Konstantinos Skriapas

Application of evolutionary fuzzy cognitive maps to the long-term prediction of prostate cancer

The prediction of multivariate time series is one of the targeted applications of evolutionary fuzzy cognitive maps (FCM). The objective of the research presented in this paper was to construct the FCM model of prostate cancer using real clinical data and then to apply this model to the prediction of patients health state. Due to the requirements of the problem state, an improved evolutionary approach for learning of FCM model was proposed. The focus point of the new method was to improve the effectiveness of long-term prediction. The evolutionary approach was verified experimentally using real clinical data acquired during a period of two years. A preliminary pilot-evaluation study with 40 men patient cases suffering with prostate cancer was accomplished. The in-sample and out-of-sample prediction errors were calculated and their decreased values showed the justification of the proposed approach for the cases of long-term prediction. The obtained results were approved by physicians emerging the functionality of the proposed methodology in medical decision making.

Sexual dysfunction in newly diagnosed multiple sclerosis women.

Objectives The aim of the study was to evaluate female sexuality in a selective population of newly diagnosed multiple sclerosis (MS) women. Materials and methods In this clinic-based study, 63 newly diagnosed consecutive women affected by definite MS were admitted. Disability and depression were evaluated with the expanded disability status scale (EDSS) and Beck depression inventory, respectively. Sexual function was evaluated with the female sexual function index (FSFI). A group of 61 healthy female volunteers with the same baseline characteristics were used as controls. Postmenopausal women and patients with other major concomitant neurological, endocrinological, vascular, gynecological, psychiatric disorders, use of medicines that can cause female sexual dysfunction (FSD) and disease-modifying drugs were excluded from the study. Results All the evaluated patients were ambulant with no major neurological impairment (mean EDSS score 2.5, range 0—3.5). None of the patients were considered clinically depressed, but some of them were sad or worried. According to the sexual history and FSFI scores, sexual dysfunction was diagnosed in 22 (34.9%) out of the 63 patients and in 13 (21.31%) out of the 61 healthy females (P > 0.05). Conclusions In the newly diagnosed MS patients, FSD represent an important issue even though disability and other concomitant disorders affecting sexual function were excluded. Multiple Sclerosis 2008; 14: 561—563. http://msj.sagepub.com

Vesicourethral anastomosis during endoscopic extraperitoneal radical prostatectomy: a prospective comparison between the single-knot running and interrupted technique.

OBJECTIVES To determine the safety and efficacy of the single-knot running versus interrupted technique for urethrovesical anastomosis during endoscopic extraperitoneal radical prostatectomy. METHODS A total of 250 consecutive patients who underwent endoscopic extraperitoneal radical prostatectomy were prospectively divided into two groups of 125 patients each who underwent urethrovesical anastomosis using the single-knot running technique (group 1) or the interrupted suture technique (group 2). Surgical data, operative time, difficulty scores, extravasation rate, catheterization time, occurrence of anastomotic strictures, and the early and late continence rates were analyzed statistically. RESULTS Regarding the clinical and pathologic findings, extravasation rate, catheterization time, and occurrence of anastomotic strictures, no significant differences were found between the two groups (P >0.05). The strongest independent predictors for extravasation were the integrity of the dorsal wall of the anastomosis and the degree of bladder neck opening (P <0.001). Overall, the continence rate at 3 and 6 months was 76% and 91.5% for group 1 and 77.6% and 93% for group 2, respectively (all P >0.05). The anastomosis technique had no impact on extravasation or continence status (all P >0.05). The only significant differences (P <0.001) in favor of the single-knot technique were the mean operative time and difficulty score (16 versus 24 minutes and 1 versus 3, respectively). CONCLUSIONS Both techniques provide satisfactory and similar functional results. However, because of its simplicity and shorter operative time, the single-knot running technique appears preferable.

Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: Combined Treatment with Fesoterodine Fumarate Extended-Release and Tamsulosin - A Prospective Study

Objective: To evaluate the efficacy and safety of fesoterodine extended-release (ER) plus tamsulosin in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Patients and Methods: Men aged ≥50 years, with LUTS, prostate volume ≤60 ml and International Prostate Symptom Score (IPSS) ≥13 were enrolled in this study. 173 consecutive patients were treated initially with tamsulosin (0.4 mg) for 1 week. At the second visit, 47 patients out of the sample of 173 who were still experiencing inconvenient LUTS were randomized into two groups. The first group received a therapy with tamsulosin and fesoterodine combination (group 1, n = 24) while the second continued the therapy with the single administration of tamsulosin (group 2, n = 23) for an additional 4-week period. Results: There was no statistically significant difference in age, prostate volume, Qmax, and postvoid residual urine between the two groups. A statistical significance appeared in the combination group regarding the storage and the total IPSS values among the second and third visits (10.5 ± 1.4 to 8.5 ± 1.3 and 16.1 ± 1.8 to 13.7 ± 1.5 respectively). Conclusion: Regarding bothersome LUTS and storage symptoms, fesoterodine ER and tamsulosin combination was significantly more effective than the single administration of tamsulosin.

Comparison Between Lidocaine and Glyceryl Trinitrate Ointment for Perianal-intrarectal Local Anesthesia Before Transrectal Ultrasonography-guided Prostate Biopsy: A Placebo-controlled Trial

OBJECTIVE To evaluate the use of topical lidocaine gel and glyceryl trinitrate ointment (GTN) vs placebo, in reducing anal pain and discomfort as an adjunct to periprostatic anesthesia because of probe insertion, during the use of transrectal ultrasonography (TRUS) prostate-guided biopsy in young patients. PATIENTS AND METHODS Two-hundred twenty-three men who underwent prostate biopsy were divided into 3 groups. Seventy-four patients (first group) and 76 patients (second group) received perianal local anesthesia with lidocaine gel 2%, and 1 g of 0.4% GTN ointment, respectively, whereas 73 patients (third group) received lubricant gel as perianal local anesthesia. All patients also underwent periprostatic nerve block (PPNB). Visual analogue scales (VAS 1 and VAS 2) were used to estimate the pain and discomfort during probe insertion and biopsy. RESULTS Men in the first and second groups reported significantly less pain score (mean, 1.7 and 1.6, respectively) vs men from the third group (mean, 5.7) during probe insertion. Comparing the 3 different groups subsequently with the periprostatic anesthesia, no significant difference in VAS scores between the first and the third groups (mean, 1.9 and 2.1, respectively) was found; in addition, patients from the second group reported significantly less pain score (mean, 1.3) during biopsy. CONCLUSIONS Lidocaine gel and GTN ointment is safe and effective in reducing anal pain associated with the insertion of an ultrasound probe. Furthermore, men with GTN ointment also reported less pain during biopsy. We suggest that analgesia before PPNB could significantly reduce anal pain and improve tolerance during TRUS prostate-guided biopsy.

A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a perpetual dispute

OBJECTIVES To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. MATERIALS AND METHODS We conducted a systematic search on Medline and Embase databases using ″prostatic neoplasm″ and ″intermittent androgen deprivation″ as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. RESULTS Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. CONCLUSIONS Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be consi¬dered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction

ABSTRACT Purpose: To identify the minimum bladder diarys length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. Materials and Methods: From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patients diary, seeking the minimum diarys length that could provide records comparable to the 7 days average, the reference point in terms of reliability. Results: From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insufficient documentation. Correlations gradually increased along the increase in diarys duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. Conclusions: A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.