support the notion that aortic root dilatation, even in absence of aneurysmatic alterations, may be regarded as an hypertensive organ damage paralleling other preclinical markers whose unfavourable prognostic significance is firmly established. Future studies are needed to assess whether or not antihypertensive therapy is able to reduce aortic root dimension and the increased risk associated with its enlargement.

Plasma aldosterone and its relationship with left ventricular mass in hypertensive patients with early-stage chronic kidney disease.

Plasma aldosterone concentrations (PACs) are often increased in the advanced stages of chronic kidney disease (CKD); however, PAC has not been fully investigated in early CKD. Moreover, little is known about the relationship between aldosteronemia and left ventricular (LV) mass in subjects with mild-to-moderate CKD. The study objectives were to analyze PAC, LV mass (LVM), LV geometry and their relationships, in a group of hypertensive patients with stage I-III CKD. One hundred ninety-five hypertensive patients with stage I-III CKD were enrolled and compared with a control group of 82 hypertensive patients without renal dysfunction. LVM was higher in subjects with CKD than in the control group and increased progressively with advancing stages of CKD (P=0.004). A similar trend was observed for PAC (P<0.0001), in which PAC was greater in CKD subjects with LV concentric geometry than in those with eccentric LV hypertrophy (P=0.01). Furthermore, in CKD patients, PAC was directly and significantly correlated with LVM (r=0.29; P<0.0001) and with relative wall thickness (RWT; r=0.36; P<0.0001). These associations remained significant even after adjustment for various confounding factors in multiple regression analyses (P<0.001). In summary, the results demonstrated that in CKD hypertensive patients, LVM, RWT and PAC are increased and related to each other from the earliest stages of renal dysfunction. Furthermore, it seems biologically plausible to speculate that aldosterone may promote a concentric geometry of the left ventricle and increase LVM in hypertensive patients with early CKD.

Subclinical atherosclerosis and fetuin-A plasma levels in essential hypertensive patients.

The intima-media thickness (IMT) is considered as a surrogate marker for atherosclerotic disease. The aim of this study was to analyze the relationship of carotid IMT with fetuin-A in patients with essential hypertension (EH) and normal renal function. The plasma levels of fetuin-A, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and the biomarker of oxidative stress 8-iso-PGF2alpha were assayed in samples from 105 untreated EH patients. Carotid IMT measurements were also performed. EH was studied overall and after dividing in EH with IMT ≥ and <0.9 mm. All of the biomarkers were significantly different between the two subgroups, in particular, the fetuin-A level was lower in the patients with an IMT ≥0.9 mm. In the overall group, the linear analysis of correlation demonstrated that the IMT was significantly inversely correlated with the fetuin-A level (r=-0.40, P<0.0001) and directly with TNF-α (r=0.39, P<0.0001), IL-6 (r=0.38, P<0.0001) and 8-iso-PGF2alpha (r=0.356, P<0.0003). The multiple regression analysis performed that assigned IMT as a dependent variable showed that fetuin-A (ß=-0.268, P<0.0001) was independently correlated with the IMT. Receiver-operator curves demonstrated that fetuin-A levels have a predictive power of IMT>0.9 mm (AUC (area under the curve) 0.738, P<0.0001). Our results suggest that in EH, fetuin-A is associated with the IMT independently of oxidative stress and renal function, thus predicting increases in the IMT.

Cardiopulmonary exercise testing (CPET) in pulmonary emphysema.

In patients affected by chronic obstructive pulmonary disease (COPD), cardiopulmonary response to exercise was never related to the severity of emphysema (E) measured by high resolution computed tomography (HRCT). Sixteen patients (age=65±8 yrs; FEV(1)=54±18%pred; RV=160±28%pred) with moderate to severe E (quantified by lung HRCT as % voxels <-910 HU) were exercised on a cycle-ergometer to exhaustion. Oxygen uptake (V˙(O2)), carbon dioxide output (V˙(CO2)), ventilation (V˙(E)), tidal volume (V(T)), and end-tidal P(CO2) (PET(CO2)) derived variables were measured breath-by-breath. The % of E correlated with: (1) the ratio V(Tpeak) (r=0.74; p=0.001); (2) the V˙(E)/V˙(CO2) slope (r=-0.77; p=0.0004); (3) PET(CO2) values at peak exercise (r=0.80; p=0.0001). Also, the %E was strongly predicted by the following exercise equation: %E(EST) = 58.1 + 11.9 × ΔV˙(E)/V˙(CO2) (r=0.94; p<0.0001). A V(Tpeak)/FEV1 ratio>1 is typically observed in severe E patients; furthermore, the V˙(E)/V˙(CO2) slope and the PET(CO2peak) values decrease and increase respectively as more as the emphysema is severe.

Relationship of fetuin-A with glomerular filtration rate and endothelial dysfunction in moderate-severe chronic kidney disease.

BACKGROUND: In end-stage renal disease, fetuin-A has been demonstrated to be reduced and inversely related to cardiovascular mortality. This study had 2 distinct aims. The first was to verify if circulating concentration of fetuin-A may depend on renal function in patients with chronic kidney disease (CKD). Furthermore, we analyzed the correlation of fetuin-A with the biomarker of endothelial dysfunction endothelin-1 (ET-1), and with the inflammatory cytokine interleukin-6 (IL-6). METHODS: In 108 subjects with stage 3-5 CKD, plasma levels of fetuin-A, ET-1 and IL-6 were assayed. Patients were studied first as a whole group and then were divided according to stages of CKD and fetuin-A tertiles. RESULTS: Fetuin-A concentration decreased in parallel with the increase in ET-1 and IL-6 levels as renal function declined. Multiple regression analysis showed that fetuin-A was independently associated with estimated glomerular filtration rate (beta=0.386; p<0.001), IL-6 (beta=-0.393; p=0.001) and ET-1 (beta=-0.219; p=0.02), in a multivariate model including also sex, parathyroid hormone and the calcium x phosphorus product. CONCLUSIONS: These results seem to indicate that in CKD, even when not severe, inflammatory processes are increased and linked to endothelial dysfunction, worsening progressively with the decline of renal function.

Elastase, myeloperoxidase, nitric oxide metabolites and oxidative status in subjects with clinical stable chronic renal failure on conservative treatment.

We evaluated, in a group of 41 CRF undialyzed subjects (29 men and 12 women, mean age 64.1 +/- 11.3 years), some parameters that reflect leukocyte activation (elastase, myeloperoxidase - MPO), plasma NO metabolites (NO(x)) and the oxidative status (lipid peroxidation expressed as thiobarbituric acid-reactive substances (TBARS) and total antioxidant status (TAS). Elastase was determined, on plasma separated from fasting venous blood, as elastase/alpha1-proteinase inhibitor complex. MPO was evaluated employing the Myeloperoxidase ELISA kit. The NO production was evaluated by a micromethod. The oxidation of polyunsaturated fatty acids was evaluated in plasma by detection of the thiobarbituric acid-reactive substances (TBARS). Total antioxidant status was measured by spectrophotometry. We found a significant increase of elastase, TBARS and NO(x), without any significant variation of MPO and TAS. In this group of CRF subjects, no statistical correlation was found between these examined parameters, creatinine level, creatinine clearance, leukocyte count and hemoglobin level. These findings need to be underlined if we consider that chronic renal failure is an inflammatory condition and this research furtherly supports literature data regarding the role of activated leukocytes in the development of the vascular complications. These observations explain why the examination of leukocyte count and function could become a tool to verify the clinical outcome in these patients.

Endothelin-1 and F2-isoprostane relate to and predict renal dysfunction in hypertensive patients.

BACKGROUND: Hypertension and additional non-traditional risk factors can damage the kidney directly and by promoting atherogenesis. Evidence indicates that increased oxidative stress and inflammation may mediate a large part of the effects of risk factors on the kidney. We hypothesized that in hypertensive patients (HT), oxidative stress, measured as 8-ISO-prostaglandin F2alpha (8-ISO-PGF2alpha), should raise paralleling decreasing renal function and should correlate with estimated glomerular filtration rate (eGFR). METHODS: In 626 HT with renal function ranging from stages 1 to 5 and 100 healthy controls, plasma levels of 8-ISO-PGF2alpha, high-sensitivity C-reactive protein (CRP), transforming growth factor-beta (TGF-beta) and endothelin-1 (ET-1) were measured. GFR was estimated by the Modification of Diet in Renal Disease study equation. RESULTS: When HT were stratified according to renal function stages, 8-ISO-PGF2alpha, CRP, TGF-beta and ET-1 increased progressively and significantly with decreasing eGFR. The multiple regression analysis, considering eGFR as a dependent variable, showed that 8-ISO-PGF2alpha (beta = -0.361, P < 0.000001), ET-1 (beta = -0.197, P < 0.0001) and TGF-beta (beta = -0.170, P < 0.0004) correlated independently with eGFR. All biomarkers were good predictors of eGFR <60 ml/min/1.73 m(2) [receiver-operator-curve (ROC) areas]. ET-1 was shown to be the best predictor with a ROC area = 0.938; with a threshold of 4 pg/ml, 91% sensitivity and 85% specificity were observed, whereas 8-ISO had a ROC area = 0.931, and for a threshold of 329 pg/ml, sensitivity and specificity were 89%, respectively. In contrast, CRP showed the lower predictive value with a ROC area = 0.917; with a threshold of 2.52 mg/l, an 87% sensitivity and an 83% specificity were obtained. CONCLUSIONS: Our findings are a clear-cut demonstration of a strong and negative correlation of both oxidative stress and ET-1 with renal function stages in HT. ET-1 and 8-isoprostane are predictive of eGFR.

Parathyroid hormone is inversely related to endothelin-1 in patients on haemodialysis.

AIM: Parathyroid hormone secretion is mainly influenced by hypocalcaemia, hyperphosphataemia and vitamin D deficiency. However, previous in vitro and in vivo studies showed that endothelin-1 can influence parathyroid hormone secretion. This study was aimed at evaluating this relationship in vivo in uraemic patients. METHODS: Parathyroid hormone and endothelin-1 plasma concentrations were measured in 67 haemodialysed patients. Patients with history of cardiovascular diseases and those with parathyroid adenoma were excluded. RESULTS: Plasma levels of endothelin-1 were found to be inversely related to those of parathyroid hormone (P < 0.04) The multiple regression analysis, carried out considering parathyroid hormone as a dependent variable, and including age, sex, blood pressure, calcium x phosphorus product, and endothelin-1, demonstrated that the independent correlates of parathyroid hormone were endothelin-1 (beta = -0.276; P = 0.015), and calcium x phosphorus product (beta = 0.417; P < 0.0001). CONCLUSION: For the first time in vivo, we demonstrated an inverse independent relationship between endothelin-1 and parathyroid hormone in haemodialysed patients. Because both endothelin-1 and parathyroid hormone are endowed with well-known harmful actions on cardiovascular apparatus, whether such inverse relation may really influence the natural history of cardiovascular damage due to secondary hyperparathyroidism remains to be elucidated.

Relationship of transforming growth factor-beta(1) with tumour necrosis factor-alpha and endothelial activation in patients with stable renal transplantation.

AIM: To evaluate whether or not transforming growth factor-beta(1) is related to inflammation markers and to intercellular and vascular cell adhesion molecules in patients with stable renal transplantation. METHODS: Serum concentrations of transforming growth factor-beta(1), tumour necrosis factor-alpha, C-reactive protein and adhesion molecules were analysed in 33 renal transplanted patients, 33 patients with chronic renal insufficiency (matched to the transplanted group for level of renal function), and 33 hypertensives with normal renal function. anova, Student's t-test and simple regression analysis were used to analyse the data. RESULTS: Transplanted patients showed higher values than hypertensives of transforming growth factor-beta(1), tumour necrosis factor-alpha, C-reactive protein and adhesion molecules (P < 0.0001 for all). Renal insufficiency group exhibited higher concentrations of transforming growth factor-beta(1), tumour necrosis factor-alpha, C-reactive protein and adhesion molecules than hypertensives (P < 0.0001 for all). Transplanted and renal insufficiency patients had similar blood pressure and renal function levels, and transforming growth factor-beta(1), tumour necrosis factor-alpha, C-reactive protein and adhesion molecules were not significantly different. In transplanted and in renal insufficiency groups transforming growth factor-beta(1), adhesion molecules and tumour necrosis factor-alpha correlated significantly each other and with glomerular filtration rate (P < 0.001 for all). CONCLUSION: In long-term renal transplantation inflammation and endothelial activation biomarkers, the pro-fibrotic cytokine transforming growth factor-beta(1) and kidney function are interrelated. Because of the relevant role that inflammation, organ fibrosis and graft dysfunction may play against renal and cardiovascular survival of graft recipients, a better comprehension of the interactions between these variables is needed.

Circulating levels of adhesion molecules in chronic kidney disease correlate with the stage of renal disease and with C-reactive protein.

BACKGROUND: Patients with chronic renal failure (CRF) suffer from a series of complications linked to the atherosclerotic process in which the endothelial dysfunction mediated by the activation of some adhesion molecules plays an important role. This study aims to evaluate circulating levels of intercellular adhesion molecules-1 (ICAM-1) and vascular cell adhesion molecules-1 (VCAM-1) in patients with predialysis CRF, on maintenance hemodialysis (HD) and after kidney transplantation (KTx) and to correlate them with some inflammation and nutritional indexes. METHODS: Thirty two patients with predialysis CRF, 30 on maintenance HD, 36 after KTx and 28 subjects as a control group (C) were included in this study. Circulating levels of ICAM-1 and VCAM-1 were assayed using a specific sandwich ELISA kit. As inflammation indexes, TNFalpha and C-reactive protein (CRP) and, as nutritional indexes, body mass index (BMI), serum albumin, cholesterol, triglycerides, and fibrinogen (F) were evaluated. RESULTS: Serum levels of ICAM-1 and VCAM-1 were progressively higher from C to KTx patients, to those with CRF and those on HD (ANOVA for both; p <0.001). TNFalpha values were lower in HD subjects than in CRF patients, even if in both groups TNFalpha levels were greater than in Tx and control subjects. F and CRP were higher in CRF and HD vs. Tx and control subjects (ANOVA for both p <0.001). No significant correlations were observed between soluble adhesion molecules, albumin and cholesterol, whereas significant correlations were found between CRP and ICAM-1 (r = 0.41; p <0.01), CRP and VCAM-1 (r = 0.39; p <0.01) and between CRP and TNFalpha (r = 0.42; p <0.01). These correlations remained statistically significant even after adjustment for age and blood pressure (all p <0.01). BMI did not differ in the three patient groups. CONCLUSIONS: Circulating levels of adhesion molecules in our study correlated positively with the stage of disease and with one of the inflammatory indexes (CRP), but not with nutritional indexes such as BMI, cholesterol and albumin. The clinical significance of our findings warrants further investigation.

Inflammation and endothelial activation are linked to renal function in long-term kidney transplantation.

The aim of this study was to investigate the relationships between inflammation and adhesion molecules in long-term kidney transplantation. We measured serum concentrations of tumor necrosis factor-alpha (TNFalpha) and intercellular and vascular cell adhesion molecules (ICAM-1 and VCAM-1) in 35 renal transplant recipients (mean age of transplantation 5 +/- 3 years) and in 35 chronic renal insufficiency (CRI) patients; twenty-six healthy subjects were enrolled as controls. Transplanted showed higher values than controls of TNFalpha (P < 0.0001), ICAM-1 (P < 0.0001), and VCAM-1 (P < 0.0001). CRI group as well exhibited higher concentrations than controls of TNFalpha (P < 0.0001), ICAM-1 (P < 0.0001), and VCAM-1 (P < 0.0001). Transplanted and CRI patients had similar blood pressure and renal function levels, and TNFalpha, ICAM-1, and VCAM-1 were not significantly different in the two groups. In transplanted group ICAM-1, VCAM-1, and TNFalpha correlated negatively and independently with glomerular filtration rate (GFR) -P < 0.00001 for all. TNFalpha as well correlated with ICAM-1 and VCAM-1 (P < 0.001, respectively). In CRI group, TNFalpha correlated with serum creatinine, ICAM-1, and VCAM-1 (P = 0.01 for all). In conclusion, in long-term renal transplantation, the level of kidney function and both inflammation and endothelial activation are closely related. In fact, the multiple regression analysis demonstrated that the level of kidney insufficiency and the levels of the studied molecules were independently associated.

Prosthetic treatment of maxillary lateral incisor agenesis with osseointegrated implants: a 24-39-month prospective clinical study.

OBJECTIVES: The present study aimed at evaluating the marginal bone resorption and the peri-implant tissue conditions around Narrow-Neck ITI implants in the implant-prosthetic treatment of the agenesis of maxillary lateral incisors. MATERIAL AND METHODS: Thirty patients affected by monolateral or bilateral agenesis of the maxillary lateral incisors were selected. Thirty-four ITI-SLA Narrow Neck implants were inserted and loaded about 4 months after the surgical procedure. The final restorations were realized using Aureo Galvan Crowns veneered with feldspathic ceramics. The follow-up period ranged from 24 to 39 months. Both marginal bone resorption and soft tissue quality were evaluated. The data were statistically analysed using analysis of variance (ANOVA) for repeated measures, one-way ANOVA and Tukey's post hoc test (P=0.05). RESULTS: During the 24-39-month follow-up period, no implant showed either pain and sensitivity or mobility. After 39 months of functional loading, a cumulative survival rate of 97.06% and a cumulative success rate of 94.12% were calculated. CONCLUSIONS: In case of maxillary lateral incisor agenesis, the implant-prosthetic approach has proved to be a reliable and predictable treatment for both re-establishment of function and aesthetics. Satisfactory values of marginal bone resorption over time and optimal conditions of peri-implant tissue around Narrow-Neck ITI implants were found.

Retrospective clinical evaluation of 86 Procera AllCeram anterior single crowns on natural and implant-supported abutments.

BACKGROUND: The Procera AllCeram (Nobel Biocare AB, Göteborg, Sweden, and Procera Sandvik AB, Stockholm, Sweden) technique is one alternative to metal-ceramic restorations. However, few long-term evaluations of its use for single crowns on natural and implant-supported abutments are available. PURPOSE: The aim of the present study was to assess the clinical performance of Procera AllCeram single crowns when placed in aesthetic sites supported by either natural teeth or implants over a period of 48 months. MATERIALS AND METHODS: Eighty-six single crowns were fabricated and used in 51 patients. The restorations were examined according to the California Dental Association's quality assessment system. RESULTS: One crown was lost after 20 months of follow-up. Of the 85 restorations that completed the 48-month follow-up, only one crown (1.2%) showed a veneering porcelain chip. All crowns were ranked as either excellent or acceptable. The success rates of single crowns supported by natural tooth and implant-supported abutments were 100% and 98.3%, respectively; the total crown success rate was 98.8%. CONCLUSION: Within the limitations of the present study, Procera AllCeram crowns proved to be a reliable therapeutic choice for the restoration of anterior teeth on both natural and implant-supported abutments. The hybrid glass-ionomer cement used in the present study appeared to be a reliable luting agent.

Polymorphonuclear leukocyte integrins in chronic renal failure.

Patients with chronic renal failure (CRF), in comparison with general population, show a higher cardiovascular mortality, not fully explained by the "traditional" risk factors. Among the new factors that have been hypothesized, leukocytes might play an important role. In a group of patients with mild CRF we determined, at baseline and after in vitro activation with 4-phorbol-12-myristate-13-acetate (PMA) and N-formyl-methionyl-leucyl-phenylalanine (fMLP), the polymorphonuclear leukocytes (PMN) beta2-integrin pattern (CD11a, CD11b, CD11c and CD18) by using indirect immunofluorescence with a flow cytometer. At baseline we observed an increase in the phenotypical expression of CD11b, CD11c and CD18 in CRF patients. In normal subjects, after activation with both agents, we noted an increase of all adhesion molecules, while in CRF patients we found an increase in the expression of CD11b, CD11c and CD18 but not of CD11a. The altered behaviour of the PMN integrin pattern in mild CRF patients, likely reflecting a state of PMN activation, might have a pathophysiological significance, considering the high incidence of cardiovascular events in CRF.