Tag: pubmed

Insights Imaging. 2023 Jul 16;14(1):124. doi: 10.1186/s13244-023-01475-w.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic value of whole-body low-dose computed tomography (CT) to detect bone metastasis in prostate cancer (PCa) patients and its possible utility in therapeutic decision-making. Also, to determine the valuable CT features for lesion characterisation.

METHODS: This IRB-approved retrospective study reviewed PCa patients who underwent ⁶⁸Ga-PSMA PET/CT in our centre from March 2017 to August 2022. Two board-certified radiologists and one nuclear medicine specialist reported all whole-body low-dose CT scans separately, unaware of the ⁶⁸Ga-PSMA-PET results. The per-lesion and per-patient diagnostic performances were calculated. Also, the significance of CT features was evaluated. Moreover, the inter-observer agreement was analysed. A two-tailed p value < 0.05 was considered significant.

RESULTS: From 727 reviewed PCa patients, 601 (mean age = 68.7 ± 8.1) were found to be eligible, including 211 (35.1%) referrals for initial staging and 390 (64.9%) for evaluating the extent of the disease after biochemical recurrence. Per-patient diagnostic analysis for three reviewers showed 81.0-89.4% sensitivity and 96.6-98.5% specificity in detecting osteo-metastasis. It was able to correctly detect high-burden disease based on both CHAARTED and LATITUDE criteria. Regarding the value of underlying CT features, size > 1 cm, ill-defined borders, presence of soft-tissue component, and cortical destruction were statistically in favour of metastasis. Also, Hu > 900 was in favour of benign entities with 93% specificity.

CONCLUSIONS: Although not as accurate as ⁶⁸Ga-PSMA PET/CT, whole-body low-dose CT might precisely classify PCa patients considering therapeutic decision-making. Additionally, we proposed diagnostic CT features that could help radiologists with better characterisation of the detected lesions.

CRITICAL RELEVANCE STATEMENT: The whole-body low-dose CT can be considered valuable in the clinical decision-making of prostate cancer patients. This modality may obviate performing multiple imaging sessions and high-cost scans in patients diagnosed with the high-burden disease.

PMID:37454388 | DOI:10.1186/s13244-023-01475-w

Environ Sci Pollut Res Int. 2023 Jul 16. doi: 10.1007/s11356-023-28835-9. Online ahead of print.

ABSTRACT

The global economic growth is hindered by resources shortage, energy demand, air pollution and climate. Energy efficiency can reduce some pollutants while potentially increase others. This study refers to sulfur dioxide (SO₂), nitrogen oxides (NO_x), and dust and smoke (DS) as primary pollutants to distinguish it from secondary ones. The influence of energy efficiency, socioeconomic, and natural climatic factors on air quality is analyzed under the theory of STIRPAT. It is highly coupled between energy efficiency and the spatial distribution of air quality. Increased energy efficiency can improve air quality by reducing SO₂ and NO_x, but the impact on DS is insignificant. Air pollutants decrease by about 0.531% for every 1% increase in temperature and 0.105% for every 1% increase in precipitation. Consumption will reduce air pollution, and there is an inverted U-shaped relationship between population density, economic scale, urbanization, technology innovation, and air pollution. It is worth mentioning that this work adds temperature and precipitation to the STIRPAT as natural climatic factors, analyzing the impact of energy efficiency on air pollution under the two-factor restrictions of socioeconomic and natural climatic factors. Finally, management suggestions are made to improve air quality.

PMID:37454380 | DOI:10.1007/s11356-023-28835-9

Langenbecks Arch Surg. 2023 Jul 16;408(1):279. doi: 10.1007/s00423-023-03003-2.

ABSTRACT

BACKGROUND: Celiac axis stenosis (CAS) often is an incidental finding in terms of diagnostic for hepatobiliary surgery since most cases remain asymptomatic. It remains unclear whether CAS is a risk factor for postoperative complications after hepatobiliary surgery. Therefore, the aim of this study was to evaluate the impact of an asymptomatic CAS on the postoperative morbidity and survival of patients undergoing hepatobiliary surgery.

METHODS: We retrospectively analyzed CT scans and clinicopathological data of 250 consecutive patients undergoing hepatobiliary surgery between 2011 and 2018 in our tertiary center. We compared the postoperative course between patients with and without an incidental CAS as well as their overall survival.

RESULTS: CAS was caused by atherosclerotic stenosis in 16 (64%) patients, by ligamentous stenosis in 4 (16%) and by combined conditions in 5 cases (20%). Mean age of patients in the CAS group was significantly higher in comparison to patients of the non-CAS group (71.0 vs. 59.1 years, p < 0.001). Major hepatectomy was conducted in 40% of the CAS patients and 19.6% of non-CAS patients, respectively (p = 0.036). Interestingly, no statistically significant differences in postoperative morbidity (40 vs. 46.2%, p = 0.673) or in overall survival between the groups (41.3 vs. 51.9 months, p = 0.611) were observed.

CONCLUSION: Our analysis found no correlation between an asymptomatic celiac axis stenosis and postoperative complications or overall survival after hepatobiliary surgery. Which impact the incidental CAS may have in highly complex cases remains unclear. Further studies are needed to identify patients who benefit from CAS treatment before hepatobiliary surgery.

PMID:37454337 | DOI:10.1007/s00423-023-03003-2

J Med Imaging Radiat Oncol. 2023 Jul 16. doi: 10.1111/1754-9485.13563. Online ahead of print.

ABSTRACT

INTRODUCTION: Guidelines for clinical target volume (CTV) to planning target volume (PTV) margins in post-prostatectomy radiation therapy (PPRT) are varied and often not clearly defined. Assessment of appropriateness of margins is commonly measured on prevalence of geographic miss.

METHODS: Cone-beam CT (CBCT) images (n = 92) for 10 PPRT patients were incorporated to provide on-treatment information on the appropriateness of six different CTV expansion margins in terms of geographic miss and change in dose-volume statistics for CTV, rectum and bladder. Uniform margins included 10 mm, 5 mm, 10 mm + 5 mm posteriorly and 5 mm + 3 mm posteriorly. In addition, two anisotropic margins were evaluated by separating the superior and inferior portions of the CTV before expansion. Treatment plans were created for each PTV retrospectively.

RESULTS: The frequency of geographic miss was the smallest for the large uniform expansions but resulted in the highest organ-at-risk (OAR) doses. Geographic miss in the smaller uniform and anisotropic PTVs was more prevalent but commonly to a small volume < 1% of CTV. When averaged over all CBCT fractions, V95% dose for all CTV margins remained > 99%. The anisotropic expansions generated smaller irradiated target volumes and consequently saw up to 7.3% reduction in bladder dose when compared with similar uniform expansion margins.

CONCLUSION: Supplementing the incidence of geographic miss with dosimetric information on target coverage and OAR doses provides more informed assessment of the appropriateness of different CTV expansion margins. Our study extends the evaluation of anisotropic margins for PPRT.

PMID:37454334 | DOI:10.1111/1754-9485.13563

Zhonghua Nan Ke Xue. 2021 Dec;27(12):1098-1102.

ABSTRACT

OBJECTIVE: To evaluate the application and effect of the lateral preputial fascial island flap (LPFIF) in hypospadias reoperation.

METHODS: We retrospectively analyzed the clinical data on the children patients undergoing hypospadias reoperation with LPFIF in our Department of Urology from December 2016 to June 2019.

RESULTS: A total of 85 cases were included in this study, including 18 cases of LPFIF, 19 cases of Duplay technique, 25 cases of tubularized incised plate urethroplasty (TIP) and 23 cases of Mathieu urethroplasty. The patients were aged from 18 months to 12 years and 8 months, averaging 4.6 years. Postoperatively, all the children were followed up for ≥ 6 months, which found satisfactory appearance of the penis body and glans, the urethral orifice in the normal position of the glans, and the external orifice of the urethra fissured. Urethral fistula occurred in 2 cases and glans dehiscence in 1 after LPFIF; 5 of the patients presented urethral fistula after Duplay; 3 developed urethral fistula and 1 urethral stricture after TIP; 6 showed urethral fistula and 2 glans dehiscence after Mathieu urethroplasty. No postoperative urethral stricture, urethral diverticulum or flap necrosis occurred in any of the cases. Hypospadias reoperation succeeded in 83.3% (15/18) of the cases after LPFIF. The urine flow curve of the LPFIF cases was bell-shaped or high flat-shaped, with a maximum urinary flow rate of 8.56 ± 3.99 ml/s and an average urinary flow rate of 5.23 ± 2.32 ml/s, not significantly different from those of the TIP and Duplay cases.

CONCLUSIONS: There is no statistically significant difference in the success rate of hypospadias reoperation between TIP and LPFIF. Urethroplasty with LPFIF can be used as one of the surgical options for hypospadias reoperation.

PMID:37454319

Zhonghua Nan Ke Xue. 2021 Dec;27(12):1092-1097.

ABSTRACT

OBJECTIVE: To explore the effects of fertility stress on the quality of life (QOL) of infertile men and the dual mediating roles of positive and negative emotions in fertility stress and fertility QOL.

METHODS: Using the Fertility Problem Inventory, Fertility Quality of Life Questionnaire and Positive and Negative Affect Scale, we conducted a cross-sectional survey among 304 infertile men. We established a structural equation model for analysis of the relationship between the four variables of fertility stress, fertility QOL, positive emotion and negative emotion.

RESULTS: The scores of the patients in fertility stress, fertility QOL, positive emotion and negative emotion were (158.42 ± 21.725), (60.72 ± 10.926), (32.15 ± 6.294) and (19.48 ± 6.378), respectively. The root mean square error approximation (RMSEA) of the direct effect model, positive emotion separate mediation model and negative emotion separate mediation model was >0.08, and the dual mediation model showed optimum fit indexes, with χ2 / df = 1.959, goodness of fit index (GFI) = 0.950, adjusted GFI (AGFI) = 0.919, normed fit index (NFI) = 0.899, incremental fit index (IFI) = 0.948, Tucker-Lewis index (TLI) = 0.926, comparative fit index (CFI) = 0.947, and RMSEA = 0.056. The results of bootstrap test indicated that the positive and negative emotions had significant mediating effects, both incomplete, on fertility stress and fertility QOL. Moreover, the separate mediation of positive emotion exhibited no statistically significant difference from that of negative emotion (95% CI: －0.063 to 0.028).

CONCLUSIONS: Positive emotion and negative emotions are part of the intermediary in fertility stress and fertility QOL. Fertility stress can affect fertility QOL through the dual mediating effect of positive emotion and negative emotions in infertile men.

PMID:37454318

Zhonghua Nan Ke Xue. 2021 Dec;27(12):1075-1080.

ABSTRACT

OBJECTIVE: To investigate the correlation between sperm nuclear maturity and the outcomes of in vitro fertilization (IVF).

METHODS: We retrospectively analyzed the clinical data on 1 393 cycles of IVF in our center from September 2018 to May 2020. According to the high DNA stainability (HDS) of sperm, we divided the patients into a mature (HDS ≤ 10%) and an immature sperm nucleus group (HDS > 10%), compared the results of IVF, embryonic development and clinical outcomes between the two groups, and analyzed their correlation with HDS.

RESULTS: The rates of fertilization and normal fertilization were significantly higher and that of fertilization failure remarkably lower in the mature than in the immature sperm nuclear group (P < 0.05). There were no statistically significant differences between the two groups in the rates of cleavage, high-quality embryo, blastocyst formation, clinical pregnancy, miscarriage and live birth (P > 0.05). Univariate logistic regression analysis showed that HDS was correlated negatively with the rates of fertilization, normal fertilization and blastocyst formation (P < 0.05), positively with fertilization failure (P < 0.05), but not significantly with the rates of cleavage, high-quality embryo, clinical pregnancy, miscarriage and live birth (P > 0.05). After adjusting for confounding factors by multivariate logistic regression analysis, HDS was found correlated negatively with the fertilization rate (OR = 0.945, 95% CI: 0.918 to 0.972, P < 0.05), positively with fertilization failure (OR = 1.043, 95% CI: 1.010 to －1.078, P < 0.05), but not significantly with the rates of normal fertilization, cleavage, high-quality embryo, blastocyst formation, clinical pregnancy, miscarriage and live birth (P > 0.05).

CONCLUSIONS: Sperm nuclear maturity significantly affects the rates of fertilization and fertilization failure in IVF patients. Taking sperm nuclear maturity indicators in consideration in the process of IVF may contribute to comprehensive evaluation of semen and male fertility and guide clinical decision-making.

PMID:37454315

Zhonghua Nan Ke Xue. 2021 Dec;27(12):1069-1074.

ABSTRACT

OBJECTIVE: To investigate the influence of the expressions of apoptosis-related Fas and FasL mRNA and proteins on sperm concentration and motility.

METHODS: We collected semen samples from 80 adult males and divided them into four groups of an equal number according to sperm concentration and the percentage of progressively motile sperm (PMS): normal, asthenospermia (AS), oligozoospermia (OS) and oligoasthenospermia (OAS). We examined the routine semen parameters, the levels of Fas and FasL proteins and the expressions of Fas and FasL genes in different groups.

RESULTS: The sperm concentrations in the normal, AS, OS and OAS groups were (68.11 ± 35.49), (92.21 ± 60.96), (8.55 ± 2.82) and (5.96 ± 3.80) ×10⁶/ml, respectively, and the percentages of PMS were (49.40 ± 13.86)%, (22.12 ± 7.13)%, (40.77 ± 8.41)% and (14.53 ± 9.74), respectively. The Fas protein level was significantly higher in the AS, OS and OAS than in the normal group (［425.03 ± 50.56］, ［442.32 ± 84.88］ and ［448.42 ± 84.79］ vs ［381.07 ± 52.37］ pg/ml, P < 0.05), correlated negatively with sperm concentration (r = －0.377, P < 0.01) and PMS (r = －0.350, P < 0.01), but exhibited no statistically significant differences between the former three and latter group (［166.98 ± 27.39］, ［169.51 ± 32.62］ and ［171.46 ± 32.61］ vs ［167.49 ± 29.91］ pg/ml, P > 0.05). The relative levels of the Fas gene in the normal, AS, OS and OAS groups were 1, (0.88 ± 1.17), (2.55 ± 2.11) and (0.69 ± 0.90) respectively, lower in the AS and OAS than in the normal group, and positively correlated with sperm motility; those of the FasL gene were 1, (1.99 ± 1.81), (2.08 ± 2.06) and (2.03 ± 2.23) respectively, higher in the OS and OAS than in the normal group, and negatively correlated with sperm motility. Compared with the normal group, the expressions of Fas and FasL were down-regulated in the AS but up-regulated in the OS group; the expression of Fas, however, was down-regulated and that of FasL up-regulated in the OAS group. The expression of Fas mRNA was positively correlated with the percentage of PMS (r = 0.355, P = 0.01) and total sperm motility (r = 0.358, P < 0.01), while sperm concentration negatively correlated with the expression FasL mRNA (r = －0.305, P < 0.05). There was no significant correlation between the other parameters.

CONCLUSIONS: Fas and FasL are differentially expressed in normal, asthenospermia, oligozoospermia and oligoasthenospermia males. Their up-regulated expressions may promote the apoptosis of spermatogenic and sperm cells and induce oligozoospermia, while their down-regulated expressions may indicate the failure of abnormal spermatogenic and sperm cells to immediately undergo programmed death, which can be one of the causes of asthenospermia.

PMID:37454314

Obes Surg. 2023 Jul 16. doi: 10.1007/s11695-023-06726-9. Online ahead of print.

ABSTRACT

BACKGROUND: Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated.

METHODS: We performed a multicenter retrospective cohort study of patients aged 65 years and older who underwent simultaneous PEH repair and RYGB from 2008 to 2022. Patient demographics, hernia characteristics, postoperative complications, and weight loss data were collected. Obesity-related medical conditions’ resolution rates were evaluated at the last follow-up. A matched paired t-test and Pearson’s test were used to assess continuous and categorical parameters, respectively.

RESULTS: A total of 40 patients (82.5% female; age, 69.2 ± 3.6 years; BMI, 39.4 ± 4.7 kg/m²) with a mean follow-up of 32.3 months were included. The average hernia size was 5.8 cm. Most cases did not require mesh use during surgery (92.5%) with only 3 (7.5%) hernial recurrences. Postoperative complications (17.5%) and mortality rates (2.5%), as well as readmission (2.5%), reoperation (2.5%), and reintervention (0%) rates at 30-day follow-up were reported. There was a statistically significant resolution in gastroesophageal reflux disease (p < 0.001), hypertension (p = 0.019), and sleep apnea (p = 0.014).

CONCLUSIONS: The safety and effectiveness of simultaneous PEH repair and RYGB are adequate for the elderly population. Patient selection is crucial to reduce postoperative complications. Further studies with larger cohorts are needed to fully assess the impact of this surgery on elderly patients with obesity.

PMID:37454304 | DOI:10.1007/s11695-023-06726-9

Rhinology. 2023 Jul 16. doi: 10.4193/Rhin22.487. Online ahead of print.

ABSTRACT

BACKGROUND: Radiotherapy (RT) is one of the main methods used in the treatment of head and neck cancers but may cause mucosal side effects in the tumor area and surrounding structures. These include nasal mucosal disorders and chronic rhinosinusitis due to disruption of the mucociliary system. This situation seriously affects the quality of life of the patients and there is no accepted effective method for its treatment yet. In our study, we aimed to examine the side effects of RT on the nasal mucosa and mucociliary system and to investigate histopathologically and immunohistochemically the effectiveness of N-acetyl cysteine (NAC) in preventing these side effects of RT.

METHODOLOGY: The study was carried out with 30 female Sprague Dawley rats devided in three groups. No intervention was made in the control group. On the second day of the experiment, 30 Gy radiotherapy was applied to the head area in the RT group. NAC was administered intraperitoneally at a dose of 1 g/kg/day for 14 days from the first day of the study to the RT+ NAC group. On the second day, 30 Gy of radiotherapy was applied to the head area 1 hour after the NAC application. On the 14th day, 1 hour after NAC was applied to the RT+NAC group, all animals were sacrificed. The nasal mucosa samples were stained with hematoxylin-eosin, and the intensity and extent of staining sentan in the nasopharyngeal tissue samples were evaluated by immunohistochemical staining using anti-SNTN antibody.

RESULTS: The loss of cilia in the nasal tissue was lower in the RT+NAC group than in the RT group. The intensity and extent of staining in the nasopharyngeal tissue of Sentan was higher in the RT+NAC group than in the RT group. Mucosal neutrophil and mononuclear inflammatory cell infiltration in the nasal tissue, vascular dilatation, hyperemia and hemorrhage, erosion and shedding of the mucosal epithelium, mucosal ulceration were found to be similar in the RT+NAC group and the control group. It was milder in the RT+NAC group than in the RT group, but not statistically significant.

CONCLUSIONS: Radiotherapy caused pathological changes in the nasal mucosa, caused loss of cilia and a decrease in the level of Sentan, the cilia apical protein. The results of our study showed that NAC treatment can reduce the side effects of RT on the nasal mucosa. It also showed that NAC was effective in preventing the loss of cilia, which is the building block of the mucociliary system, and improving the expression of Sentan.

PMID:37454274 | DOI:10.4193/Rhin22.487