Publications by authors named "Sciarra Alessandro"

The role of urethrectomy at the time of Robotic-Assisted or Open Radical Cystectomy (RARC, ORC) is controversial. Whether urethrectomy should be performed at the time of RARC/ORC or delayed up to a 3-6 month interval is unclear. We performed a retrospective cohort analysis of perioperative and survival outcomes in patients with high-risk NMIBCs or non-metastatic MIBCs at our institution who underwent either concomitant or deferred urethrectomy after RC.

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Leveraging high-resolution 7 T magnetic resonance imaging (MRI) and vessel distance mapping (VDM), the arterial supply patterns and dominances of the motor cortex, which could previously only be studied postmortem, were assessed in vivo and fully noninvasively. Beyond vessel patterns and dominances, the potential relation between the vascularization and the motor cortex thickness was studied. Twenty-one healthy participants underwent 7 T MRI scans to map arterial supply and motor cortex at 0.

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Single Port (SP) surgery is the most relevant surgical innovation of the past six years. Few data are available on the advantages and disadvantages of SP Robotic-Assisted reconstructive urology. In the present systematic review, we summarize the results of available literature exploring the feasibility of SP reconstructive urological procedures and comparing the SP and Multi Port (MP) approaches.

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In the domain of medical imaging, many supervised learning based methods for segmentation face several challenges such as high variability in annotations from multiple experts, paucity of labelled data and class imbalanced datasets. These issues may result in segmentations that lack the requisite precision for clinical analysis and can be misleadingly overconfident without associated uncertainty quantification. This work proposes the PULASki method as a computationally efficient generative tool for biomedical image segmentation that accurately captures variability in expert annotations, even in small datasets.

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Introduction: The locus coeruleus (LC) is linked to the development and pathophysiology of neurodegenerative diseases such as Alzheimer's disease (AD). Magnetic resonance imaging-based LC features have shown potential to assess LC integrity in vivo.

Methods: We present a deep learning-based LC segmentation and feature extraction method called Ensemble-based Locus Coeruleus Segmentation Network (ELSI-Net) and apply it to healthy aging and AD dementia datasets.

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: Radical cystectomy (RC) is the gold standard for urothelial cT2-4a, N0, M0 muscle-invasive bladder cancer (MIBC). However, bladder-sparing strategies (BSS) such as Trimodality Therapy (TMT) have emerged as alternative treatments for a select group of localized muscle-confined (cT2) urothelial bladder cancers. Accordingly, reliable preoperative staging and a reliable risk factor assessment linked to pathological upstaging play a key role in adequate counselling and patient selection for BSS.

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Introduction: In recent years, due to the increasing life expectancy and the growing popularity of nephron sparing strategies (NSS), more elderly and frail patients are undergoing Robotic-Assisted Partial Nephrectomy (RAPN) for the treatment of localized Renal Cell Carcinoma (RCC). A Single Port Approach has demonstrated itself to reduce estimated blood loss (EBL), complication rates, and length of stay (LOS). In the present study, we aim to compare perioperative and postoperative outcomes of SP RAPN and Multi Port (MP) RAPN, with a focus on elderly patients.

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It has been shown that the pathogenic variants (PVs) of the DNA Damage Response (DDR) genes, whether of a germinal or somatic nature, represent a predictive biomarker of high sensitivity to treatment with inhibitors of the enzyme poly-ADP-ribose polymerase (PARP) in patients with hormone-resistant metastatic prostate cancer (HRPCa). Moreover, the detection of PVs of the Homologous Recombination Repair (HRR) genes in PCa patients can help to define the patient's prognosis and the choice of the therapeutic procedure. Among men with metastatic PCa, the frequency of PVs in HRR genes ranges from 11% to 33%, which is a significantly higher rate compared to non-metastatic PCa, where the incidence is between 5% and 10%.

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: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon.

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The National Cancer Institute (NCI) recognizes the potential of technologies based on the use of nanoparticles (NPs) in revolutionizing clinical approaches to the diagnosis and prognosis of cancer. Recent research suggests that once NPs come into contact with the biological fluid of cancer patients, they are covered by proteins, forming a "protein corona" composed of hundreds of plasma proteins. The concept of a personalized, disease-specific protein corona, demonstrating substantial differences in NP corona profiles between patients with and without cancer, has been introduced.

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: The advantage of a robotic-assisted (RARP) over a laparoscopic (LRP) approach in radical prostatectomy (RP) remains to be demonstrated. : The aim of the study is to use a homogeneous population in real life and single primary surgeon surgery to analyze the oncological and functional results based on the type of surgical approach and pathological features. : This is a prospective trial on non-metastatic prostate cancer (PCa) patients considered after a multidisciplinary decision to conduct a RP, using a RARP or LRP approach.

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Article Synopsis
  • The CUT-less trial investigates whether patients diagnosed with low-risk non-muscle-invasive bladder cancers (NMIBCs) can safely skip a second transurethral resection of bladder tumor (Re-TURBT) by using advanced imaging and diagnostic techniques during their initial treatment.
  • The study involves 327 patients who will receive either standard care with a second TURBT or an experimental procedure using photodynamic diagnosis (PDD) without the second resection, to see if outcomes remain comparable.
  • Key measures of the trial include short-term recurrence rates of bladder cancer, as well as assessments of patients' quality of life and the economic impact of the treatment options.
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High-spatial resolution MRI produces abundant structural information, enabling highly accurate clinical diagnosis and image-guided therapeutics. However, the acquisition of high-spatial resolution MRI data typically can come at the expense of less spatial coverage, lower signal-to-noise ratio (SNR), and longer scan time due to physical, physiological and hardware limitations. In order to overcome these limitations, super-resolution MRI deep-learning-based techniques can be utilised.

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Article Synopsis
  • Platinum-based chemotherapy is the standard first-line treatment for advanced urothelial carcinoma (mUC), but recent studies have explored the benefits of adding immune checkpoint inhibitors (ICIs) to this regimen.
  • A comprehensive analysis of individual patient data from four clinical trials (EV302, CHECKMATE-901, IMVIGOR130, KEYNOTE-361) involving 3047 patients showed that the combination of Pembrolizumab and EV demonstrated superior overall survival (OS) and progression-free survival (PFS) compared to other immunotherapy and chemotherapy combinations.
  • Limitations of the study include the inability to adjust for patient-level factors using reconstructed data and potential variability in the patient populations included in the analysis.
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Introduction: The Locus Coeruleus (LC) is linked to the development and pathophysiology of neurodegenerative diseases such as Alzheimer's Disease (AD). Magnetic Resonance Imaging based LC features have shown potential to assess LC integrity in vivo.

Methods: We present a Deep Learning based LC segmentation and feature extraction method: ELSI-Net and apply it to healthy aging and AD dementia datasets.

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Contrast-enhanced ultrasound (CEUS) is an advanced imaging technique that integrates conventional US with the intravenous injection of specific US contrast agents (UCAs), combining the non-invasiveness of US with the higher accuracy of contrast-enhanced imaging. In contrast with magnetic resonance imaging (MRI), computed tomography (CT) and cystoscopy, CEUS has few contraindications, and UCAs are non-nephrotoxic agents that can be safely used in patients with kidney failure. CEUS is a well-established method for the detection of liver lesions and for echocardiography, and its indications are expanding.

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Background: Radical prostatectomy (RP) is recommended in case of localized or locally advanced prostate cancer (PCa), but it can lead to side effects, including urinary incontinence (UI) and erectile dysfunction (ED). Magnetic resonance imaging (MRI) is recommended for PCa diagnosis and staging, but it can also improve preoperative risk-stratification.

Purpose: This nonsystematic review aims to provide an overview on factors involved in RP side effects, highlighting anatomical and pathological aspects that could be included in a structured report.

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Article Synopsis
  • Lipidomics using high-resolution mass spectrometry (HRMS) is important in clinical chemistry for linking lipid imbalances to various diseases, but identifying specific structures beyond fatty acids remains challenging, particularly concerning the arrangement of carbon-carbon double bonds.* -
  • Researchers have proposed methods to analyze these double bonds, including a new approach that utilizes the inverse-electron-demand Diels-Alder (IEDDA) reaction with tetrazines, which provides fast results and effective characterization.* -
  • This study successfully applied a catalyst-free IEDDA reaction to identify double bonds in fatty acids and lipid regioisomers, allowing for detailed analysis and quantification in complex samples, like plasma from prostate cancer patients.*
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Background: Metabolomics is nowadays considered one the most powerful analytical for the discovery of metabolic dysregulations associated with the insurgence of cancer, given the reprogramming of the cell metabolism to meet the bioenergetic and biosynthetic demands of the malignant cell. Notwithstanding, several challenges still exist regarding quality control, method standardization, data processing, and compound identification. Therefore, there is a need for effective and straightforward approaches for the untargeted analysis of structurally related classes of compounds, such as acylcarnitines, that have been widely investigated in prostate cancer research for their role in energy metabolism and transport and β-oxidation of fatty acids.

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Objective: To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in prostate cancer (PCa) patients stratified in non-metastatic and metastatic diseases.

Methods: A literature search process was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In our meta-analysis, the pooled event rate estimated and the pooled hazard ratio were calculated using a random effect model.

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Article Synopsis
  • Urinary incontinence (UI) is a frequent issue following radical prostatectomy, with this study investigating the relationship between the length of the preserved urethra and urinary continence within the first 90 days post-surgery.
  • The study involved 190 prostate cancer patients who underwent robotic surgery, measuring pre-operative urethral length via MRI and correlating it with post-operative outcomes categorized into two groups: those with UI and those without.
  • Results showed that a higher percentage of preserved urethra significantly correlates with quicker recovery of urinary continence, supporting the importance of preserving urethral length during surgery.
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  • Biochemical recurrence (BCR) in prostate cancer presents variability, necessitating a risk stratification to differentiate low- and high-risk cases for progression.
  • Current methods, particularly PSA doubling time (PSA-DT), help classify BCR cases, while the use of advanced imaging like PSMA PET/CT is important for identifying metastases before deciding on treatment.
  • Low-risk BCR patients should be monitored without immediate systemic therapy, while high-risk patients benefit from early intervention with treatments like enzalutamide combined with leuprolide, which has shown to improve metastasis-free survival without compromising quality of life.
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Background: Contrast-enhanced ultrasound (CEUS) is a diagnostic tool that is gaining popularity for its ability to improve overall diagnostic accuracy in bladder cancer (BC) staging. Our aim is to determine the cumulative diagnostic performance of CEUS in predicting preoperative muscle invasiveness using a comprehensive systematic review and pooled meta-analysis.

Methods: A systematic review until October 2023 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

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