Androgen deprivation therapy (ADT) use in prostate cancer (PCa) has seen a rising trend. We are looking into the relationship between ADT and development of metabolic diseases in Chinese patients.
MethodsThis is a prospective multi-centre cohort yielded from the READT database (Real-life experience of ADT in Asia), in which patients diagnosed of PCa and offered ADT were prospectively recruited since 2016. Chinese patients recruited from Hong Kong were selected and compared to another cohort of newly diagnosed PCa patients in Hong Kong (HK-Cap database), which was collected prospectively and retrieved retrospectively for this study. Patient outcomes are followed through for 2 years. We compared between the groups the new diagnoses of hypertension, diabetes and hyper-lipidaemia, as well as the initiation of related medication for these conditions. Baseline characteristics including pre-treatment comorbidities, medications and tumour characteristics are documented.
Results151 patients receiving ADT (from READT database) and 447 patients not receiving ADT (from HK-Cap database) were analysed. ADT is related to higher risks of developing any of concerned medical co-morbidities (23.8% vs 13.0*, p?=?0.001) and new-onset DM (16.6% vs 4.4%, p?<?0.001). Initiation of new medications is also more common in ADT patients. New anti-hypertensives (37.8% vs 12.5%, p?<?0.001), oral hypoglycemic agents (12.6% vs 4.9%, p?=?0.001), insulin (4.0% vs 0.05%, p?=?0.001) and statin (23.7% vs 12.8%, p?=?0.023) are more commonly added in ADT cohort.
ConclusionChinese receiving ADT are exposed to increased risks of new-onset hypertension, diabetes and hyper-lipidaemia, and a higher likelihood of stepping up pharmaceutical control for pre-existing comorbidities. This highlights physicians’ role to monitor metabolic profiles in at-risk men upon offering ADT.
相似文献This study aims to determine whether perioperative treatment with dexmedetomidine (DEX) during laparoscopic radical prostatectomy (LRP) can provide a reno-protective effect.
MethodsThis pilot study enrolled 89 patients between 60 and 79 years old, who underwent LRP. These patients were randomly allocated into two groups: group D (n?=?44) and group C (n?=?45). For patients in group D, 1 µg/kg of DEX was intravenously administered within 10 min, followed by 0.5 µg/kg/h of DEX infusion during the operation. This was stopped at 30 min before the end of surgery. For patients in group C, saline was administered at the same doses. The primary outcome was the incidence of acute kidney injury (AKI), and secondary outcomes included other postoperative variables.
ResultsThe incidence of AKI in group D and C was 4.5% and 13.3%, respectively (P?>?0.05). Compared with group C, patients in group D had significantly lower urea nitrogen levels at 6 h after surgery, lower creatinine levels at 6 and 48 h after surgery, and significantly lower CysC levels at 48 h after surgery. A significant decrease in VAS scores for pain and postoperative nausea and vomiting (PONV) at the second and third day after surgery was observed in patients in group D when compared to patients in group C.
ConclusionIntraoperative DEX does not reduce the incidence of AKI, but provides a potential reno-protective effect, and alleviates postoperative pain and PONV in patients undergoing LRP.
相似文献In chronic kidney disease (CKD) patients, dysbiosis is associated with inflammation and cardiovascular risk, so many nutritional strategies are being studied to reduce these complications. Resistant starch (RS) can be considered a prebiotic that promotes many benefits, including modulation of gut microbiota which is linked to immune-modulatory effects. The aim of this study was to evaluate the effects of RS supplementation on proinflammatory cytokines in CKD patients on hemodialysis (HD).
MethodsA double-blind, placebo-controlled, randomized trial was conducted with sixteen HD patients (55.3?±?10.05 years, body mass index (BMI) 25.9?±?5.42 kg/m2, 56% men, time on dialysis 38.9?±?29.23 months). They were allocated to the RS group (16 g RS/day) or placebo group (manioc flour). The serum concentration of ten cytokines and growth factors was detected through a multiparametric immunoassay based on XMap-labeled magnetic microbeads (Luminex Corp, USA) before and after 4 weeks with RS supplementation.
ResultsAfter RS supplementation, there was a reduction of Regulated upon Activation, Normal T-Cell Expressed and Secreted (p?<?0.001), platelet-derived growth factor (two B subunits) (p?=?0.014) and interferon-inducible protein 10 (IP-10) (p?=?0.027). The other parameters did not change significantly.
ConclusionThis preliminary result indicates that RS may contribute to a desirable profile of inflammatory markers in CKD patients.
相似文献As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS?) in women undergoing total mastectomy after NAC.
MethodsWomen with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS? was examined and the accuracy of 1 cm TND on imaging for predicting NS? was determined.
ResultsAmong 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p?<?0.05). The likelihood of NS? was higher with increasing TND on pre- and post-NAC imaging (p?<?0.05). TND ≥?1 cm predicted NS? in 97% and 95% of breasts on pre- and post-NAC imaging, respectively.
ConclusionsIncreasing TND was associated with a higher likelihood of NS?. A TND ≥?1 cm on pre- or post-NAC imaging is highly predictive of NS? and could be used to determine eligibility for nipple-sparing mastectomy after NAC.
相似文献Prostate cancer is the second most common cancer in men and sixth leading cause of mortality. If not recognized early, patients with advanced prostate cancer can experience debilitating complications which can otherwise be prevented by early androgen deprivation therapy. This research intends to define clear diagnostic tools that will guide practitioners in the rural community setting toward early management of advanced prostate cancer.
MethodsWe conducted a cross-sectional observational study at three referral hospitals in Kigali, Rwanda on patients who presented with clinical suspicion of advanced prostate cancer over a period of 6 months. All patients underwent prostate biopsy as well as metastatic work up (CT or MRI), for those who were eligible. Statistical analysis was done using STATA 14.2.
Results114 patients were included in the study. The median age was 70 years (interquartile range: 65–79 years). In total 14 (12.3%) patients were found to have benign disease, while 100 (87.7%) patients were found to have cancer. Among those who had cancer, 85 (85%) had advanced prostate cancer. 110/114 (96.5%) were symptomatic at presentation. Common presenting symptoms were lower urinary tract symptoms (80.7%), back pain (54.4%), and urinary retention (36.8%). Abnormal digital rectal examination (DRE) was a strong risk factor for both cancer and advanced disease. Prostate cancer was found in 92.2% of those with abnormal DRE compared to 41.7% in those with normal DRE (p?=?0.001). Also, cancer was found in 96.1% of those with multinodular prostate on DRE (p?=?0.02) and had high odds (OR 14.6; CI 3.41–62.25) of having advanced prostate cancer (p?<?0.001). The mean (±?SD) PSA was 643.3?±?1829.8 ng/ml and the median (range) was 100 ng/ml (9.05–10,000 ng/ml) for the whole study population. All patients with prostatic-specific antigen (PSA) of 100 ng/ml or above had advanced prostate cancer.
ConclusionThe results show that there is a significant correlation between clinical findings and advanced prostate cancer. All patients with abnormal DRE and PSA above 100 ng/ml had advanced prostate cancer. Diagnosis of advanced prostate cancer is possible at the community level if PSA testing is utilized and practitioners are well trained.
相似文献To delineate the range of “risk thresholds” for prostate biopsy to determine how improved prostate cancer (CaP) risk prediction tools may impact shared decision-making (SDM).
MethodsWe conducted a cross-sectional survey study involving men 45–75 years old attending a multispecialty urology clinic. Data included demographics, personal and family prostate cancer history, and prostate biopsy history. Respondents were presented with a summary of the details, risks, and benefits of prostate biopsy, then asked to indicate the specific risk threshold (% chance) of high-grade CaP at which they would proceed with prostate biopsy.
ResultsOf a total of 103 respondents, 18 men (17%) had a personal history of CaP, and 31 (30%) had undergone prostate biopsy. The median risk threshold to proceed with prostate biopsy was 25% (interquartile range 10–50%). Risk thresholds did not vary by race, education, or employment. Personal history of CaP or prostate biopsy was significantly associated with lower mean risk thresholds (19% vs. 32% [P?=?0.02] and 23% vs. 33% [P?=?0.04], respectively). In the lowest versus highest risk threshold quartiles, there were significantly higher rates of CaP (36% vs. 1%, P?=?0.01) and prior prostate biopsy (46% vs. 17%, P?<?0.01).
ConclusionsMen have a wide range of risk thresholds for high-grade CaP to proceed with prostate biopsy. Men with a prior history of CaP or biopsy reported lower risk thresholds, which may reflect their greater concern for this disease. The extent to which refined risk prediction tools will improve SDM warrants further study.
相似文献Background
Breast papillomas often are diagnosed with core needle biopsy (CNB). Most studies support excision for atypical papillomas, because as many as one half will be upgraded to malignancy on final pathology. The literature is less clear on the management of papillomas without atypia on CNB. Our goal was to determine factors associated with pathology upgrade on excision.Methods
Our pathology database was searched for breast papillomas diagnosed by CNB during the past 10 years. We identified 277 charts and excluded lesions associated with atypia or malignancy on CNB. Two groups were identified: papillomas that were surgically excised (group 1) and those that were not (group 2). Charts were reviewed for the subsequent diagnosis of cancer or high-risk lesions. Appropriate statistical tests were used to analyze the data.Results
A total of 193 papillomas were identified. Eighty-two lesions were excised (42%). Caucasian women were more likely to undergo excision (p = 0.03). Twelve percent of excised lesions were upgraded to malignancy. Increasing age was a predictor of upgrading, but this was not significant. Clinical presentation, lesion location, biopsy technique, and breast cancer history were not associated with pathology upgrade. Two lesions in group 2 ultimately required excision due to enlargement, and both were upgraded to malignancy.Conclusions
Twenty-four percent of papillomas diagnosed on CNB have upgraded pathology on excision—half to malignancy. All of the cancers diagnosed were stage 0 or I. For patients in whom excision was not performed, 2 of 111 papillomas were later excised and upgraded to malignancy. 相似文献Malnutrition is highly prevalent and a consequence of inflammation and related comorbidities among patients on maintenance hemodialysis. Oral nutritional supplementation (ONS) is recommended for malnourished patients with kidney failure. The study aimed to evaluate renal-specific oral nutrition (ONCE dialyze) supplement on nutritional status in patients on hemodialysis.
MethodsPatients were randomized into 3 groups; treatment groups received 370 kcal/day of ONCE Dialyze (N?=?26) or 370 kcal/day of NEPRO (N?=?30) for 30 days. The control group (N?=?24) received no intervention. All patients were counseled by the same registered dietitian during the study. The nutritional status was evaluated using malnutrition inflammation score (MIS) assessment, body compositions, serum albumin and pre-albumin levels at baseline and 30 days.
ResultsEighty patients were analyzed with mean age of 57.2?±?15.9 years. The intervention group exhibited significant improvements in energy, protein, fat, fiber and magnesium intake by dietary interview compared with the control group. Percentage of changes in MIS was ? 29.0% (95% CI ? 40.5 to ? 17.4), ? 23.9% (95% CI ? 37.2 to ? 10.6) and 12.1% (95% CI ? 19.2 to 43.4) for the ONCE dialyze, NEPRO and control groups, respectively (overall P?=?0.006). Percentage of changes in serum albumin was 5.3% (95% CI 1.9–8.7), 3.3% (95% CI ? 0.1 to 6.7) and ? 0.8% (95% CI ? 4.3 to 2.7) for the ONCE dialyze, NEPRO, and control groups, respectively (overall P?=?0.039; P?=?0.043 for ONCE dialyze vs. control). No serious adverse effects were reported in any group.
ConclusionDietary advice combined with ONS especially ONCE dialyze was associated with improved MIS, serum albumin, dietary energy and macronutrient intake among patients with kidney failure on maintenance hemodialysis.
Clinical trial registrationTCTR20200801001.
相似文献This study aimed at reporting a head-to-head comparison between water vapor thermal therapy using the Rezūm? system and prostatic urethral lift using the Urolift? system in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).
Patients and methodsFrom December 2017 to November 2019, consecutive patients who underwent Rezūm? and Urolift? procedures in two urology centers have been retrospectively considered. Only patients with a prostate size less than 80 mL were included. We used the PSM method to adjust baseline differences between both groups. The co-primary endpoint included the change in International Prostate Symptom Score (IPSS) and IPSS- quality of life (QoL) from baseline to 12 months.
ResultsA total of 61 (52.1%) and 56 (47.9%) patients underwent Rezum? and Urolift? procedures, respectively. After PSM adjustment, 24 patients were included in both groups. No serious adverse events occurred (>?Clavien II) in both groups. At 12 months, higher IPSS improvement was observed in the Rezum? group (median:4 [IQR 3–5]) than in the Urolift? group (median:8 [IQR 7–12]), without statistical difference (p?=?0.08). The improvement in term of QoL at 12 m was similar (p?=?0.43). The retreatment rates were 25% (Urolift?) and 8.3% (Rezum?), p?=?0.24. Erection and ejaculatory function scores did not change significantly in either treatment group. Results in the full cohort showed that Rezum? appeared to deliver greater improvements for IPSS and IPSS-QoL (p?<?0.001 and p?=?0.006, respectively) and lower reintervention rate (p?=?0.006) than Urolift?.
ConclusionsIn this small retrospective study, our results indicate that both Rezum? and Urolift? provide a clinically significant improvement in symptoms and QoL, although some of these improvements were greater in the Rezum? arm. Future studies are needed to definitively assess which treatment would be best suited for each patient.
相似文献About 20–25% of patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric metabolic surgery (BS). Therefore, we aimed to retrospectively assess the effectiveness of adjunct treatment with the GLP-1 receptor agonist semaglutide in non-diabetic patients with WR or IWL after BS.
Materials and MethodsPost-bariatric patients without type 2 diabetes (T2D) with WR or IWL (n?=?44) were included in the analysis. The primary endpoint was weight loss 3 and 6 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP, and liver enzymes.
ResultsPatients started semaglutide 64.7?±?47.6 months (mean?±?SD) after BS. At initiation of semaglutide, WR after post-bariatric weight nadir was 12.3?±?14.4% (mean?±?SD). Total weight loss during semaglutide treatment was???6.0?±?4.3% (mean?±?SD, p?<?0.001) after 3 months (3.2 months, IQR 3.0–3.5, n?=?38) and???10.3?±?5.5% (mean?±?SD, p?<?0.001) after 6 months (5.8 months, IQR 5.8–6.4, n?=?20). At 3 months, categorical weight loss was?>?5% in 61% of patients,?>?10% in 16% of patients, and?>?15% in 2% of patients. Triglycerides (OR?=?0.99; p?<?0.05), ALT (OR?=?0.87; p?=?0.05), and AST (OR?=?0.89; p?<?0.05) at baseline were negatively associated with weight loss of at least 5% at 3 months’ follow-up (p?<?0.05).
ConclusionTreatment options to manage post-bariatric excess weight (regain) are scarce. Our results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients. However, these results need to be confirmed in a prospective randomized controlled trial to close the gap between lifestyle intervention and revision surgery in patients with IWL or WR after BS.
Graphical abstract 相似文献Polypoid lesions of the gallbladder (PLG) are common, and most are benign. Few lesions are found to be malignant, but are not preoperatively distinguished as such using common imaging modalities. Therefore, we compared characteristics of benign and malignant PLGs in depth.
MethodsWe enrolled 1204 consecutive patients diagnosed with PLG at Taipei Veterans General Hospital between January 2004 and December 2013. Patients underwent either surgery or regular follow-up with various imaging modalities for at least 24 months. The mean follow-up duration was 72 ± 32 months.
ResultsOf 1204 patients, 194 underwent surgical treatment and 1010, regular follow-up. In addition, 73 % patients were asymptomatic. The mean PLG size was 6.9 ± 7.7 (range 0.8–129) mm; the PLGs of 337 patients (28 %) grew during their follow-up periods. The majority of PLGs (90.4 %) were single lesions, and 10.5 % of patients had associated gallstones. The PLGs of 20.1 % of surgical patients were malignant. Malignant PLGs were found in 32.4 % of patients ≥50 years old and in 4.7 % of those <50 years old (p < 0.001). Right quadrant abdominal pain, epigastric pain, and body weight loss were the three most common symptoms associated with malignancy. Malignant PLGs were significantly larger than benign lesions (means: 27.5 ± 18.4 mm vs. 12.3 ± 12.3 mm, respectively, p < 0.001). Notably, the size of 5 % of malignant PLGs was 3–5 mm, and that of 8 % was 5–10 mm. The negative predictive value for gallbladder malignancy was 92.8 % based on a size ≥10 mm and 100 % based on a size ≥3 mm.
ConclusionsOur study reassesses the PLG size that warrants more aggressive intervention. Cholecystectomy remains mandatory for PLGs > 10 mm, but should also be considered a definitive diagnostic and treatment modality for PLGs with diameters of 3–10 mm.
相似文献