Comparison of the Results of Therapy for cT1 Renal Carcinoma with Nephron-Sparing Surgery (NSS) vs. Percutaneous Thermal Ablation (TA).

Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour-nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. OBJECTIVES: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. MATERIAL AND METHODS: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier's curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25-75%). RESULTS: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients' death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. CONCLUSION: 1. NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.

Effect of Ethylene and Abscisic Acid on Steroid and Triterpenoid Synthesis in Calendula officinalis Hairy Roots and Saponin Release to the Culture Medium.

Phytohormones (plant growth regulators) can be applied as efficient elicitors to enhance the productivity of plant in vitro cultures, due to their significance in regulating the plant metabolism and strong influence on plant defense responses. In the present study, the effects of exogenous ethylene (ETY, applied in the form of ethephon as an ethylene-generating agent) and abscisic acid (ABA) on the synthesis of triterpenoids and steroids in Calendula officinalis hairy roots were investigated. ABA appeared to be an efficient elicitor of the biosynthesis of triterpenoid oleanolic acid (almost two-fold) and the release of its glycosides (saponins) to the culture medium (up to 6.6-fold). ETY had only a slight effect on triterpenoid metabolism; instead, it strongly influenced steroid metabolism, leading to profound modifications of the quantitative profiles of these compounds, particularly the ratio of stigmasterol to sitosterol. Both the applied phytohormones influenced the interplay between steroid and triterpenoid biosynthetic pathways, revealing the symptoms of their competition.

Increased synthesis of a new oleanane-type saponin in hairy roots of marigold (Calendula officinalis) after treatment with jasmonic acid.

Native plant of marigold (Calendula officinalis L.) synthesizes oleanolic acid saponins classified as glucosides or glucuronides according to the first residue in sugar chain bound to C-3 hydroxyl group. Hairy root culture, obtained by transformation with Agrobacterium rhizogenes strain 15834, exhibit a potent ability of synthesis of oleanolic acid glycosides. The HPLC profile of saponin fraction obtained from C. officinalis hairy roots treated with plant stress hormone, jasmonic acid, showed the 10-times increase of the content of one particular compound, determined by NMR and MALDI TOF as a new bisdesmoside saponin, 3-O-ß-d-glucuronopyranosyl-28-O-ß-d-galactopyranosyl-oleanolic acid. Such a diglycoside does not occur in native C. officinalis plant. It is a glucuronide, whereas in the native plant glucuronides are mainly accumulated in flowers, while glucosides are the most abundant saponins in roots. Thus, our results revealed that the pathways of saponin biosynthesis, particularly reactions of glycosylation, are altered in C. officinalis hairy root culture.

Municipal waste stabilization in a reactor with an integrated active and passive aeration system.

To test whether an integrated passive and active aeration system could be an effective solution for aerobic decomposition of municipal waste in technical conditions, a full-scale composting reactor was designed. The waste was actively aerated for 5d, passively aerated for 35 d, and then actively aerated for 5d, and the entire composting process was monitored. During the 45-day observation period, changes in the fractional, morphological and physico-chemical characteristics of the waste at the top of the reactor differed from those in the center of the reactor. The fractional and morphological analysis made during the entire process of stabilization, showed the total reduction of organic matter measured of 82 wt% and 86 wt% at the respective depths. The reduction of organic matter calculated using the results of Lost of Ignition (LOI) and Total Organic Carbon (TOC) showed, respectively, 40.51-46.62% organic matter loss at the top and 45.33-53.39% in the center of the reactor. At the end of the process, moisture content, LOI and TOC at the top were 3.29%, 6.10% and 4.13% higher, respectively, than in the center. The results showed that application of passive aeration in larger scale simultaneously allows the thermophilic levels to be maintained during municipal solid waste composting process while not inhibiting microbial activity in the reactor.

Mini-slings - an option in stress urinary incontinence treatment. Case studies.

INTRODUCTION: Stress urinary incontinence (SUI) is a social disease caused by numerous contributing factors such as natural childbirth, obesity, hormonal deficiencies and changes in collagen fibers, to name a few. Currently, mini-slings, among all the surgical treatment methods, have gained significance. The aim of this study was to establish the effectiveness of this method. MATERIAL AND METHODS: From 2008 to 2012, one hundred sixty women suffering from SUI underwent surgical procedures to implant mini-slings under the middle part of the urethra and 140 (87.5%) of them remained under observation. In 65 cases, Johnson & Johnson's TVT-Secur was used; in 70 cases, BARD's Adjust mini-sling was used; and in 5 cases, AMS Mini-Arc mini-sling was used. The average period of hospitalization was 3 days per admission, operation and discharge day. RESULTS: In 82 cases, patients urinated well after the removal of the catheter, and had full urine continence. Fourteen patients showed great improvement, and in four cases temporary urine retention was observed. In two cases vaginal bleeding was observed, yet there was no need for wound revision. Evaluation of the 'quality of life improvement' was done using the Visual Analog Scale (VAS). CONCLUSIONS: The obtained results allowed the conclusion that the implantation of mini-slings is a low invasive, relatively safe and effective procedure for the treatment of SUI even in cases of recurrence. Almost full recovery was achieved in all the cases of this study. The mini-sling has become an important element in modern urogynecology.

Cystolithiasis in women as a distant complication after minimal invasive treatment of stress urinary incontinence.

INTRODUCTION: Stress urinary incontinence (SUI) is a condition of social dimension which generally pertains to women of various age. The only effective treatments of SUI are surgical procedures. The use of tension-free vaginal tape (TVT) ensures low invasiveness but also carries the risk of complications. One of the complications may be migration of the tape into the urinary bladder creating conditions for urinary stones. There is a number of treatment methods for cystolithiasis, among them the optical lithotripter, ultrasound and pneumatic probes, and recently, the holmium laser. MATERIAL AND METHODS: From January 2009 to February 2010, six women suffering from bladder stones were treated at our department. All patients had previously undergone SUI procedures and over time, thread or tape had penetrated into the urinary bladder. The stone diameters were in the range of 1.6 cm-3.5 cm. Lithotripsy was performed with the use of an 80 W holmium YAG laser as an endoscopic procedure: beam frequency length of 2100 nm and applied energy was in the range of 0.2-3.5 J. RESULTS: The urinary bladder stones were disintegrated and suctioned out. During the same procedure, the threads or tape from the SUI procedure were excised from the bladder. All patients were discharged from the hospital in good general condition after two days. CONCLUSIONS: The holmium laser is an effective treatment for patients with bladder stone complications after SUI procedures when threads or tape have migrated and penetrated the bladder wall. The procedure is straightforward and safe for patients.

HIF-1, GLUT1, endoglin, and BIRC5 expression in urine samples obtained from patients with bladder malignancies - after photodynamic diagnosis (PDD).

INTRODUCTION: Bladder cancer (BC) is a serious medical problem. The high rate of recurrence and progression demands the development of new methods, such as genetic markers, which allow diagnosis and patient follow-up. OBJECTIVES: The aim of this study was to compare expression of HIF-1, GLUT1, endoglin, and BRIC5 in patients without and those with BC. The second group was divided into sub-groups: those without a history of PDD (photodynamic diagnosis) in the diagnostic process and those after PDD. METHODS: Patients with BC were diagnosed using the PDD method using hexaminolevulinate (Hexvix(®)). The expressions of HIF-1, GLUT1, endoglin, and BRIC5 genes were established in urine specimens by real-time quantitative polymerase chain reaction (PCR). RESULTS: The expressions of all tested genes were higher in the group of patients with BC than in the group without BC. In the group after PDD, a statistically significant overexpression of HIF-1 was observed. In this group, changes were not observed in cases of the other three tested genes. CONCLUSIONS: The differences between the group with PDD and the group without it can be connected with the direct influence of PDD on malignant tissue, which can cause overexpression of HIF-1 only. This is, however, only a hypothesis and needs further study.