Tag: pubmed

Eur Urol Focus. 2022 Oct 29:S2405-4569(22)00232-2. doi: 10.1016/j.euf.2022.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Management of complex renal cysts is guided by the Bosniak classification system, which may be inadequate for risk stratification of patients for intervention. Fractional tumor vascularity (FV) calculated from volumetric contrast-enhanced ultrasound (CEUS) images may provide additional useful information.

OBJECTIVE: To evaluate CEUS and FV calculation for risk stratification of patients with complex renal cysts.

DESIGN, SETTING, AND PARTICIPANTS: This was a pilot prospective study with institutional review board approval involving patients undergoing surgery for Bosniak IIF-IV complex renal cysts. CEUS was performed preoperatively on the day of surgery with two-dimensional (2D) and three-dimensional (3D) imaging and sulfur hexafluoride lipid-type A microspheres as the ultrasound contrast agent.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A custom MATLAB program was used to select regions of interest on CEUS scans. FV was calculated according to FV = 1 – (total nonenhancing area/total lesion area). We assessed the ability of 2D- and 3D-derived percentage FV (2DFV%, and 3DFV%) and Bosniak classification schemes (pre-2019 [P2019B] and post-2019 [B2019]) to predict malignancy, aggressive histology, and upstaging on surgical pathology. Performance was assessed as area under the receiver operating characteristic curve (AUC).

RESULTS AND LIMITATIONS: Twenty eligible patients were included in final analysis, of whom 85% (n = 17) had Bosniak IV cysts and 85% (n = 17) had malignant disease on final pathology. Four (24%) of the malignant lesions were International Society of Urological Pathology grade 3-4. The AUC for predicting malignancy was 0.980, 0.824, 0.863, and 0.824 with P2019B, B2019, 2DFV%, and 3DFV%, respectively. When the Bosniak classification was combined with FV%, three models had an AUC of 1, while the combined 2DFV% + B2019 model had AUC of 0.980.

CONCLUSIONS: FV is a novel metric for evaluating complex cystic renal masses and enhances the ability of the Bosniak classification system to predict malignancy. This metric may serve as an adjunct in risk stratification for surgical intervention. Further prospective evaluation is warranted.

PATIENT SUMMARY: Cysts in the kidney are currently classified using a scheme called the Bosniak system. We assessed measurement of the percentage of vascular tissue (called fractional vascularity) in cysts on a special type of ultrasound scan. This promising test adds information when combined with the Bosniak system and can help in guiding appropriate treatment.

PMID:36319560 | DOI:10.1016/j.euf.2022.10.004

Urol Oncol. 2022 Oct 29:S1078-1439(22)00312-X. doi: 10.1016/j.urolonc.2022.09.004. Online ahead of print.

ABSTRACT

PURPOSE: The ability of 5α-reductase inhibitors (5ARI) to reduce the risk of new onset bladder cancer (BC) has been studied with variable results. Our objective was to conduct a retrospective cohort population-based study to evaluate the association between 5ARI use, BC diagnosis, and BC mortality.

PATIENTS AND METHODS: We used routinely collected health care data from Ontario, Canada. Men ≥66 years of age with a prescription for a 5ARI were matched to non-5ARI users. Matching was done using a propensity score of selected covariates to make 96 different covariates comparable. We measured 5 additional baseline variables which may have impacted the risk of future BC diagnosis: prior cystoscopy, urine cytology, urinalysis, gross hematuria episodes, and transurethral resection of a bladder lesion. Only the first period of continuous usage of 5ARIs was considered. The prespecified at-risk period for outcomes started 1 year after initiating therapy and ended at the last date of 5ARI exposure + 1 year.

RESULTS: We identified 93,197 men who initiated 5ARI therapy (52% dutasteride, and 48% finasteride) between 2003 and 2013 and matched them 1:1 to men who did not start a 5ARI. The median at-risk period for the 5ARI group was 1.68 years (interquartile range 1.00, 4.27). With adjustment for the variables related to prior BC investigations there was no significant difference in BC diagnosis (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.82-1.32) during the period of 0 to <2 years of 5ARI use; however, after ≥2 years of 5ARI use, the risk of BC diagnosis was significantly lower among the 5ARI group (HR 0.82, 95% CI 0.79-0.94). In a similarly adjusted model, BC mortality was lower among 5ARI users, but no longer statistically significant (HR 0.82, 95% CI 0.65, 1.02). When stratified by type of 5ARI, finasteride significantly reduced the risk of BC diagnosis after ≥2 years of continuous use (HR 0.86, 95% CI 0.76, 0.96); however, dutasteride did not (HR 0.92, 95% CI 0.83, 1.03).

CONCLUSIONS: In a large cohort of men, the use of a 5ARI was associated with a significantly decreased the risk of BC diagnosis after more than 2 years of continuous therapy.

PMID:36319553 | DOI:10.1016/j.urolonc.2022.09.004

J Fr Ophtalmol. 2022 Oct 29:S0181-5512(22)00350-3. doi: 10.1016/j.jfo.2022.05.020. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of the present study is to assess the levels of Maresin 1 (MaR1) in patients with idiopathic acute anterior uveitis (IAAU) and to compare the MaR1 results with healthy controls.

METHODS: This study includes 24 patients with idiopathic AAU and 24 healty controls (C). The serum MaR1 levels were analyzed using enzyme-linked immunosorbent assays (ELISA). The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at the time of diagnosis.

RESULTS: MaR1 levels were statistically significant when the IAAU group was compared with group C (P<0.001). When idiopathic AAU patients were compared with group C, no statistically significant difference was found between ESR and CRP levels (P=0.086, P=0.549 respectively).

CONCLUSION: Serum MaR1 levels are an important biomarker of disease in patients with idiopathic AAU.

PMID:36319522 | DOI:10.1016/j.jfo.2022.05.020

Med Dosim. 2022 Oct 29:S0958-3947(22)00070-X. doi: 10.1016/j.meddos.2022.09.003. Online ahead of print.

ABSTRACT

Whole pelvic radiotherapy (WPRT) can sterilize microscopic lymph node metastases in treatment of prostate cancer. WPRT, compared to prostate only radiotherapy (PORT), is associated with increased acute gastrointestinal, and hematological toxicities. To further explore minimizing normal tissue toxicities associated with WPRT in definitive IMRT for prostate cancer, this planning study compared dosimetric differences between static 9-field-IMRT, full arc VMAT, and mixed partial-full arc VMAT techniques. In this retrospective study, 12 prostate cancer patients who met the criteria for WPRT were randomly selected for this study. The initial volume, PTV46, included the prostate, seminal vesicles, and pelvic nodes with margin and was prescribed to 4600 cGy. The cone-down volume, PTV78, included the prostate and proximal seminal vesicles with margin to a total dose of 7800 cGy. For each CT image set, 3 plans were generated for each of the PTVs: an IMRT plan, a full arc (FA) VMAT plan, and a mixed partial-full arc (PFA) VMAT plan, using 6MV photons energy. According to RTOG protocols none of the plans had a major Conformity Index (CI) violation by any of the 3 planning techniques. PFA plan had the best mean CI index of 1.00 and significantly better than IMRT (p = 0.03) and FA (p = 0.007). For equivalent PTV coverage, the average composite gradient index of the PFA plans was better than the IMRT and the FA plans with values 1.92, 2.03, and 2.01 respectively. The defference was statistically significant between PFA/IMRT and PFA/FA, with p- values of < 0.001. The IMRT plans and the PFA plans provided very similar doses to the rectum, bladder, sigmoid colon, and femoral heads, which were lower than the dose in the FA plans. There was a significant decrease in the mean dose to the rectum from 4524 cGy with the FA to 4182 cGy with the PFA and 4091 cGy with IMRT (p < 0.001). The percent of rectum receiving 4000 cGy was also the highest with FA at 66.1% compared to 49.9% (PFA) and 47.5% (IMRT). There was a significant decrease in the mean dose to the bladder from 3922 cGy (FA) to 3551 cGy (PFA) and 3612 cGy (IMRT) (p < 0.001). The percent of bladder receiving 4000 cGy was also the highest with FA at 45.4% compared to 36.6% (PFA) and 37.4% (IMRT). The average mean dose to the sigmoid colon decreased from 4177 cGy (FA) to 3893 cGy (PFA) and 3819 cGy (IMRT). The average mean dose to the femoral heads decreased from 2091 cGy (FA) to 2026 cGy (PFA) and 1987 cGy (IMRT). Considering the improvement in plan quality indices recorded in this study including the dose gradient and the dose to organs at risk, mixed partial-full arc plans may be the preferred VMAT treatment technique over full arc plans for prostate cancer treatments that include nodal volumes.

PMID:36319515 | DOI:10.1016/j.meddos.2022.09.003

Transplant Proc. 2022 Oct 29:S0041-1345(22)00655-8. doi: 10.1016/j.transproceed.2022.10.011. Online ahead of print.

ABSTRACT

BACKGROUND: The role of non-HLA antibody is gaining special attention in solid-organ transplantation and in highly sensitized (HS) patients because of its potential involvement in graft loss (GL) and/or antibody-mediated rejection (ABMR). The identification of non-HLA antibodies while listed may provide deeper information about the increased immunologic risk prior to transplant. We aimed to identify non-HLA antibodies pretransplant that could involve GL in HS patients.

METHODS: Nineteen pretransplant samples from HS patients who underwent transplant at the Marqués de Valdecilla University Hospital were studied for both HLA antibodies and a panel of 39 non-HLA antigens analyzed based on Luminex platform.

RESULTS: Eleven patient (57.9%) maintained the graft (KT group), whereas 8 (42.1%) had a GL within a median of 30 days. The median fluorescent intensity (MFI) of the 39 non-HLA antigens were compared within the groups, obtaining a statistically significant differences in protein tyrosine phosphatase receptor type N (P < .04) with a MFI mean of 1408 vs 4931 for KT and GL groups, respectively. However, no significant differences were observed in non-HLA MFI between ABMR and non-ABMR KT recipients.

CONCLUSIONS: The presence of non-HLA antibodies in HS is high. The levels of anti-protein tyrosine phosphatase receptor type N before transplant could indicate a potential risk of GL, although longitudinal studies with large number of cases are needed to define anti-non-HLA profiles of risk of ABMR.

PMID:36319497 | DOI:10.1016/j.transproceed.2022.10.011

Transplant Proc. 2022 Oct 30:S0041-1345(22)00668-6. doi: 10.1016/j.transproceed.2022.10.009. Online ahead of print.

ABSTRACT

BACKGROUND: An organ shortage is the reason why it is necessary to expand the pool of donors, which can be achieved by using elderly donors. The main goal of this study is to analyze the outcomes of liver transplant (LT) when it is performed with donors older than 75 years.

METHODS: We carried out a retrospective case-control study (N = 212) that included LTs with donors older than 75 years (group A, n = 106 cases) that were performed in our center between the years 2010 and 2020. This cohort has been paired off with a similar control group (group B, n = 106) whose donors were significantly younger. A survival analysis using the Kaplan-Meier model was performed.

RESULTS: Average (SD) age of donors in group A was statistically greater than group B (A, 79.1 [3.0] years vs B, 54.4 [15.3], P < .001). There were no differences either in the average age of the recipients or in the Model for End-Stage Liver Disease score of both groups. Indications for LT were distributed equally in both groups: the most common was cellular hepatocarcinoma followed by alcohol-related cirrhosis. Survival rates for group A were 81%, 78%, and 67%, in 1, 3, and 5 years, respectively, while in group B they were 85%, 76%, and 71%, respectively, without differences found between the groups (P = .57).

CONCLUSIONS: Using elderly liver donors is safe, achieving good outcomes in terms of short- and midterm rates of survival.

PMID:36319496 | DOI:10.1016/j.transproceed.2022.10.009

Zhonghua Zhong Liu Za Zhi. 2022 Oct 23;44(10):1146-1154. doi: 10.3760/cma.j.cn112152-20200818-00751.

ABSTRACT

Objective: To analyze the clinical features and prognosis of patients with cutaneous melanoma. Methods: The clinical data and follow-up data of 125 patients with cutaneous malignant melanoma (CMM) treated in the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between February 2008 and August 2019 were collected. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox proportional risk regression model was used for impact factor analysis. Results: Among the 125 patients, 12 were stage Ⅰ, 62 were stage Ⅱ, 30 were stage Ⅲ, and 21 were stage Ⅳ; 76 were acral and 49 were non-acral. The median survival time was 44 months, and the 1-, 2-, and 5-year survival rates were 85.4%, 63.2% and 38.7%, respectively. Kaplan-Meier univariate survival analysis showed that Karnofsky performance status score, tumor stage, primary site, vascular infiltration, Ki-67, BRAF, lactate dehydrogenase (LDH), and surgical treatment were related to the prognosis of patients (P<0.05). The median overall survival (OS) time of patients receiving interferon treatment was 53 months, which was better than 40 months of patients not receiving interferon treatment, but the difference was not statistically significant (P=0.448). Among stage Ⅲ patients, the median OS time of patients receiving interferon therapy was 40 months, which was better than 17 months of patients not receiving interferon therapy (P=0.012). Among stage Ⅱ patients, the 1-, 2-, and 5-year survival rates of acral patients were 97.1%, 84.7%, and 65.8%, and the 1-, 2-, and 5-year survival rates of non-acral patients were 93.3%, 70.0% and 17.0%. The prognosis of patients with stage Ⅱ acral type was better than that of non-acral type (P=0.043). The median survival time of stage Ⅲ patients with acral type was 32 months, better than 17 months of non-acral type, but the difference was not statistical significance (P=0.164). The median survival time of acral type and non-acral type was 8 months and 11 months respectively (P=0.458). Cox multivariate analysis showed that tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma. Conclusions: Interferon treatment can improve the prognosis of patients with stage Ⅲ, and stage Ⅱ acral type patients have better prognosis than that of non-acral type patients. Tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma.

PMID:36319462 | DOI:10.3760/cma.j.cn112152-20200818-00751

Zhonghua Zhong Liu Za Zhi. 2022 Oct 23;44(10):1132-1138. doi: 10.3760/cma.j.cn112152-20210517-00390.

ABSTRACT

Objective: To investigate the incidence and the related risk factors of para-aortic lymph node metastasis in cervical cancer. Methods: The pathological data of 727 patients with cervical cancer who underwent radical hysterectomy and pelvic and para-aortic lymph node dissection were retrospectively analyzed. The relative postoperative pathological parameters of para-aortic lymph node metastasis were statistically analyzed. Results: Among the 727 patients with cervical cancer, 123(16.9%) had para-aortic lymph node metastasis. Univariate analysis showed that the tumor size, the depth of muscular invasion, the vessel invasion, the uterine body invasion, the vaginal invasion, the parametrial invasion, positive surgical margin, the ovary metastasis, the fallopian tubes metastasis, the pelvic lymph node metastasis, and the common iliac lymph node metastasis were associated with para-aortic lymph node metastasis. While the multivariate logistic regression analysis showed that the diameter of primary tumor >4.2 cm, the parametrial invasion, the pelvic lymph node metastasis, and the common iliac lymph node metastasis were the independent risk factors of para-aortic lymph node metastasis. Conclusions: The diameter of primary tumor >4.2 cm, the parametrial invasion, the pelvic lymph node metastasis, and the common iliac lymph node metastasis are the independent risk factors of para-aortic lymph node metastasis in cervical cancer. The tumor size and the common iliac lymph node status should be fully evaluated before the initial operation. Additionally, assessment of the postoperative pelvic lymph node status and the parametrial status will help reduce the rate of misdiagnosis and missed diagnosis, providing a basis for individualized treatment and prognostic judgment.

PMID:36319460 | DOI:10.3760/cma.j.cn112152-20210517-00390

Zhonghua Zhong Liu Za Zhi. 2022 Oct 23;44(10):1112-1118. doi: 10.3760/cma.j.cn112152-20201114-00986.

ABSTRACT

Objective: To investigate the prevalence and risk factors of coronary artery calcification (CAC) on lung cancer screening with low-dose computed tomography (LDCT). Methods: A total of 4 989 asymptomatic subjects (2 542 males and 2 447 females) who underwent LDCT lung cancer screening were recruited at Cancer Hospital, Chinese Academy of Medical Sciences from 2014 to 2017. The visual scoring method was used to assess coronary artery calcification score. χ(2) test or independent t-test was used to compare the difference of CAC positive rate among different groups. Multivariate logistic regression was used to analyze risk factors associated with CAC in the study. Results: Of the 4 989 asymptomatic subjects, CAC occurred in 1 018 cases. The positive rate was 20.4%, of which mild, moderate and severe calcification accounted for 86.3%, 11.4% and 2.3%, respectively. Gender, age, BMI, education level, occupation, smoking history, diabetes, hypertension and hyperlipidemia had statistically significant differences in CAC positive rates among groups. Multivariate logistic regression analysis showed that gender, age, diabetes, hypertension, hyperlipidemia and smoking history were risk factors for CAC. Age, diabetes, hypertension and smoking history were statistically significant risk factors between the mild and moderate CAC group. A total of 1 730 coronary arteries in 1 018 CAC positive cases had calcification, CAC positive rate of left anterior descending was the highest(51.3%); 568 cases (55.8%) were single vessel calcification, 450 cases (44.2%) were multiple vessel calcification. Conclusions: LDCT can be used for the ‘one-stop’ early detection of lung cancer and coronary atherosclerosis. Gender, age, diabetes, hypertension, hyperlipidemia and smoking are related risk factors for coronary atherosclerosis.

PMID:36319457 | DOI:10.3760/cma.j.cn112152-20201114-00986

Zhonghua Zhong Liu Za Zhi. 2022 Oct 23;44(10):1096-1101. doi: 10.3760/cma.j.cn112152-20200225-00125.

ABSTRACT

Objective: To describe the epidemic characteristics of esophageal cancer mortality in Qidong from 1972 to 2016, and to provide baseline for making control measures and strategies for prevention. Methods: The cancer registry data were collected and analyzed on mortality of oesophagus cancer during 1972-2016 in Qidong in different sex, age and time. Indices of statistics included crude mortality rate (CR), China age-standardized rate (CASR), world age-standardized rate (WASR), 35-64 years truncated rate, 0-74 years cumulative rate, cumulative risk, average annual percentage change (AAPC), mortality by period and mortality in the birth cohort. Results: A total of 4 795 esophageal cancer cases (male: 3 315, female: 1 480) died during the 45 years, accounting for 4.85% of all cancer deaths. The crude mortality was 9.48/10(5) (CASR: 3.62/10(5,) WASR: 6.30/10(5)) from 1972 to 2016. The crude mortality was significantly increased with age. In 2016, the crude mortality was 11.61/10(5) (CASR: 2.64/10(5,) WASR: 4.89/10(5)), respectively. The average annual percentage change (AAPC) were 0.99%、-2.03%、-1.72%. The mortalities of esophageal cancer in all age groups from 35 to 74 have been decreasing since the 1980s. The age-birth cohort analysis showed a decline in mortality rates in age groups from 40 to 79. Conclusions: The crude mortality rate of esophageal cancer increases slightly in Qidong, while the China age-standardized rate and world age-standardized rate decrease significantly. However, esophageal cancer is still one of the malignant tumors that affects the health of residents and seriously threatens the people’s lives and health. The situation of cancer prevention and control is still serious in Qidong.

PMID:36319455 | DOI:10.3760/cma.j.cn112152-20200225-00125