The impact of the “cisplatin era” of treatment on survival in testicular cancer

Summary The records of all testicular cancer patients evaluated and treated at our medical center during two consecutive 9-year periods were reviewed and analyzed for prognostic factors, particularly the impact of cisplatin-based combination chemotherapy. The data base of 244 patients was divided into two eras: 1970–1978, defined as the pre-cisplatin era (n=101) and 1979–1987, the cisplatin era (n=143). Statistically improved survival (P=0.024) was noted for the 165 nonseminoma patients and for a grouping of 143 patients treated with combination chemotherapy (P=0.004) during the cisplatin era. Stratification by stage revealed that stage II patients had the most significant survival advantage (P=0.001) during the cisplatin era; cancer mortality improved from 48% to 9%. Cancer death rates for stage III patients decreased from 58% to 39% which is clinically but not statistically significant (P=0.497). Stage I patients and the seminoma population did well during both eras, and the impact of cisplatin could not be statistically confirmed in this study for these subgroups. Multivariate statistical analysis confirmed the importance of the era of treatment for the nonseminoma population.     

The impact of hypertriglyceridemia on prostate cancer development in patients aged ≥60 years

Study Type – Aetiology (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Patients aged ≥60 years with high TG levels may be move vulnerable to the development of prostate cancer with aggressive biology. We urologists have to pay attention to select the treatment for patients aged ≥60 year with high TG levels.

OBJECTIVE

• ? To investigate the relationship between serum triglyceride (TG) levels and the incidence and characteristics of prostate cancer detected on biopsy.

PATIENTS AND METHODS

• ? We evaluated data from consecutive patients who underwent prostatic biopsy. Data analysed included age, total serum prostate‐specific antigen (PSA) level, prostatic volume, body mass index (BMI), TG levels, and cholesterol‐lowering medications.

RESULTS

• ? We analysed data from 905 patients, including 528 (58.3%) with positive biopsy findings.
• ? Using 150 mg/dL as the threshold point of TG levels, multivariate analysis yielded an adjusted odds ratio (OR) reflecting the association of higher TG levels with prostate cancer diagnosis of 1.66 (95% confidence interval (CI) 1.21–2.29, P = 0.002).
• ? Pearson correlation coefficient analysis including age, PSA level, prostatic volume, BMI and TG, showed TG level significantly correlated with BMI (r = 0.185, P < 0.001).
• ? In the analysis by age intervals (≤59, 60–69, and ≥70 years), the association between high TG levels and positive biopsy findings was enhanced in the age groups 60–69 and ≥70 years (OR 2.10, 95% CI 1.31–3.37, P = 0.002 and OR 1.91, 95% CI 1.03–3.53, P = 0.039, respectively), but not in the group aged ≤59 years.
• ? In patients aged ≥60 years, high TG levels were statistically significantly associated with a Gleason score of ≥8.

CONCLUSIONS

• ? High TG levels correlated well with a higher incidence of prostate cancer, especially in patients aged ≥60 years.
• ? High TG levels were also associated with a Gleason score of ≥8 in this age group.
• ? Our results suggest that elderly patients with high TG levels may be more vulnerable to the development of prostate cancer with an aggressive biology.

     

The impact of liver disease on mortality in cystic fibrosis–A systematic review

BackgroundThere is conflicting evidence on the impact of liver disease (CFLD) on life expectancy in CF. Therefore the aim of this systematic review was to evaluate the impact of liver disease (CFLD) on mortality in CF.MethodsThe protocol was published at (https://hrbopenresearch.org/articles/3-44/v3) using PRISPMA-P guidelines and registered in Prospero 2020 (CRD42020182885). Three databases were searched for publications (1938-2020) where the outcome was all-cause mortality (defined as death and transplantation) or CF-specific mortality in participants with CFLD. Studies with and without a comparator group were included. Studies were divided into 2 groups based on the definition of CFLD: Group 1 used 2 categories of liver disease (i) liver disease with portal hypertension (PH) (ii) non-specific abnormalities which did not meet the criteria for PH, Group 2 studies only included participants with PH.ResultsAll 14 eligible studies were observational, with a moderate-high risk of bias, Six of the 14 studies directly compared mortality between those with CFLD and those with no liver disease, and 5/6 demonstrated that those with CFLD had at least 3 time the risk of death compared to those with no liver disease. Pulmonary complications were the primary cause of death.ConclusionThis SR demonstrates that liver disease shortens life expectancy in CF, and that pulmonary complications are the primary cause of death in those with CFLD. There has been no improvement in survival for persons with CFLD despite significant improvements in life expectancy for persons with CF who have no evidence of liver disease     

Does speed matter? The impact of operative time on outcome in laparoscopic surgery

Introduction  

Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery.     

The risk factors of nosocomial infection in severe craniocerebral trauma

Objective:To explore the risk factors of nosocomial infection in severe craniocerebral trauma and the way of prevention.Methods:The clinical data of 387 patients with severe craniocerebral trauma were reviewed.Results:The total nosocomial infection rate of this study was 22.99% .Pulmonary nosocomial infection presented most frequently.The G-bacilli were the most common infectious bacteria.The mortality rate of the infection group was 38.20%.Conclusions:Complications of nosocomial infection affect the prognosis of craniocerebral trauma patients.Nosocomial infection is related to the age of the patients, craniocerebral trauma severity, unreasonable utilization of antibiotics and invasive operations, such as tracheal cannula, mechanical ventilation,urethral catheterization and deep venous catheterization.Patients with severe craniocerebral trauma should be carefully treated and nursed to avoid nosocomial infection.In order to reduce the rate of nosocmial infection,intensive measurement should be adopted.     

The impact of lifestyle factors on serum 25-hydroxyvitamin D levels: a cross-sectional study in Japanese women aged 19–25 years

Insufficient levels of serum 25-hydroxyvitamin D [25(OH)D] lead to low bone mineral density (BMD) by increasing serum levels of intact parathyroid hormone (PTH), and are associated with a high mortality rate. Therefore, the 25(OH)D level is used as an indicator of frailty in older persons. To obtain higher serum 25(OH)D levels, management of lifestyle habits and nutrient intake is important beginning in a person's younger years. This study evaluated the degree of association between serum 25(OH)D concentrations and lifestyle factors in young Japanese women. A cohort study was conducted from December 2003, and the survey was finished by February 2004. The subjects were 274 Japanese women aged 19–25 years old. The parameters evaluated in these subjects included: (1) serum concentrations of 25(OH)D, intact PTH, calcium, and phosphorus; (2) BMD in the lumbar spine and hip; and (3) lifestyle factors (nutrient intake, physical activity, and duration of sunlight exposure). The serum 25(OH)D level was negatively associated with the intact PTH level (Spearman; r = –0.17, P = 0.006). The BMD was significantly higher in the high 25(OH)D and low intact PTH group than the other group (P < 0.05). The serum 25(OH)D level was significantly correlated with daily intake of dietary vitamin D (r = 0.20, P = 0.001), the mean number of steps taken per day (r = 0.16, P = 0.010) and the mean time spent in sedentary activity (r = –0.14, P = 0.018) among the lifestyle factors evaluated. Multiple regression analysis showed the degree of association between lifestyle factors and serum 25(OH)D to be small (R ² = 0.084). Daily intake of dietary vitamin D and daily walking may be useful for increasing the serum 25(OH)D level in young Japanese women.     

The quality of life and associated factors in patients on maintenance hemodialysis – a multicenter study in Shanxi province

Objectives: To assess the quality of life (QOL) and factors affecting QOL in hemodialysis patients so as to improve QOL of dialysis patients and provide the basis for better clinical care.

Methods: A retrospective study was performed to assess the QOL and factors affecting QOL in hemodialysis patients. We recruited 125 patients who had been receiving hemodialysis for at least 2?years in the dialysis units of nine hospitals in Shanxi Province, China, and conducted a multi-center questionnaire survey between 1 May 2015 and 1 July 2016. We investigated the patients’ general condition and clinical data and used the Short Form-36 (SF-36) scale to measure QOL in these patients.

Results: The overall SF-36 score was 107.55?±?14.50 in patients who had received hemodialysis for more than 2 years. Age (p?<?.05, F?=?4.972) and gender (p?<?.01, t?=?3.993) significantly affected the overall QOL score in these patients. Education level was also an influencing factor (p?<?.05, Z=??0.838), especially on the mental health of these patients. In addition, residual urine volume (p?<?.05, Z=??2.465) and diabetic nephropathy (p?<?.05, Z=??2.062) were important factors that affected the physical strength and QOL score in these patients. However, sources of medical expenses, marital status and different methods of dialysis, had no effect on the QOL score.

Conclusion: The overall score of QOL in patients who have received maintenance hemodialysis for more than 2 years is higher in Shanxi Province than that in other provinces of China. Only a few factors influenced the QOL of these patients.     

影响哺乳时限的社会人口学因素分析

在影响哺乳的诸多因素中，社会经济及人口学因素不容忽视，本研究旨在探讨社会人口学因素对哺乳时限的影响。应用来自“中国农村已婚育龄妇女使用避孕方法变化”调查资料经生命表方法结果表明，江苏省农村产后妇女哺乳率为９７，６％，平均哺乳时限为１４．４个月，其中苏北地区为２０．７个月，苏南地区为１２．６个月。比例风险模型分析结果进一步表明，居住地区、妇女生育年龄、婴儿性别、分娩地点、妇女文化程度及其职业和丈夫的职业是主要的影响因素。经济落后地区、大生育年龄组妇女、男婴、丈夫从事农业、妇女为文盲、婴儿在家分娩的妇女哺乳时限长。在控制了其他社会人口学因素后，仍存在着地区间哺乳时限的差异，这可能与苏南、苏北文化风俗不同有关。针对影响因素采取相应措施，使之利于妇女延长完全哺乳时限。     

分娩镇痛对母乳喂养影响的临床研究进展

围生期多种因素均可能对母乳喂养施加影响,其中分娩镇痛可通过缓解疼痛、改善情绪或分娩镇痛药物本身等对母乳喂养产生作用。但目前关于此类研究资料较少,现有的研究主要考虑分娩镇痛是一种符合生理的分娩方式,因此进行临床推广。文章通过简介当前分娩镇痛的临床研究现状,分别针对椎管内分娩镇痛、静脉分娩镇痛、吸入分娩镇痛、非药物性分娩镇...     

孕前身体质量指数对母乳喂养持续时间影响的前瞻性队列研究

目的 探讨孕前身体质量指数对母乳喂养持续时间的影响,筛选早期中断母乳喂养的高危人群和时间节点,为实施针对性母乳喂养指导提供依据。方法 便利抽取370例孕妇为研究对象,入院待产时建立研究队列,电话随访2年内母乳喂养情况。结果 研究对象总体母乳喂养持续时间为11.0(7.0,13.0)个月,12个月内母乳喂养中断速度较快;孕前消瘦组的母乳喂养持续时间较孕前体质量正常组短2.0个月;多因素Cox回归分析显示,调整混杂因素后,孕前消瘦会增加早期中断母乳喂养的风险[HR=1.429,95%CI(1.028,1.985),P<0.05];孕前超重对母乳喂养持续时间无显著影响[HR=1.105,95%CI(0.813,1.502),P>0.05]。结论 孕前消瘦是早期中断母乳喂养的高危因素,12个月内是母乳喂养中断的时间节点。建议育龄期女性孕前将体质量控制在正常范围内,卫生保健人员进行母乳喂养指导时需考虑产妇的孕前营养状态,行个性化的母乳喂养指导,合理延长母乳喂持续时间。     

孕前身体质量指数对母乳喂养持续时间影响的前瞻性队列研究

目的 探讨孕前身体质量指数对母乳喂养持续时间的影响,筛选早期中断母乳喂养的高危人群和时间节点,为实施针对性母乳喂养指导提供依据。 方法 便利抽取370例孕妇为研究对象,入院待产时建立研究队列,电话随访2年内母乳喂养情况。 结果 研究对象总体母乳喂养持续时间为11.0（7.0,13.0）个月,12个月内母乳喂养中断速度较快;孕前消瘦组的母乳喂养持续时间较孕前体质量正常组短2.0个月;多因素Cox回归分析显示,调整混杂因素后,孕前消瘦会增加早期中断母乳喂养的风险［HR=1.429,95%CI（1.028,1.985）,P＜0.05］;孕前超重对母乳喂养持续时间无显著影响［HR=1.105,95%CI（0.813,1.502),P＞0.05］。 结论 孕前消瘦是早期中断母乳喂养的高危因素,12个月内是母乳喂养中断的时间节点。建议育龄期女性孕前将体质量控制在正常范围内,卫生保健人员进行母乳喂养指导时需考虑产妇的孕前营养状态,行个性化的母乳喂养指导,合理延长母乳喂持续时间。     

The influence of the duration of isoflurane anaesthesia on neuromuscular effects of mivacurium

Background: The pharmacodynamic profile of muscle relax-ants is usually changed by volatile anaesthetics. These changes seem to be time-dependent, even though few data are available to substantiate this.
Methods: We studied neuromuscular effects of a single dose of mivacurium (0.2 mg·kg^-1) during short and intermediate duration of isoflurane anaesthesia. Forty-five children 1–10 years of age were randomized to receive 1.5% end-tidal concentration of isoflurane in N₂O/O₂ for 10 or 30 min (groups Iso-10 and Iso-30, respectively) or to receive nitrous oxide in oxygen for 10 min (Group N₂O) before 0.2 mg · kg^-1 of mivacurium was given. Neuromuscular response was recorded by adductor pollicis electromyogram.
Results: The onset time of mivacurium was shorter in Group Iso-30, 1.7 (1.0–2.3) min than in Group Iso-10, 2.3 (1.7-3.3) rnin or Group N₂O, 2.3 (1.7-3.3) min (median with 10–90% percen-tiles) ( P <0.05). In Group Iso-30 the recovery time of the first EMG response was significantly longer than in groups Iso-10 and N₂O ( P <0.0001). Groups Iso-10 and N₂O did not differ from each other.
Conclusions: Our results indicate that the duration of a constant concentration of isoflurane anaesthesia influences significantly the pharmacodynamics of mivacurium. The duration of a volatile anaesthesia is critical when potentiation of NMB is evaluated or compared in neuromuscular studies.     

The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study

International Urology and Nephrology - Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to...     

Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy

Clonidine, an alpha–2–adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. In this study, therefore, the analgesic and circulatory effects of intrathecal clonidine were studied in patients undergoing knee arthroscopy under spinal anaesthesia. Forty ASA I–II patients were randomly divided to two groups. One group received clonidine 3 μg–kg^-1 mixed with 15 mg 0.5% bupivacaine and the other group an identical saline volume mixed with bupivacaine as above, in a double–blind fashion. Sensory analgesia, blood pressure, heart rate and sedation were followed during and after the operation. Oxycodone 0.14 mg– kg"' i.m. or ketoprofen 100 mg p.o. was administered when needed. The duration of sensory analgesia (until regression of the block to L2) was longer in the clonidine group (mean 217 min) than in the control group (mean 160 min) ( P < 0.05). Duration of motor blockade was also longer in the clonidine group (mean 215 min) compared to the control group (161 min) ( P < 0.05). Mean arterial pressure and heart rate were significantly lower in the clonidine group compared to the control group. The clonidine patients needed fewer supplemental doses of oxycodone (8 doses) than those in the control group (16 doses) ( P < 0.05). More patients in the clonidine group were sedated 3–6 h after the injection ( P < 0.05). Addition of clonidine prolonged the bupivacaine spinal block. However, marked haemodynamic changes and sedation may limit the usefulness of intrathecal clonidine.     

The impact of red blood cell storage duration on tissue oxygenation in cardiac surgery

Objective

Although storage alters red blood cells, several recent, randomized trials found no differences in clinical outcomes between patients transfused with red blood cells stored for shorter versus longer periods of time. The objective of this study was to see whether storage impairs the in vivo ability of erythrocytes to traverse the microcirculation and deliver oxygen at the tissue level.