Treatment of castration-resistant prostate cancer remains an area of unmet medical need. Evidence suggests that this entity continues to be driven by androgens and androgen receptor (AR) signaling. Abiraterone acetate, a pregnenolone derivative, is an oral selective and irreversible inhibitor of the key steroidogenic enzyme CYP17. It possesses dual 17-α hydroxylase and C17,20-lyase blocking activity, the result of which is decreased gonadal and extra-gonadal androgen synthesis. Abiraterone was first approved by the US Food and Drug Administration (FDA) in 2011 following the demonstration of superior survival compared with placebo in the post-docetaxel population. Since that time, more evidence has been generated from preclinical studies and clinical trials which have considerably enhanced our understanding of this complex disease. In this paper, we review the development of abiraterone acetate, its pharmacological characteristics, and its effects on the androgen-AR signaling axis, along with the combined experience from clinical trials. We also discuss some of the ongoing trials using this agent, as well as potential mechanisms of abiraterone resistance, novel bio-marker development, and future directions using AR-directed therapies.
{"title":"Clinical Evaluation of Abiraterone in the Treatment of Metastatic Prostate Cancer.","authors":"Jatinder Goyal, Emmanuel S Antonarakis","doi":"10.4137/CMU.S8337","DOIUrl":"https://doi.org/10.4137/CMU.S8337","url":null,"abstract":"<p><p>Treatment of castration-resistant prostate cancer remains an area of unmet medical need. Evidence suggests that this entity continues to be driven by androgens and androgen receptor (AR) signaling. Abiraterone acetate, a pregnenolone derivative, is an oral selective and irreversible inhibitor of the key steroidogenic enzyme CYP17. It possesses dual 17-α hydroxylase and C17,20-lyase blocking activity, the result of which is decreased gonadal and extra-gonadal androgen synthesis. Abiraterone was first approved by the US Food and Drug Administration (FDA) in 2011 following the demonstration of superior survival compared with placebo in the post-docetaxel population. Since that time, more evidence has been generated from preclinical studies and clinical trials which have considerably enhanced our understanding of this complex disease. In this paper, we review the development of abiraterone acetate, its pharmacological characteristics, and its effects on the androgen-AR signaling axis, along with the combined experience from clinical trials. We also discuss some of the ongoing trials using this agent, as well as potential mechanisms of abiraterone resistance, novel bio-marker development, and future directions using AR-directed therapies.</p>","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"2013 7","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2013-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMU.S8337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32078579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Overactive bladder (OAB) is a common problem whose prevalence increases with advancing age and compromises health-related quality of life. Tolterodine was the first antimuscarinic drug specifically designed to treat OAB. Through MEDLINE, we reviewed articles, standardization reports and meeting abstracts, published between 2001 and 2011, on the efficacy and tolerability of Tolterodine extended release (ER). Our search terms included Tolterodine, extended release, overactive bladder, therapeutic use, efficacy, tolerance, and adverse events. Tolterodine ER, via steady drug release during the daytime, gives the benefit of constant serum concentration and thus better efficacy and tolerability in comparison to Tolterodine immediate release, even in elderly patients with co-morbid conditions.
{"title":"Clinical Use of Tolterodine Extended Release in Overactive Bladder","authors":"O. E. Y. Adli, J. Corcos","doi":"10.4137/CMU.S6425","DOIUrl":"https://doi.org/10.4137/CMU.S6425","url":null,"abstract":"Overactive bladder (OAB) is a common problem whose prevalence increases with advancing age and compromises health-related quality of life. Tolterodine was the first antimuscarinic drug specifically designed to treat OAB. Through MEDLINE, we reviewed articles, standardization reports and meeting abstracts, published between 2001 and 2011, on the efficacy and tolerability of Tolterodine extended release (ER). Our search terms included Tolterodine, extended release, overactive bladder, therapeutic use, efficacy, tolerance, and adverse events. Tolterodine ER, via steady drug release during the daytime, gives the benefit of constant serum concentration and thus better efficacy and tolerability in comparison to Tolterodine immediate release, even in elderly patients with co-morbid conditions.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77556447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muscarinic receptor antagonists form the mainstay of pharmacologic therapy for overactive bladder (OAB), a prevalent, debilitating, and costly condition. Antimuscarinics differ in their specificity for certain muscarinic receptors, their metabolism, and their ability to cross the blood-brain barrier. Trospium chloride is the only antimuscarinic that is a quarternary amine and its positive charge prevents the crossing of the blood-brain barrier, thus minimizing CNS side effects. Level I evidence supports the efficacy and tolerability of both the immediate-release and extended-release formulations of trospium. Furthermore, subanalyses of data pooled from large randomized, controlled trials support the efficacy is subpopulations such as men, the obese, and the elderly. The adverse event profile is favorable, with dry mouth and constipation presenting as the main adverse sequelae. As expected, CNS side effects have been rare and cognition does not appear to be impaired in those patients taking multiple medications.
{"title":"OAB Update: Focus on Trospium","authors":"A. Gomelsky, R. Dmochowski","doi":"10.4137/CMU.S5068","DOIUrl":"https://doi.org/10.4137/CMU.S5068","url":null,"abstract":"Muscarinic receptor antagonists form the mainstay of pharmacologic therapy for overactive bladder (OAB), a prevalent, debilitating, and costly condition. Antimuscarinics differ in their specificity for certain muscarinic receptors, their metabolism, and their ability to cross the blood-brain barrier. Trospium chloride is the only antimuscarinic that is a quarternary amine and its positive charge prevents the crossing of the blood-brain barrier, thus minimizing CNS side effects. Level I evidence supports the efficacy and tolerability of both the immediate-release and extended-release formulations of trospium. Furthermore, subanalyses of data pooled from large randomized, controlled trials support the efficacy is subpopulations such as men, the obese, and the elderly. The adverse event profile is favorable, with dry mouth and constipation presenting as the main adverse sequelae. As expected, CNS side effects have been rare and cognition does not appear to be impaired in those patients taking multiple medications.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79555477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ureteral stricture, regardless of etiology, remains difficult to treat. Mainstays of therapy include polymeric double J stents and percutaneous nephrostomy tubes, each with respective complications. Multiple retrospective studies have now been published using the Resonance metallic double J stent, which is the focus of this review. A literature search was completed utilizing Pub Med. Key words included metallic stent, Resonance stents, and ureteral stricture. All identified papers were included. The stent is generally well tolerated, with infections, hematuria, and voiding symptoms requiring removal in 0% –14% of patients. Stents remained in place for mean of 4 to 9.4 months with the exception of a single study evaluating ureteroenteric strictures, where average duration was 21 days. In most studies a subset of patients kept the stent in situ for > 12 months, indicating that for some, the Resonance stent is a viable option, though predicting which patients will do well remains difficult.
{"title":"Full-Length Metallic Double J Stents: A Review of Resonance® Stents","authors":"M. Newton, James A. Brown","doi":"10.4137/CMU.S6604","DOIUrl":"https://doi.org/10.4137/CMU.S6604","url":null,"abstract":"Ureteral stricture, regardless of etiology, remains difficult to treat. Mainstays of therapy include polymeric double J stents and percutaneous nephrostomy tubes, each with respective complications. Multiple retrospective studies have now been published using the Resonance metallic double J stent, which is the focus of this review. A literature search was completed utilizing Pub Med. Key words included metallic stent, Resonance stents, and ureteral stricture. All identified papers were included. The stent is generally well tolerated, with infections, hematuria, and voiding symptoms requiring removal in 0% –14% of patients. Stents remained in place for mean of 4 to 9.4 months with the exception of a single study evaluating ureteroenteric strictures, where average duration was 21 days. In most studies a subset of patients kept the stent in situ for > 12 months, indicating that for some, the Resonance stent is a viable option, though predicting which patients will do well remains difficult.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81648380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Walid El-Ayass, Joelle el-Amm, Maneesh Jain, J. Aragon-Ching
Recent drug approvals in the field of prostate cancer therapy have brought about a change in the treatment landscape of locally advanced and metastatic castration-resistant prostate cancer. While this improvement offers a welcoming change in the standard treatment practice of prostate cancer, questions remain with regard to the proper sequencing of the right therapy for the appropriate patient. This review highlights the pre-clinical, safety and clinical studies that help bring to the forefront the drugs recently approved for the treatment of advanced prostate cancer and offer some insights to its use.
{"title":"New Pharmacotherapies in the Treatment of Advanced Prostate Cancer","authors":"Walid El-Ayass, Joelle el-Amm, Maneesh Jain, J. Aragon-Ching","doi":"10.4137/CMU.S5075","DOIUrl":"https://doi.org/10.4137/CMU.S5075","url":null,"abstract":"Recent drug approvals in the field of prostate cancer therapy have brought about a change in the treatment landscape of locally advanced and metastatic castration-resistant prostate cancer. While this improvement offers a welcoming change in the standard treatment practice of prostate cancer, questions remain with regard to the proper sequencing of the right therapy for the appropriate patient. This review highlights the pre-clinical, safety and clinical studies that help bring to the forefront the drugs recently approved for the treatment of advanced prostate cancer and offer some insights to its use.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79870829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction This multicenter, randomized, double-blind, parallel-group, Phase III, pivotal trial investigated the efficacy and safety of solifenacin succinate 10 mg, a once-daily (OD) oral antimuscarinic agent, in overactive bladder syndrome (OAB). Materials and methods A total of 634 adult patients with OAB symptoms were randomized to either solifenacin 10 mg (n = 318) or placebo (n = 316) OD over 12 weeks, to examine changes from baseline in micturition-, incontinence-, urgency- and nocturia-episodes/24 hours, measured using a 3-day diary. Results Solifenacin significantly reduced the mean number of micturition-, urgency- and incontinence-episodes/24 hours at end of treatment (P < 0.001 for all versus placebo); these improvements were observed at 4 weeks, and continued over 12 weeks. Adverse events were generally mild or moderate in severity and typically anticholinergic in nature. Conclusions Solifenacin 10 mg OD was well tolerated and effective in treating major OAB symptoms, including urinary incontinence, frequency and urgency.
{"title":"Efficacy and Safety of 10 mg Solifenacin Succinate in Patients with Overactive Bladder Syndrome: Results from a Randomized, Double-Blind, Placebo-Controlled Phase III Pivotal Trial","authors":"F. Govier, N. Smith, T. Uchida","doi":"10.4137/CMU.S4960","DOIUrl":"https://doi.org/10.4137/CMU.S4960","url":null,"abstract":"Introduction This multicenter, randomized, double-blind, parallel-group, Phase III, pivotal trial investigated the efficacy and safety of solifenacin succinate 10 mg, a once-daily (OD) oral antimuscarinic agent, in overactive bladder syndrome (OAB). Materials and methods A total of 634 adult patients with OAB symptoms were randomized to either solifenacin 10 mg (n = 318) or placebo (n = 316) OD over 12 weeks, to examine changes from baseline in micturition-, incontinence-, urgency- and nocturia-episodes/24 hours, measured using a 3-day diary. Results Solifenacin significantly reduced the mean number of micturition-, urgency- and incontinence-episodes/24 hours at end of treatment (P < 0.001 for all versus placebo); these improvements were observed at 4 weeks, and continued over 12 weeks. Adverse events were generally mild or moderate in severity and typically anticholinergic in nature. Conclusions Solifenacin 10 mg OD was well tolerated and effective in treating major OAB symptoms, including urinary incontinence, frequency and urgency.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87744391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Elwagdy, R. Ramadan, T. Salem, S. El-Hakim, Ismail El Helali, F. Samir
Purpose To evaluate the feasibility of transrectal computed ultrasound tomography (TRCUT) in localization and targeted biopsy for men who have been shown to be negative in the first biopsy guided by two-dimensional transrectal ultrasound (2D TRUS) but continue to have figures suggestive of prostate cancer, so as to minimize with confidence the number of core needle biopsies, especially when the repeat or random required. Materials and Methods Sixty-three patients aged 53–78 years (mean, 64.9 years) with suspected prostate cancer were enrolled when a repeat or random biopsy was indicated after at least one prostatic biopsy with negative findings. The 2D TRUS random (sextant) and TRCUT guided shot-biopsies were obtained. Imaging-biopsy consequences were finally compared with the post-operative findings and the histopathologic staging. Results TRCUT enabled display of the prostate gland in planes usually not obtainable at conventional 2D TRUS. Transverse and oblique thin cuts of TRCUT were more significant in all patients than other planes. Diagnostic performance of TRCUT imaging on prostate cancer localization for targeted biopsy proved an accuracy of 97.4% (P value = 0.001). TRCUT for bilateral disease detection proved an accuracy of 78.6% compared to the final post-operative pathology. Accuracy for identification of positive tumor margins proved 82.4%. Gleason score on final post-operative pathology was upgraded to 7, compared with a median score of 6 on imaging biopsies. Conclusion TRCUT guided target-biopsy of the prostate gland represents a technique with a higher rate of accuracy and can minimize the number of biopsy shots than using 2D TRUS in men who have high PSA levels and negative in the first biopsy procedure.
{"title":"Prostate Cancer: Value of Transrectal Computed Ultrasound Tomography (TRCUT) in Targeted Biopsy Guidance when the Repeat or Random Biopsies Indicated: Early Experience","authors":"S. Elwagdy, R. Ramadan, T. Salem, S. El-Hakim, Ismail El Helali, F. Samir","doi":"10.4137/CMU.S3405","DOIUrl":"https://doi.org/10.4137/CMU.S3405","url":null,"abstract":"Purpose To evaluate the feasibility of transrectal computed ultrasound tomography (TRCUT) in localization and targeted biopsy for men who have been shown to be negative in the first biopsy guided by two-dimensional transrectal ultrasound (2D TRUS) but continue to have figures suggestive of prostate cancer, so as to minimize with confidence the number of core needle biopsies, especially when the repeat or random required. Materials and Methods Sixty-three patients aged 53–78 years (mean, 64.9 years) with suspected prostate cancer were enrolled when a repeat or random biopsy was indicated after at least one prostatic biopsy with negative findings. The 2D TRUS random (sextant) and TRCUT guided shot-biopsies were obtained. Imaging-biopsy consequences were finally compared with the post-operative findings and the histopathologic staging. Results TRCUT enabled display of the prostate gland in planes usually not obtainable at conventional 2D TRUS. Transverse and oblique thin cuts of TRCUT were more significant in all patients than other planes. Diagnostic performance of TRCUT imaging on prostate cancer localization for targeted biopsy proved an accuracy of 97.4% (P value = 0.001). TRCUT for bilateral disease detection proved an accuracy of 78.6% compared to the final post-operative pathology. Accuracy for identification of positive tumor margins proved 82.4%. Gleason score on final post-operative pathology was upgraded to 7, compared with a median score of 6 on imaging biopsies. Conclusion TRCUT guided target-biopsy of the prostate gland represents a technique with a higher rate of accuracy and can minimize the number of biopsy shots than using 2D TRUS in men who have high PSA levels and negative in the first biopsy procedure.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80522111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mostafa S. El-Rehewy, M. A. El-Feky, M. Hassan, H. Abolella, A. Abolyosr, R. M. A. El-Baky, G. F. Gad
Background Ureteral catheters are valuable indispensable devices may readily acquire biofilms on the inner or outer surfaces. This study evaluated the efficacies of ureteral catheters impregnated with ciprofloxacin, N-acetylcysteine each alone and in combination on microbial adherence. Methods Antimicrobial durability of ureteral catheters coated, through instant dip method, with ciprofloxacin were determined using modified Kirby-Bauer method. Ciprofloxacin-coated catheters showed zones of inhibition ranged from 15 to 45 mm in diameter (baseline) against nine clinical strains recently isolated from patients undergoing ureteral stent removal. Segments coated with ciprofloxacin, N-acetylcysteine each alone and in combination, through instant dip method, were incubated with the tested microorganisms, washed, sonicated, cultured and the number of viable cells were determined. Results Ciprofloxacin-coated catheters soaked in urine and incubated at 37 °C, maintained antimicrobial activities and produce zones of inhibition that measured 2–10 mm for at least 8 weeks. Effect of ciprofloxacin and N-acetylcysteine coated catheters on microbial adherence were found to be dose dependent. Catheters impregnated with ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on microbial adherence when compared with controls (85.5%–100%). Conclusion Catheters impregnated with ciprofloxacin, using instant dip method, were shown to have broad spectrum, prolonged antimicrobial durability and high efficacy. On the other hand, Catheters impregnated with ciprofloxacin/NAC showed the highest inhibitory effect on microbial adherence to stent surfaces.
{"title":"In vitro Efficacy of Ureteral Catheters Impregnated with Ciprofloxacin, N-acetylcysteine and their Combinations on Microbial Adherence","authors":"Mostafa S. El-Rehewy, M. A. El-Feky, M. Hassan, H. Abolella, A. Abolyosr, R. M. A. El-Baky, G. F. Gad","doi":"10.4137/CMU.S3367","DOIUrl":"https://doi.org/10.4137/CMU.S3367","url":null,"abstract":"Background Ureteral catheters are valuable indispensable devices may readily acquire biofilms on the inner or outer surfaces. This study evaluated the efficacies of ureteral catheters impregnated with ciprofloxacin, N-acetylcysteine each alone and in combination on microbial adherence. Methods Antimicrobial durability of ureteral catheters coated, through instant dip method, with ciprofloxacin were determined using modified Kirby-Bauer method. Ciprofloxacin-coated catheters showed zones of inhibition ranged from 15 to 45 mm in diameter (baseline) against nine clinical strains recently isolated from patients undergoing ureteral stent removal. Segments coated with ciprofloxacin, N-acetylcysteine each alone and in combination, through instant dip method, were incubated with the tested microorganisms, washed, sonicated, cultured and the number of viable cells were determined. Results Ciprofloxacin-coated catheters soaked in urine and incubated at 37 °C, maintained antimicrobial activities and produce zones of inhibition that measured 2–10 mm for at least 8 weeks. Effect of ciprofloxacin and N-acetylcysteine coated catheters on microbial adherence were found to be dose dependent. Catheters impregnated with ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on microbial adherence when compared with controls (85.5%–100%). Conclusion Catheters impregnated with ciprofloxacin, using instant dip method, were shown to have broad spectrum, prolonged antimicrobial durability and high efficacy. On the other hand, Catheters impregnated with ciprofloxacin/NAC showed the highest inhibitory effect on microbial adherence to stent surfaces.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"77 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87892352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1177/117956110800200001
Xiangyi Lu
Modern medicine has brought us many miracle cures. In the 21st century, especially, we are blessed with increasingly powerful disease combating tools, such as functional genomics, proteomics and stem cells. Decades of medical and pharmaceutical research have produced thousands of medicines that allow us to treat and prevent diseases better than ever before. Furthermore, risk factors for many major diseases are being identified. To name a few, we now know that high cholesterol and chronic inflammation are two most prominent risk factors for cardiovascular diseases. We also know that obesity is one of the major contributing factors for type II diabetes. Cigarette smoking and air pollution are major environmental causes of respiratory diseases and lung cancers. Unfortunately, specific risk factors for many urologic diseases are yet to be identified. In this editorial, I will discuss emerging urologic risk factors based on recent research findings and their implications on what we should be looking ahead. Understanding risk factors is obviously important because it allows us to avoid disease development in the first place. Risk assessment facilitates clinical prognosis and understanding of disease development mechanisms.
{"title":"Emerging Risk Factors for Urologic Diseases","authors":"Xiangyi Lu","doi":"10.1177/117956110800200001","DOIUrl":"https://doi.org/10.1177/117956110800200001","url":null,"abstract":"Modern medicine has brought us many miracle cures. In the 21st century, especially, we are blessed with increasingly powerful disease combating tools, such as functional genomics, proteomics and stem cells. Decades of medical and pharmaceutical research have produced thousands of medicines that allow us to treat and prevent diseases better than ever before. Furthermore, risk factors for many major diseases are being identified. To name a few, we now know that high cholesterol and chronic inflammation are two most prominent risk factors for cardiovascular diseases. We also know that obesity is one of the major contributing factors for type II diabetes. Cigarette smoking and air pollution are major environmental causes of respiratory diseases and lung cancers. Unfortunately, specific risk factors for many urologic diseases are yet to be identified. In this editorial, I will discuss emerging urologic risk factors based on recent research findings and their implications on what we should be looking ahead. Understanding risk factors is obviously important because it allows us to avoid disease development in the first place. Risk assessment facilitates clinical prognosis and understanding of disease development mechanisms.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86695217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The Kt/V value demonstrates the dose of hemodialysis (HD). However, because of several existing methods for calculating delivered dialysis dose, Kt/V values can, in fact, be different for the same set of pre-/post-dialysis blood urea concentrations. Methods In the study presented here, another formula was derived for calculating Kt/V from the pre- and post-dialysis BUN. We prospectively compared the Kt/V values obtained using this new formula and the Kt/V values obtained via the other existing formulae to see whether reliance on the latter approach was likely to lead to errors in over- or underprescribing dialysis regimens. Data were processed on 268 dialysis patients. Results The estimated Kt/V (Kt/Vest) values were statistically different (p < 0.05) from the calculated Kt/V values from other models, except for those Kt/V values calculated according to the lowrie (P = 0.112), Keshaviah (P = 0.069), Daugirdas First Generation (P = 0.059), Basile (P = 0.102), Ijely (P = 0.286) and Daugirdas Second Generation (P = 0.709). The best correlations were seen with the Daugirdas second generation formula (R = 0.958 and R2 = 0.919). Conclusion Since the best correlations were seen between Kt/Vest and the Daugirdas second generation Kt/V we can demonstrate that these two models are more accurate than the other models.
{"title":"Estimation of Accurate and New Method for Hemodialysis Dose Calculation","authors":"A. Azar","doi":"10.4137/CMU.S771","DOIUrl":"https://doi.org/10.4137/CMU.S771","url":null,"abstract":"Background The Kt/V value demonstrates the dose of hemodialysis (HD). However, because of several existing methods for calculating delivered dialysis dose, Kt/V values can, in fact, be different for the same set of pre-/post-dialysis blood urea concentrations. Methods In the study presented here, another formula was derived for calculating Kt/V from the pre- and post-dialysis BUN. We prospectively compared the Kt/V values obtained using this new formula and the Kt/V values obtained via the other existing formulae to see whether reliance on the latter approach was likely to lead to errors in over- or underprescribing dialysis regimens. Data were processed on 268 dialysis patients. Results The estimated Kt/V (Kt/Vest) values were statistically different (p < 0.05) from the calculated Kt/V values from other models, except for those Kt/V values calculated according to the lowrie (P = 0.112), Keshaviah (P = 0.069), Daugirdas First Generation (P = 0.059), Basile (P = 0.102), Ijely (P = 0.286) and Daugirdas Second Generation (P = 0.709). The best correlations were seen with the Daugirdas second generation formula (R = 0.958 and R2 = 0.919). Conclusion Since the best correlations were seen between Kt/Vest and the Daugirdas second generation Kt/V we can demonstrate that these two models are more accurate than the other models.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"05 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85973472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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