Risk factors for perioperative complications in transurethral prostate resection in patients at a Colombian institution. / Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de Colombia.

OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I - II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 - 4.39), INR (RR: 7.59, IC95%:4.63 - 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 - 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 - 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity.

OBJETIVO: Determinar la tasa de complicaciones y los factores de riesgo para complicaciones perioperatorias tempranas de la Resección Transuretral de Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio de cohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna (HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las características basales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. RESULTADOS: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%) fueron intrahospitalarias. Según la clasificación Clavien Dindo el 14,79% fueron complicaciones grado I y II: la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tracto urinario (4,64%) y disfunción de la sonda uretrovesical (1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 ­ 4,39), aumento del valor del INR por unidad (RR: 7,59, IC95%: 4,63 ­ 12,44) y cada día adicional de irrigación vesical (RR: 1,32, IC95%:1,22 ­ 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02­ 1,05). CONCLUSIONES: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de meno rdel 20%, siendo las complicaciones grados I y II las más frecuentes. Los factores de riesgo encontrados son modificables lo que podría reducir la morbilidad postoperatoria.

Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de colombia / Risk factors for perioperative complications in transurethral resection of the prostate in patients from a Colombian institution

Objetivo: Determinar la tasa de complicaciones y los factores de riesgo para complicacionesperioperatorias tempranas de la Resección Transuretralde Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. Materiales y métodos: Se realizó un estudio decohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna(HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las característicasbasales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. Resultados: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%)fueron intrahospitalarias. Según la clasificación ClavienDindo el 14,79% fueron complicaciones grado I y II:la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tractourinario (4,64%) y disfunción de la sonda uretrovesical(1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 – 4,39), aumento del valor del INRpor unidad (RR: 7,59, IC95%: 4,63 – 12,44) y cadadía adicional de irrigación vesical (RR: 1,32, IC95%:1,22 – 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02– 1,05). Conclusiones: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de menordel 20%, siendo las complicaciones grados I y II lasmás frecuentes. Los factores de riesgo encontrados sonmodificables lo que podría reducir la morbilidad postoperatoria.(AU)

Objetive: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolartransurethral resection of the prostate at a complex careinstitution in Colombia. Material and methods: A mixed cohort study wasconducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolartransurethral resection of the prostate between 2012and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate ofcomplications determined up to 30 postoperative days. Results: A total of 67 patients (19.45%) presentedperioperative complications of which 17 (25.37%)were previously hospitalized. According to the ClavienDindo classification, 14.79% were grade I – II: secondary hematuria was the most reported complication andwas present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The riskfactors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 – 4.39), INR (RR: 7.59, IC95%:4.63 – 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 – 1.42) and urethral catheter use(RR: 1.04, CI95%: 1.02 – 1.05). Conclusions: In this study, the complication rate after bipolar transurethral resection of the prostate was lessthan 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. Therisk factors that were found are modifiable, which couldreduce postoperative morbidity.(AU)

Factores de riesgo asociados a complicaciones perioperatorias en la resección transuretral de próstata con bipolar. Revisión narrativa de la literature / Bipolar transurethral resection of prostate: risk factors for perioperative complications. A literature review

RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.

SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.

Role for mitogen-activated protein kinase p38 alpha in lung epithelial branching morphogenesis.

In the early stages of lung development, the endoderm undergoes extensive and stereotypic branching morphogenesis. During this process, a simple epithelial bud develops into a complex tree-like system of tubes specialized for the transport and exchange of gas with blood. The endodermal cells in the distal tips of the developing lung express a special set of genes, have a higher proliferation rate than proximal part, undergo shape change and initiate branching morphogenesis. In this study, we found that of the four p38 genes, only p38 alpha mRNA is localized specifically to the distal endoderm suggesting a role in the regulation of budding morphogenesis. Chemical inhibitors specific for the p38 alpha and p38 beta isoforms suppress budding of embryonic mouse lung explants and isolated endoderm in vitro. Specific knockdown of p38 alpha in cultured lung endoderm using shRNA also inhibited budding morphogenesis, consistent with the chemical inhibition of the p38 signaling pathway. Disruption of p38 alpha did not affect proliferation or expression of the distal cell markers, Sox9 and Erm. However, the amount of E-cadherin protein increased significantly and ectopic expression of E-cadherin also impaired budding of endoderm in vitro. These results suggest that p38 alpha modulates epithelial cell-cell interactions and possibly cell rearrangement during branching morphogenesis. This study provides the first evidence that p38 alpha is involved in the morphogenesis of an epithelial organ.

ERK8 down-regulates transactivation of the glucocorticoid receptor through Hic-5.

Extracellular signal-regulated kinase 8 (ERK8) is the most recently identified member of the ERK subfamily of MAPKs. Although other members of the ERK subfamily are established regulators of signaling pathways involved in cell growth and/or differentiation, less is known about ERK8. To understand the cellular function of ERK8, a yeast two-hybrid screen of a human lung library was performed to identify binding partners. One binding partner identified was Hic-5 (also known as ARA55), a multiple LIM domain containing protein implicated in focal adhesion signaling and the regulation of specific nuclear receptors, including the androgen receptor and the glucocorticoid receptor (GR). Co-immunoprecipitation experiments in mammalian cells confirmed the interaction between Hic-5 and both ERK8 and its rodent ortholog ERK7. The C-terminal region of ERK8 was not required for the interaction. Although the LIM3 and LIM4 domains of Hic-5 were sufficient and required for this interaction, the specific zinc finger motifs in these domains were not. Transcriptional activation reporter assays revealed that ERK8 can negatively regulate transcriptional co-activation of androgen receptor and GRalpha by Hic-5 in a kinase-independent manner. Knockdown of endogenous ERK8 in human airway epithelial cells enhanced dexamethasone-stimulated transcriptional activity of endogenous GR. Transcriptional regulation of GRalpha and interaction with its ligand binding domain by ERK8 were dependent on the presence of Hic-5. These results provide the first physiological function for human ERK8 as a negative regulator of human GRalpha, acting through Hic-5, and suggest a broader role for ERK8 in the regulation of nuclear receptors beyond estrogen receptor alpha.