Gian Rosario Russo

Age: “a natural anesthetic” in pain perception during the transrectal ultrasound-guided prostate biopsy procedure

Introduction The purpose of this study was to evaluate how the age factor might influence the tolerance biopsy examination, and then choose the modality of a local or general anesthetic technique. Materials and Methods This study evaluated 248 consecutive patients undergoing transrectal ultrasound-guided prostate biopsy for the first time. Each patient was treated under local anesthesia with lidocaine spray (10gr/100ml). Patients were divided into two groups according to age: Group A) 112 with age range ≤65 years, Group B) 136 with age range >65 years. Our first aim was to obtain a schedule of 14 biopsy samples in both groups. After the procedure each patient was given a verbal numeric pain scale (VNS), which was designed with 0 representing absence of pain and 10 the maximum pain they perceived in life. Results The average pain assessed with VNS was around 4.2 (2–8) and 2.8 (0–6) for the patients in Group A and Group B, respectively. The two groups appeared to be homogeneous in terms of pain perception regarding PSA value and gland volume, and appeared to have different pain scores with regard to age. In fact, the first group of patients, with the same anesthetic technique used, perceived more intense pain sensations related to acute biopsy. Conclusions In conclusion, we can say that a local anesthetic in clinical practice in the course of prostate biopsy is more sensitive if performed in a person aged 65 years.

Differential expression of microRNA501‐5p affects the aggressiveness of clear cell renal carcinoma

Renal cell carcinoma is a common neoplasia of the adult kidney that accounts for about 3% of adult malignancies. Clear cell renal carcinoma is the most frequent subtype of kidney cancer and 20–40% of patients develop metastases. The absence of appropriate biomarkers complicates diagnosis and prognosis of this disease. In this regard, small noncoding RNAs (microRNAs), which are mutated in several neoplastic diseases including kidney carcinoma, may be optimal candidates as biomarkers for diagnosis and prognosis of this kind of cancer. Here we show that patients with clear cell kidney carcinoma that express low levels of miR501‐5p exhibited a good prognosis compared with patients with unchanged or high levels of this microRNA. Consistently, in kidney carcinoma cells the downregulation of miR501‐5p induced an increased caspase‐3 activity, p53 expression as well as decreased mTOR activation, leading to stimulation of the apoptotic pathway. Conversely, miR501‐5p upregulation enhanced the activity of mTOR and promoted both cell proliferation and survival. These biological processes occurred through p53 inactivation by proteasome degradation in a mechanism involving MDM2‐mediated p53 ubiquitination. Our results support a role for miR501‐5p in balancing apoptosis and cell survival in clear cell renal carcinoma. In particular, the downregulation of microRNA501‐5p promotes a good prognosis, while its upregulation contributes to a poor prognosis, in particular, if associated with p53 and MDM2 overexpression and mTOR activation. Thus, the expression of miR501‐5p is a possible biomarker for the prognosis of clear cell renal carcinoma.

[Reorganizing the management of specialist uro-andrologic ultrasound health-care service: impact on professional quality].

Introduction. The process of organizing a ultrasound service nowadays can be improved by properly managing the users request, the speed of response and safety, the standardization of methods and skills. Materials and Methods. The outpatients at our uro-andrologic ultrasound clinic (O.U. of Urology in Ferrara) received a questionnaire each; we administered a total of 640 questionnaires. The number of questionnaires collected was 532. Patients were asked to give an assessment of services using a qualitative method according to a 4-parameter response scale: very satisfied, satisfied, dissatisfied, very dissatisfied. Results. The identification of indicators to be monitored by the users perceived quality was accomplished by establishing the correlation coefficient between different parameters of analysis and an overall rating of the sample. Some of these parameters were: the relationship with the practitioner, the availability of doctors, the ability of doctors for reassurance, the completeness of information and facilities hygiene conditions. When these parameters vary, positively or negatively, also the citizens overall opinion changes. Conclusions. The customer satisfaction is an important component of the quality of care, it represents both an indicator of the effectiveness of health intervention and the ability to meet quality requirements of the health service organization. The objective of an ultrasound service should be to provide, within a reasonable timeframe, the supply of high quality with qualified personnel, with adequate tools and procedures.