Search

The aim of the study was to determine optimal threshold of the Prostate Health Index (Phi) for predicting aggressive prostate cancer (PCa), taking into account misclassification costs, prevalence, and plausible risk factors. This prospective cohort study analyzed patients undergoing prostate biopsy and Phi testing. The primary endpoint was aggressive PCa, defined as biopsy Gleason score ≥ 7. The data about age, total prostate-specific antigen (PSA), percentage of free PSA (%fPSA), and digital rectal examination (DRE) were extracted from the patient files. We divided the patients to the low- and high-risk group. The clinical usefulness of the Phi was assessed by the decision curve analysis. The predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), per-class metrics, and the potential reduction in unnecessary biopsies. The uncertain interval of Phi values was also determined. There were 200 men included in the study, 35 (17.5%) of them having aggressive PCa. Important predictors of aggressive PCa were %fPSA, DRE, Phi, and belonging to the high-risk group. With optimal threshold of 30.7, about 32% unnecessary biopsies would be avoided. The optimal threshold of Phi was lower in the high-risk group than in the low-risk group. The AUC for detection of aggressive PCa was 0.791. Per-class metrics showed that the Phi has insufficient diagnostic accuracy. The lower and upper limits of the uncertain interval were 41.8 and 51.4, respectively. Different thresholds of the Phi could be optimal, depending on prevalence, patient characteristics, and misclassification costs. Further studies with a larger patient sample are necessary to confirm our conclusions.

Background/Aim. Benign prostatic hyperplasia (BPH) is a pathological process, which is one of the most common causes of so-called lower urinary tract symptoms (LUTS). LUTS affect many aspects of daily activities and almost all domains of health-related quality of life (HRQoL). The objective of this study was to evaluate the effects of operative treatment of BPH using standard clinical diagnostic procedures and effects on LUTS using the symptom-score validated to Serbian language as well as implications on HRQoL. Methods. Seventy-four patients underwent surgical treatment for BPH. The study protocol included objective and subjective parameters of the following sets of variables measured before and after the surgery: voiding and incontinence symptoms were measured using the International Continence Society male Short Form (ICS male SF) questionnaire, HRQoL was measured using the SF-36 questionnaire along with standard clinical measurement of residual urine and urine flow. Results. After the surgery, all patients had decrease of voiding scores (13.5 ? 3.3 before and 1.5 ? 1.4 after surgery) and incontinence symptoms (5.7 ? 3.9 before and 0.6 ? 0.8 after surgery) in comparison to period before operative treatment. Significant improvements in all dimensions of HRQoL were noticed, particularly in emotional health. Although mental and physical total scores were significantly better than prior to the surgery, the level of improvement of voiding and incontinence scores were significantly correlated only with the level of improvement of mental score. Conclusion. After BPH surgery, patients are likely to have normal voiding symptoms, barely some involuntary control over urination and overll better HRQoL, particularly in emotional domain.

Background The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ±Â 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct cores of schizophrenia, the Positive and the Negative, while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition. © 2021 Cambridge University Press. All rights reserved.

BACKGROUND AND OBJECTIVES To evaluate the results of testis-sparing surgery (TSS) in patients, with small testicular lesions and a normal contralateral testicle. METHODS In all, 28 patients were treated with TSS for small testicular lesions and a normal contralateral testicle. TSS was considered in patients with testicular lesions smaller than 2 cm and no evidence of metastatic disease. RESULTS The mean age of patients was 35.3 ± 7.3 years, while the mean diameter of the testicular lesions was 11.4 ± 3.7 mm. After pathological examination, 18 patients (64.3%) were diagnosed with stromal tumors and miscellaneous lesions, while 10 (35.7%) had a germ cell tumor. The median follow-up time for the former group was 33 months and no recurrences were observed. In one patient with germ cell tumor, immediate orchiectomy was performed, while the remaining nine were followed-up (median time, 45 months). One patient developed local recurrence after 39 months. CONCLUSIONS Excellent outcomes for benign lesions could be achieved using TSS. TSS could be offered safely in highly selected patients with germ cell tumors, specifically within a clinical trial but there is more data needed regarding the potential risks and benefits. J. Surg. Oncol. 2017;115:287-290. © 2016 Wiley Periodicals, Inc.

Objective:Our aim was to analyze differences between home and office blood pressure (BP) values obtained in epidemiological study and impact on prevalence and distribution of BP categories in a random sample of Croatian population, an original cohort from the EHUH study.Design and method:EHUH study

Resume L’objectif L’effet des cycloplegiques sur les mesures keratorefractometriques et tomographiques corneennes est peu connu. L’objectif de notre etude etait de tester et de comparer les effets des cycloplegiques (cyclopentolate et atropine) sur la forme corneenne et la puissance refractive de l’œil. Methodes Quarante-neuf participants ont ete inclus (84 yeux) dans cette etude prospective. Les patients ont ete randomises en deux groupes, atropine 1 % (32 yeux) et cyclopentolate 1 % (52 yeux). L’orbscan IIz a ete utilise pour evaluer la tomographie corneenne. Pour evaluer la forme corneenne, les valeurs de SimK, BFS, anterieure et posterieure, W-W, la puissance corneenne tangentielle et axiale ont ete mesurees pour les faces corneennes anterieures et posterieures, avant et pendant la cycloplegie. Le diametre de la pupille, la profondeur de la chambre anterieure, l’epaisseur de la cornee dans les zones circulaires de 3,5 et 7 mm, et dans la partie la plus mince de la cornee et aussi l’epaisseur corneenne au centre de fixation ont ete egalement examines. Le logiciel de statistique SPSS a ete utilise pour l’analyse statistique des donnees. Resultats La BFS anterieure et posterieure, la puissance corneenne tangentielle et axiale, le SimK, n’ont pas change lors de la cycloplegie dans les deux groupes traites par atropine et cyclopentolate. L’ACD etait plus profonde lors de l’utilisation de l’atropine que lors de l’utilisation du cyclopentolate. L’epaisseur corneenne est restee inchangee pendant la cycloplegie dans les deux groupes. Le diametre des pupilles etait plus large chez les iris clairs traites avec le cyclopentolate que dans le groupe traite avec l’atropine. Dans les deux groupes, les mesures du diametre corneen – blanc a blanc n’ont pas montre une difference statistique avant ( p = 0,473) et pendant la cycloplegie ( p = 0,287). Conclusion Les examens effectues sur notre echantillon montrent que l’utilisation de l’atropine 1 % et du cyclopentolate 1 % ne change pas la forme corneenne (mesuree par la tomographie corneenne).

One-third of subjects in our cohort having smartphone would use mobile applications for hypertension. Interestingly, all sub- jects older than 55 years and 58 % of subjects younger than 55 years who own a smartphone would like to use mobile applications for BP control.

Objective: The aim of this study was to obtain data on prevalence and awareness of hypertension, cardiovascular risk factors, and life-style habits in individuals (aged 18 years or older) participating in the 2017 World Hypertension Day in Croatia. Design and method: Blood pressure (BP) was measured at 26 sites in 5 cities in Croatia. Along with BP measurement, a short questionnaire on hypertension awareness/salt intake/smartphone use was completed in the time of the interview. The average of two BP measurements, taken in seated position after a few minutes rest by a validated oscillometric device (Omron M6) was recorded. BP measurements were performed from 10 AM to 2 PM in hospital open points, central squares and pharmacies. BP was measured by physicians, trained nurses, pharmacist or medical students. This action was organized and supported by the Croatian Society of Hypertension. Results: A total of 2175 subjects, 873 (40.1%) men, 1211 (59.9%) women were examined. Men were older, had higher BP, BMI and waist circumference (64.7 (13.9)vs.61.8 (14.5) ; 142.9/85.4 (19.8/11.7)vs.136.3/82.9 (21.2/11.3) ; 28.3 (4.4)vs.26.7 (5.4) ; 103 (12.2)vs.92.8 (15.7), respectively). Proportion of patients with BMI over 25 and 25–30 kg/m2 was 32.4% and 20% respectively. In the whole group there were 53.4% subjects with BP 140/90 mmHg or higher (women vs.men 54.1% vs.45.9%, p < 0.001), 68.4% were aware of hypertension (men vs. women 66.9% vs.67.8%, p > 0.05). Positive family history (FH) for hypertension, stroke and myocardial infarction was found in 46.7%, 17.9% and 23.5% subjects respectively. FH was more frequently positive in women than in men (51.0% vs.40.3%, p < 0.001 ; 20.3% vs.14.3%, p = 0.008, 26% vs.19.6%, p = 0.01). We failed to find association between BP values and positive FH. There were 18.7% smokers (more women never smoked 66.5% vs.57.1%, p < 0.001), average pack- years was 5. Only 9.4% of population declared regular physical activity (more than twice per week), and 49.7% were never physically active (no gender differences). Conclusions: Prevalence of subjects with BP values in hypertensive ranges is high, awareness is insufficient, and high proportion of subjects is obese and physically inactive. There is an urgent need of education not only hypertensives but general population as a true measure of primordial prevention.

Vascular age (VA) represents chronological age (CA) adjusted for individual's atherosclerotic burden. The presence of erectile dysfunction (ED) has been considered as a clinical sentinel of premature atherosclerosis. The objective of this study was to explore the predictive value of ED in assessing the discrepancy between VA and CA. In the period from 1 January 2014 to 1 January 2015, all consecutive men referring to the outpatient departments of the Clinics of Urology and Cardiology in Belgrade (Serbia) were considered for enrolment in this cross-sectional study. General exclusion criteria were: age below 18, heart failure, history of myocardial infarction, impaired renal and liver function, acute infection, history of endocrine disease other than type 2 diabetes, pelvic surgery or trauma, and acute coronary syndrome within the last 6 months. According to the presence of ED, hypertension, type 2 diabetes and history of coronary artery disease participants were assigned into five study groups. Hierarchical multiple regression analysis was conducted to identify the predictive value of ED in detection of advanced VA. The mean age of males enrolled in the study was 52.9 ± 7.7 years. The predominance of VA over CA was statistically significantly higher in the group of participants with coexistence of ED and hypertension compared to the group of patients with ED and type 2 diabetes (p = 0.027) and the group of patients with ED (p = 0.014) and control group (p < 0.01). Regression analysis highlighted that ED represented a highly important marker (p < 0.01) of advanced VA, which independently accounted for 6.1% of the variance in the discrepancy between VA and CA. Our study suggests that assessment of ED could be a part of a more comprehensive prediction of patients' advanced VA. Screening among such a highly selected population may help identify those that would most benefit from drug treatments and life style changes.

Introduction To assess predictive value of new tumor markers, precursor of prostate specific antigen (p2PSA) and its derivates-%p2PSA and prostate health index (PHI) in detection of patients with indolent and aggressive prostate cancer (PC) in a subcohort of man whose total PSA ranged from 2 to 10ng/mL. Materials and Methods This cross-sectional study included 129 consecutive male patients aged over 50 years, with no previous history of PC and with normal digital rectal examination findings, but with serum PSA in interval between 2 and 10ng/mL. All patients underwent standard transrectal ultrasonography guided prostate biopsy for the first time. For all patients, serum PSA, free PSA (fPSA) and p2PSA were measured and PHI and %p2PSA were calculated. Results PHI and %p2PSA levels were significanlty higher in patients with PC compared to those without this malignancy. The same findings have been observed in group of patients with Gleason score ≥7 compared to those with Gleason score

Background and Objective To assess the oncologic and functional outcomes of testicular sparing surgery (TSS) based on a single institution experience. Methods Forty-one patients with bilateral and 3 patients with solitary testicle tumors were referred to our institution. The inclusion criteria for TSS were normal serum testosterone levels, and tumor size (

Whether cycloplegics affect standard keratorefractometric and tomographic measurements is unknown. The purpose of our study was to compare the effects of cycloplegics (cyclopentolate and atropine) on corneal shape and refractive power of the eye.This study was performed on 84 eyes of 49 study participants. Patients were randomized into two groups: atropine 1% (32 eyes) and cyclopentolate 1% (52 eyes). Corneal tomography was performed with the Orbscan IIz. To evaluate the corneal shape, simulated keratometry values, anterior and posterior best-fit sphere, white-to-white and tangential and axial corneal power were performed for the anterior and posterior corneal surfaces before and during cycloplegia. Pupil diameter, anterior chamber depth, corneal thickness at the 3, 5 and 7mm optical zones, thinnest area of the cornea and corneal thickness at the visual axis were examined. Data were analyzed using an SPSS statistical package.The anterior and posterior BFS (in the atropine 1% group, anterior BFS was P=0.188; anterior BFS in the cyclopentolate group was P=0.227) and tangential and axial corneal power showed no change during cycloplegia in either group. SimK showed no statistical significance. The ACD was deeper when using atropine than cyclopentolate. Corneal thickness remained unchanged during cycloplegia in both groups. Pupil diameter was larger in light-colored irides in the cyclopentolate group than the atropine group. There was no change in W to W before (P=0.473) and during cycloplegia (P=0.287) in either group.Our results suggest that usage of atropine or cyclopentolate does not alter corneal shape.

Objective To identify the impact of tumour location on the disease recurrence and survival of patients who were treated surgically for upper urinary tract transitional cell carcinoma (UUT-TCC). Patients and methods A single-centre series of 189 consecutive patients who were treated surgically for UUT-TCC between January 1999 and December 2009 was evaluated. Patients who had previously undergone radical cystectomy, preoperative chemotherapy or contralateral UUT-TCC were excluded. In all, 133 patients were available for evaluation. Tumour location was categorized as renal pelvis or ureter based on the location of the dominant tumour. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses. Results The 5-year recurrence-free and cancer-specific survival estimates for the cohort in the present study were 66% and 62%, respectively. The 5-year bladder-only recurrence-free probability was 76%. Using multivariate analysis, only pT classification (hazard ratio, HR, 2.46; P = 0.04) and demographic characteristics (HR, 2.86 for areas of Balkan endemic nephropathy, vs non-Balkan endemic nephropathy areas; 95% confidence interval, 1.37-5.98; P = 0.005) were associated with disease recurrence. Tumour location was not associated with disease recurrence in any of the analyses. There was no difference in cancer-specific survival between renal pelvis and ureteral tumours (P = 0.476). Using multivariate analysis, pT classification (HR, 8.04; P = 0.001) and lymph node status (HR, 4.73; P = 0.01) were the only independent predictors associated with a worse cancer-specific survival. Conclusion Tumour location is unable to predict outcomes in a single-centre series of consecutive patients who were treated with radical nephroureterectomy for UUT-TCC.

Objective: The aim of this study was to evaluate changes in general population attitude and awareness on harmful effects of high salt consumption ten years after Croatian national action on salt and health (CRASH) was launched. Design and method: Data on salt awareness were collected in individuals (aged 18 years or older) participating in the 2008 and 2017 World Hypertension Day in Croatia. In 2017 blood pressure (BP) was measured at 26 sites in 5 cities in Croatia from 10 AM to 2 PM in hospital open points, central squares and pharmacies. BP was measured by physicians, trained nurses, pharmacist or medical students. Along with BP measurements, a short questionnaire on hypertension awareness, salt intake and smartphone use was completed at the time of the interview. This action was organized and supported by the Croatian Society of Hypertension. Results: A total of 2175 subjects, 873 (40.1%) men, 1211 (59.9%) women were examined. Awareness that increased salt intake is harmful and associated with high BP significantly increased from 2008 to 2017 (65.3% vs.95.8%) ; in 2017 women are more aware (91.8% vs.87.3% ; p = 0.013). Comparing to 2008, in 2017, population is much more informed about harmful effects of exaggerated salt intake from physicians (48.9% vs.89.1%). In 2017 more subjects are aware that they are eating too salty than they were in 2008 (27% vs.36.1%), and more men than women thinks they are eating too salty (36.1% vs.29.8%, p = 0.02). Comparing data from 2008 and 2017 the same proportion of women believes that they would be able to reduce salt intake if suggested (86.5% vs.85.8%), but significantly more men in 2017 compared to 2008 declared that they could follow recommendations for reducing salt intake (62% vs.83.9%). Although significantly more subjects in 2017 than in 2008 are aware that bread and bakery products are the main sources of salt intake (9.5% vs.20.9%), the majority (52%) still believes that smoked meat, salami etc. is the main pathway of salt ingestion. Conclusions: Significant improvements in awareness of harmful effects of high salt consumption were noticed in Croatia.

Background/Aim. Although radiotherapy is considered to be a standard treatment of stage A testicular seminoma, an increasing number of studies have reported encouraging results of the treatment by carboplatin monochemotherapy (CBDCA). The aim of this study was to analyse the treatment results of patients with clinical stage A seminoma treated by CBDCA on daily basis in the period June 1999 to September 2008. Methods. A total of 124 patients, mean age 36.63 years (20-62 years), with stage A testicular seminoma were treated, upon radical orchiectomy, by adjuvant CBDCA (400 mg/m2 on day 1 and 22). Results. Chemotherapy was well tolerated, except moderate nausea on the day of the drug administration and the following day. No patient had any serious disorders in blood cells count requiring substitutional treatment. During the mean follow-up period of 37.5 (range 6-111) months, three relapses were noted (2.41%) and none neoplasm of contralateral testicle or any other organ. Conclusion. Simple and easy carboplatin administration with excellent treatment results, along with good tolerance and absence of comorbidity, poses itself as a new 'gold standard' of treatment for stage A testicular seminoma.

Introduction. Testicular tumors most frequently metastasize to regional lymph nodes. Non-seminomatous tumor metastasis of testicle (NSGCTT) to the eyeball is rare. Case report. We presented a 24-year old man, referred to the ophthalmologist due to acute pain and abrupt loss of sight in the left eye accompanied by its enlargement. Orbital and endocranial computerized tomography (CT) was carried out, indicating the tumor in the left eye. His previous medical history provided the information that the right testicle was painlessly enlarged for 8 months. Ultrasonography showed a completely tumorously altered testis. Abdominal and chest CT failed to reveal any secondary deposits in visceral organs and lymph glands. Tumor markers (AFP - alpha-fetoproteins, beta hCG - human choronic gonadotropin beta) were elevated. Right radical orchiactomy was performed (showed NSGCTT), followed by polychemotherapy with cisplatinum 100 mg/m2, etoposide 120 mg/m2, bleomycin 15 mg/m2 (PEB ´ 4), resulting in normalization of tumor marker values and significant regression of the left eyeball. Next, the left eye enucleation and ocular prosthesis implantation was carried out. Pathohistological evaluation indicated fibrosis and necrosis only. In a 5-year follow-up period, the patient was free of recurrence. Conclusion. Isolated hematogenous metastasis of the NSGCTT to the eye is rare. In our case, the left eye was the only metastatic localization. After chemotherapy and eye enucleation the patient was in a 4- year follow-up period free of the recurrence.

Objective:Chronic kidney disease(CKD) is established CV risk factor, and already early renal impairment(RI) increases risk for hypertension(HT) and loss of renal function. It was reported that blood pressure (BP) and metabolic derangements are associated with glomerular hyperfiltration(GHF), and GHF