RESUMO
Background: Policy makers in Saudi Arabia greatly rely on published studies to make major public health decisions. Prostate cancer (PCa) studies in Saudi Arabia are either outdated or limited to local regions. Aim: The authors aim to analyze the Saudi Cancer Registry to determine the incidence of PCa across all regions of the Kingdom and the risk factors of poor prognosis in the population. Methods: Patients diagnosed with primary PCa from 1 January 2008 to 31 December 2017 were included in the study from the Saudi Cancer Registry. Incidence rates and risk factors for poor survival were calculated. Results: A total of 3607 PCa patients were retrieved. PCa incidence rates ranged from 0.2 to 1.4 per 100 000. Most of the patients were aged 60 and older (86.5%; n=3120), married (97%; n=3497) and lived in the central region (38.1%; n=1375). The mean age at diagnosis was 71.1 (10.8) years. Over half of all tumors were poorly differentiated (64.2%; n=2317), and localized (60.4%; n=2180). The all-time metastasis rate reached 31.4% (n=1131). The lowest mean survival was in those with distant metastasis (P=0.039). Age groups, marital status, tumor morphology, place of residency, and grade were not proven to significantly influence survival. Conclusion: The high metastasis rate and evidence of a greater incidence of newly diagnosed metastatic PCa indicate that the idea of select screening for certain high-risk populations is not farfetched. The authors encourage the promotion of awareness regarding PCa risk factors and screening to optimize prognosis and minimize late presentations and high metastasis rates.
RESUMO
The revascularization of grafted tissues is a complicated and non-straightforward process, which makes it challenging to perform reconstructive surgery for critical-sized bone defects. This challenge is combined with the low vascularity that results from radiotherapy. This low vascularity could result from ischemia-reperfusion injuries, also known as ischemia which may happen upon grafting. Ischemia may affect the hard tissue during reconstruction, and this can often cause resorption, infections, disfigurement, and malunion. This paper therefore reviews the clinical and experimental application of procedures that were employed to improve the reconstructive surgery process, which would ensure that the vascularity of the tissue is maintained or enhanced. It also presents the key strategies that are implemented to perform tissue engineering within the grafted sites aiming to optimize the microenvironment and to enhance the overall process of neovascularization and angiogenesis. This review reveals that the current strategies, according to the literature, are the seeding of the mature and progenitor cells, use of extracellular matrix (ECM), co-culturing of osteoblasts with the ECM, growth factors and the use of microcapillaries incorporated into the scaffold design. However, due to the unstable and regression-prone capillary structures in bone constructs, further research focusing on creating long-lasting and stable blood vessels is required.
