Skaudickas, Darijus

Background: Transrectal ultrasound-guided prostate biopsy remains the gold standard in diagnosing prostate cancer, but is associated with infectious and non-infectious complications. Increasing fluoroquinolone resistance and regulatory restrictions have prompted evaluation of alternative prophylactic strategies, including fluoroquinolone-sparing agents and targeted prophylaxis. This study compared ciprofloxacin and fosfomycin as empirical prophylactic agents, focusing on microbiological concordance, clinical outcomes, and patient-reported outcomes. Methods: In this prospective observational study, 265 men undergoing transrectal ultrasound-guided prostate biopsy received empirical antibiotic prophylaxis with either ciprofloxacin (n = 146) or fosfomycin trometamol (n = 119). Rectal swabs were obtained prior to biopsy, and antimicrobial susceptibility was analyzed post hoc. Infectious and non-infectious complications were recorded. Lower urinary tract symptoms (IPSS), erectile function (IIEF-5), and patient-reported quality of life were assessed before and after biopsy. Results: Microbiological concordance between administered prophylaxis and rectal flora susceptibility was higher in the ciprofloxacin group than in the fosfomycin group (80.1% vs. 65.0%, p = 0.007), while resistance rates were similar (10.9% vs. 10.2%). Post-biopsy fever occurred in 5.3% of patients, and hospitalization was required in 3.1%, with no significant differences between prophylaxis groups. IPSS increased significantly after biopsy (p < 0.001), while IIEF-5 scores remained unchanged. Patients with microbiological concordance reported significantly better post-biopsy quality of life (p = 0.006). Conclusions: Ciprofloxacin and fosfomycin showed similar safety profiles as empirical prophylaxis before transrectal prostate biopsy. Although ciprofloxacin achieved higher microbiological concordance, fosfomycin remains a viable alternative. The link between microbial concordance and improved patient-reported quality of life underscores the importance of targeted prophylaxis and supports antimicrobial stewardship in prostate cancer diagnostics.

Introduction & Objectives: Chronic inflammation has been increasingly recognized as a contributing factor in prostate cancer (PCa) development and progression. Pro-inflammatory cytokines and immune mediators are known to influence tumor initiation, immune evasion, and disease progression. However, their specific diagnostic potential in distinguishing PCa from benign conditions remains unclear. This study aims to investigate the association between inflammatory markers in serum and prostate biopsy tissue with PCa presence. Specifically, we seek to (1) identify inflammatory cytokines that differ significantly between PCa patients and cancer-free controls, (2) assess their potential as diagnostic biomarkers, and (3) determine whether inverse associations between inflammatory markers in prostate tissue suggest a protective role in PCa development. Materials & Methods: This prospective study included 60 PCa patients and 22 cancer-free controls enrolled in Lithuania's PSA-based early detection program. Ethical approval was obtained from the Regional Bioethics Committee (Permission No. BE-2-10). To minimize confounding effects, patients with underlying inflammatory conditions were excluded. Serum and prostate biopsy samples were analyzed for IL-2, IL-4, IL10, IL-13, IL-33, Oncostatin M, TNF-alpha, PDGF-BB, and TREM-1 using Luminex technology. Statistical analyses included the MannWhitney U test, logistic regression, and ROC curve analysis to assess marker distribution and diagnostic performance. Results: PCa patients exhibited significantly higher serum levels of IL-2 (p = 0.001), IL-10 (p < 0.001), IL-33 (p < 0.001), Oncostatin M (p = 0.018), and TNF-alpha (p = 0.017) compared to controls. In contrast, biopsy tissue levels of IL-4 (p < 0.001), IL-10 (p < 0.001), IL-13 (p = 0.004), Oncostatin M (p = 0.012), PDGF-BB (p = 0.039), and TREM-1 (p = 0.013) were significantly lower in PCa patients, suggesting a potential protective role. Logistic regression revealed that higher IL-2 and IL-33 in serum increased PCa risk (OR = 3.38, p = 0.010; OR = 1.77, p = 0.021, respectively), while IL-4 and IL-13 in biopsy tissue were inversely associated with PCa (OR = 0.313, p < 0.001; OR = 0.159, p = 0.008, respectively). ROC analysis demonstrated that IL-10 in serum (AUC = 0.788, sensitivity = 69.2%, specificity = 81.0%) and IL-4 (inverted) in biopsy samples (AUC = 0.804, sensitivity = 72.7%, specificity = 81.7%) had the strongest discriminative ability for PCa detection. Conclusions: This study highlights IL-4, IL-10, and IL-13 in biopsy tissue as potential protective biomarkers, whereas elevated IL-2 and IL-33 in serum are associated with increased PCa risk. The exclusion of patients with inflammatory conditions strengthens the validity of these findings. These results support the potential role of inflammatory markers in PCa diagnosis and risk stratification, warranting further validation in larger cohorts.

Introduction & Objectives: Chronic inflammation has been increasingly recognized as a contributing factor in prostate cancer (PCa) development and progression. Pro-inflammatory cytokines and immune mediators are known to influence tumor initiation, immune evasion, and disease progression. However, their specific diagnostic potential in distinguishing PCa from benign conditions remains unclear. This study aims to investigate the association between inflammatory markers in serum and prostate biopsy tissue with PCa presence. Specifically, we seek to (1) identify inflammatory cytokines that differ significantly between PCa patients and cancer-free controls, (2) assess their potential as diagnostic biomarkers, and (3) determine whether inverse associations between inflammatory markers in prostate tissue suggest a protective role in PCa development. Materials & Methods: This prospective study included 60 PCa patients and 22 cancer-free controls enrolled in Lithuania's PSA-based early detection program. Ethical approval was obtained from the Regional Bioethics Committee (Permission No. BE-2-10). To minimize confounding effects, patients with underlying inflammatory conditions were excluded. Serum and prostate biopsy samples were analyzed for IL-2, IL-4, IL10, IL-13, IL-33, Oncostatin M, TNF-alpha, PDGF-BB, and TREM-1 using Luminex technology. Statistical analyses included the MannWhitney U test, logistic regression, and ROC curve analysis to assess marker distribution and diagnostic performance. Results: PCa patients exhibited significantly higher serum levels of IL-2 (p = 0.001), IL-10 (p < 0.001), IL-33 (p < 0.001), Oncostatin M (p = 0.018), and TNF-alpha (p = 0.017) compared to controls. In contrast, biopsy tissue levels of IL-4 (p < 0.001), IL-10 (p < 0.001), IL-13 (p = 0.004), Oncostatin M (p = 0.012), PDGF-BB (p = 0.039), and TREM-1 (p = 0.013) were significantly lower in PCa patients, suggesting a potential protective role. Logistic regression revealed that higher IL-2 and IL-33 in serum increased PCa risk (OR = 3.38, p = 0.010; OR = 1.77, p = 0.021, respectively), while IL-4 and IL-13 in biopsy tissue were inversely associated with PCa (OR = 0.313, p < 0.001; OR = 0.159, p = 0.008, respectively). ROC analysis demonstrated that IL-10 in serum (AUC = 0.788, sensitivity = 69.2%, specificity = 81.0%) and IL-4 (inverted) in biopsy samples (AUC = 0.804, sensitivity = 72.7%, specificity = 81.7%) had the strongest discriminative ability for PCa detection. Conclusions: This study highlights IL-4, IL-10, and IL-13 in biopsy tissue as potential protective biomarkers, whereas elevated IL-2 and IL-33 in serum are associated with increased PCa risk. The exclusion of patients with inflammatory conditions strengthens the validity of these findings. These results support the potential role of inflammatory markers in PCa diagnosis and risk stratification, warranting further validation in larger cohorts.

Inflammation plays a critical role in prostate cancer (PCa) pathophysiology, yet the diagnostic value of specific inflammatory markers remains unclear. This study evaluates the association between circulating and tissue inflammatory markers with PCa presence and their potential as biomarkers for risk stratification. This prospective study analyzed serum and prostate biopsy samples from 60 patients with PCa and 22 cancer-free controls. Concentrations of inflammatory markers, including IL-2, IL-4, IL-10, IL-13, IL-33, Oncostatin M, TNFα, PDGF-BB, and TREM-1, were measured using Luminex technology. Statistical analyses included the Mann-Whitney test, logistic regression, and ROC curve analysis to assess differences and diagnostic performance. PCa patients exhibited significantly higher serum levels of IL-2 (p = 0.001), IL-10 (p < 0.001), IL-33 (p < 0.001), Oncostatin M (p = 0.018), and TNFα (p = 0.017) compared to controls. In contrast, biopsy tissue levels of IL-4 (p < 0.001), IL-10 (p < 0.001), IL-13 (p = 0.004), Oncostatin M (p = 0.012), PDGF-BB (p = 0.039), and TREM-1 (p = 0.013) were significantly lower in PCa patients, suggesting an inverse association. IL-10 (inverse) and IL-4 (inverse) in biopsy tissue showed high specificity in ROC analysis (AUC = 0.788 and 0.804, respectively), while IL-2 and IL-33 in serum were positively associated with PCa risk. This study suggests that IL-4, IL-10, and IL-13 in biopsy tissue may serve as biomarkers of a protective effect, while elevated IL-2 and IL-33 in serum are associated with an increased risk of PCa. These findings highlight the potential of inflammatory markers in PCa risk stratification, warranting further investigation in larger cohorts.

Background information ‒ Delayed graft function (DGF), defined as the need for dialysis within the first week of a kidney transplant, is a common complication, particularly in extended criteria donor transplants, where its incidence ranges from 21 to 31%. Objectives ‒ We observed a prolonged case of DGF in a 47-year-old patient with chronic kidney disease (CKD) resulting from diabetic nephropathy. The patient, classified in a moderate immunologic mismatch group, received a marginal deceased donor kidney. Results ‒ For the first 4 weeks post-transplantation, graft function was impaired. After 29 days of anuria, the transplanted kidney began to recover. The literature review found few clinical cases of DGF extending beyond 1 month. Our patient had several risk factors for DGF, including diabetes mellitus, pre-transplant hemodialysis, and moderate immunologic mismatch. Additionally, the marginal graft increased the risk of ischemia-reperfusion injury and glycocalyx damage. However, it remains unclear how these factors influenced the duration of DGF. The exact cause of the extended DGF in this case remains unknown. Although the literature identifies key risk factors for DGF, data on factors leading to prolonged kidney dysfunction are lacking. Therefore, decisions to remove a non-functioning transplanted kidney should not be made hastily.

Background and Objectives: Radiofrequency catheter ablation (RFCA) is a highly successful intervention. By comparing the lesion changes in prostate parenchymal and striated muscle tissues after RFCA with and without cooling, it was possible to assess the correlation between the shape regularity, area, and perimeter of the thermal lesion, and to predict the geometric shape changes of the lesions. Materials and Methods: A standard prostate and striated muscle RFCA procedure was performed on 13 non-purebred dogs in two sessions: no cooling and cooling with 0.1% NaCl solution. Microtome-cut 2–3 µm sections of tissue samples were stained with haematoxylin and eosin and further examined. The quotient formula was employed to evaluate the geometric shape of the damage zones at the ablation site. Results: The extent of injury following RFCA in striated muscle tissue was comparable to that in prostate parenchymal tissue. Regression analysis indicated a strong and positive relationship between area and perimeter in all experimental groups. In the experimental groups of parenchymal tissues with and without cooling, an increase in the area or perimeter of the damage zone corresponded to an increase in the quotient value. A similar tendency was observed in the striated muscle group with cooling. However, in the striated muscle group without cooling, an increase in lesion area or perimeter lowered the quotient value. Standardised regression coefficients demonstrated that in the striated muscle with cooling, the damage zone shape was more determined by area than perimeter. However, in the parenchymal tissue, the perimeter had a more substantial impact on the damage zone shape than the area. Conclusions: The damage area and perimeter have predictive power on the overall shape regularity of damage zone geometry in both striated muscles and parenchymal tissue. This approach is employed to achieve a balance between the need for tumour eradication and the minimisation of ablation-induced complications to healthy tissue.

Ultragarsinis pėdos kraujotakos stimuliavimo įrenginys apima vidpadį ant kurio vienos pusės yra pritvirtinta lanksti plokštelė, apimanti bent du bimorfinius pjezoelementus, arba bent tris bimorfinius pjezoelementus, kurie elektriniais laidais yra pajungti prie ultragarsinio generatoriaus ir valdiklio (paveiksluose neparodyti), sudarant bimorfinį pjezoelektrinį keitiklį. Pajungus ultragarsinį generatorių, tam tikro dažnio elektriniai signalai, sužadina bimorfiniuose pjezoelektriniuose keitikliuose mechanines deformacijas, o jų sklidimą vidpadyje ir lanksčioje plastikinėje plokštelėje reguliuoja valdiklis. Taip mechaninė deformacija bangos pavidalu persiduoda į pėdos padą ir stimuliuoja kraujotaką visoje kojoje. Tokiu būdu yra skatinamas kraujo priplūdimas į audinius ir taip gerinama medžiagų apykaita, suaktyvinama limfos apytaka, skatinama odos ir poodžio mikrocirkuliacija, didinamas leukocitų kiekis kraujyje.

Background information ‒ Chronic prostatitis (CP) is one of the diseases that reduce the quality of life (QoL) of young men. To date, there is no consensus on the management of these patients. Objectives ‒ It is essential to continue research into the treatment of CP, despite the use of various therapies, including low-energy extracorporeal shockwave therapy (ESWT). The main objective of this study is to observe and record the clinical symptomatology of patients during a 48-week follow-up period after ESWT treatment. Methods ‒ Between 2019 and 2021, 28 patients with type IIIB CP/chronic pelvic pain syndrome were enrolled. Patients underwent ESWT once weekly for 4 weeks (3,000 individual sessions, maximum total energy flux density 0.25 mJ/mm2, frequency 3 Hz). Participants were assessed at 0, 4, 12, 24, 36 and 48 weeks post-treatment using the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function (IIEF)-5. Results ‒ The mean age of patients was 47.1 ± 13.7 years (range 28–4 years). The positive effect of LI-ESWT was reflected in improvements in VAS, NIH-CPSI, and IIEF-5 scores. Regression of patients’ symptoms was observed as early as 4 weeks after treatment. The greatest progress was achieved at week 24. In addition, a slight worsening was observed at week 36 and 48, with stable progress. The treatment significantly improved the QoL of the patients, with the most significant improvement in the VAS score. Conclusions ‒ This treatment approach is safe, most effective in the first 6 months. Thereafter, the efficacy of the treatment diminishes, but is sustained over a longer period.

Gliomas are the most frequent intrinsic central nervous system tumors. The new 2021 WHO Classification of Central Nervous System Tumors brought significant changes into the classification of gliomas, that underline the role of molecular diagnostics, with the adult-type diffuse glial tumors now identified primarily by their biomarkers rather than histology. The status of the isocitrate dehydrogenase (IDH) 1 or 2 describes tumors at their molecular level and together with the presence or absence of 1p/19q codeletion are the most important biomarkers used for the classification of adult-type diffuse glial tumors. In recent years terminology has also changed. IDH-mutant, as previously known, is diagnostically used as astrocytoma and IDH-wildtype is used as glioblastoma. A comprehensive understanding of these tumors not only gives patients a more proper treatment and better prognosis but also highlights new difficulties. MR imaging is of the utmost importance for diagnosing and supervising the response to treatment. By monitoring the tumor on followup exams better results can be achieved. Correlations are seen between tumor diagnostic and clinical manifestation and surgical administration, followup care, oncologic treatment, and outcomes. Minimal resection site use of functional imaging (fMRI) and diffusion tensor imaging (DTI) have become indispensable tools in invasive treatment. Perfusion imaging provides insightful information about the vascularity of the tumor, spectroscopy shows metabolic activity, and nuclear medicine imaging displays tumor metabolism. To accommodate better treatment the differentiation of pseudoprogression, pseudoresponse, or radiation necrosis is needed. In this report, we present a literature review of diagnostics of gliomas, the differences in their imaging features, and our radiology’s departments accumulated experience concerning gliomas.

Background and Objectives: Prostate cancer is on the rise in the European Union, and radiofrequency ablation (RFA) is one of the minimally invasive treatment options used for its treatment. Therefore, the aim of this study was to investigate and analyze the effects of RFA on prostate tissues. Materials and Methods: A standard prostate RFA procedure was performed on 13 non-purebred dogs in three sessions: no cooling (NC), cooling with a 0.1% NaCl solution (C.01), and cooling using a 0.9% NaCl solution (C.09). Microtome-cut 2–3 µm sections of prostate samples were stained with hematoxylin and eosin and further examined. Results: A histopathologic evaluation identified four zones of exposure: direct, application, necrosis, and transitional, as the damage on tissues decreased going further from the ablation site. The areas and perimeters of these zones were calculated, and geometric shapes of ablative lesions were evaluated using the quotient formula. Areas and perimeters of prostate tissue lesions in the NC and C.09 sessions were of similar size, whereas those found in C.01 were statistically significantly smaller. Lesions observed in session C.01 were of the most regular geometric shape, while the most irregular ones were found in session C.09. The shapes of lesions closest to the ablation electrode were the most irregular, becoming more regular the further away from the electrode they were. Conclusions: Prostate RFA leads to tissue damage with distinct morphological zones. Notably, the prostate lesions were the smallest and the most regular in shape after RFA procedures using the 0.1% NaCl cooling solution. It can be argued that smaller ablation sites may result in smaller scars, thus allowing for faster tissue healing if the blood flow and innervation at the ablation site are not compromised.