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1.
Waqar Haque Vivek Verma Nilan Naik E. Brian Butler Bin S. Teh 《Annals of surgical oncology》2018,25(4):928-936
Purpose
Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer with limited data to guide management. This study of a large, contemporary US database described national practice patterns and addressed the impact of radiotherapy (RT) on survival.Methods
The National Cancer Data Base was queried (2004–2013) for women with non-metastatic MBC. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan–Meier analysis evaluated overall survival (OS) between patients treated with either lumpectomy or mastectomy with or without RT, while substratifying patients into pT1–2N0 and pT3–4/N+ subcohorts. Cox proportional hazards modeling determined variables associated with OS.Results
Of 5211 total patients, 447 (9%) had lumpectomy alone, 1831 (35%) had post-lumpectomy RT, 2020 (39%) had mastectomy alone, and 913 (18%) had post-mastectomy RT (PMRT). Most patients underwent chemotherapy (79%), and mastectomy was the most common surgical approach (56%). RT delivery was impacted by many factors, including higher nodal disease (p < 0.001), but not T classification or estrogen receptor status (p > 0.05 for both). Post-lumpectomy RT was associated with higher OS in both the pT1–2N0 and pT3–4/N+ subsets (p < 0.001 for both), while PMRT was associated with OS benefits in pT3–4/N+ cases (p < 0.001), but not in pT1–2N0 cases (p = 0.259).Conclusions
In the largest study to date evaluating MBC, practice patterns of surgery, systemic therapy, and RT are described. The addition of RT in the post-lumpectomy setting was associated with higher OS, in addition to pT3–4/N+ in the post-mastectomy setting. Although not implying causation, further work is required to corroborate the conclusions herein.2.
Devi Mukkai Krishnamurty Alexander T. Hawkins Katerina O. Wells Matthew G. Mutch Mathew L. Silviera Sean C. Glasgow Steven R. Hunt Sekhar Dharmarajan 《Journal of gastrointestinal surgery》2018,22(5):906-912
Background
A paucity of data exists in the use of neoadjuvant chemoradiation therapy (NRT) for T4, non-metastatic colon cancer. This study was conducted to determine the effect of NRT on outcomes after resection for T4 colon cancer.Methods
All patients with non-metastatic resected clinical T4 colon cancer from 2000 to 2012 at a tertiary care center were included. The cohort was divided into two groups—those that received NRT and those that did not (non-NRT). The primary outcomes were margin-negative resection and overall survival (OS).Results
One hundred and thirty-one consecutive patients with non-metastatic clinical T4 colon cancer with a mean age of 65 years were included. NRT was used in 23 patients (17.4%). NRT group was noted to have non-statistically significant improvement in R0 resection rate (NRT 95.7% vs non-NRT 88.0%; p?=?0.27) and local recurrence (NRT 4.3% vs non-NRT 15.7%; p?=?0.15). There was a significant difference in T-stage downstaging between the two groups (NRT 30.4% vs non-NRT 6.5%; p?=?0.007). In a bivariate analysis, NRT was associated with improved 5-year OS (NRT 76.4% vs non-NRT 51.5%; p?=?0.03). This relationship did not persist in a Cox proportional hazard analysis that included age and comorbidity (HR 2.19; 95% CI 0.87–5.52; p?=?0.09).Conclusions
The use of NRT in locally advanced T4 colon cancer is safe and associated with increased downstaging. While there was a trend toward improvement in local recurrence and the ability to obtain margin-negative resections in the NRT group, this was not significant. Significantly improved overall survival was not observed in a multivariable analysis.3.
Arfon Powell Alexandra Harriet Coxon Neil Patel David Chan Adam Christian Wyn Lewis 《Journal of gastrointestinal surgery》2018,22(9):1516-1527
Background
Survival and relapse after gastric cancer surgery are largely attributed to tumor biology and surgical radicality; yet, other prognostic factors have been reported, including respiratory sepsis and anastomotic leakage, but not global morbidity severity score (MSS). The hypothesis tested was that MSS would be associated with both disease-free (DFS) and overall survival (OS).Methods
Consecutive 373 patients undergoing potentially curative surgery for gastric adenocarcinoma between 2004 and 2016 in a UK cancer network were studied. Complications were defined prospectively as any deviation from a pre-determined post-operative course within 30 days of surgery and classified according to the Clavien-Dindo severity classification (CDSC). Primary outcome measures were DFS and OS.Results
Post-operative complications were identified in 127 (34.0%) patients, which was associated with 9 (2.4%) post-operative deaths. Five-year DFS and OS were 35.9 and 38.5% for patients with a post-operative complication compared with 59.5 and 61.5% in controls (p?<?0.001, p?=?0.001, respectively). On multivariable DFS analysis, post-operative morbidity [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.06–2.50, p?=?0.026] was independently associated with poor survival. On multivariable OS analysis, post-operative morbidity HR 2.25 (95% CI 1.04–4.85, p?=?0.039) and CDSC HR 1.76 (95% CI 1.35–2.29, p?<?0.001) were independently associated with poor survival. These associations were also observed in patients with TNM stage I and II disease with morbidity HR 7.06 (95% CI 1.89–26.38, p?=?0.004) and CDSC HR 2.93 (95% CI 1.89–4.55, p?<?0.001) offering independent prognostic value.Conclusion
Post-operative CDSC was an important independent prognostic factor after potentially curative gastrectomy for carcinoma associated with both DFS and OS. Prehabilitation strategies to minimize complications are warranted.4.
Caitlin Hester Ibrahim Nassour Beverley Adams-Huet Mathew Augustine Michael A. Choti Rebecca M. Minter John C. Mansour Patricio M. Polanco Matthew R. Porembka Sam C. Wang Adam C. Yopp 《Journal of gastrointestinal surgery》2018,22(12):2080-2087
Background
Data on the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (dCCA) is limited. This study aimed to determine the role of AT in resected dCCA and identify subgroups that benefit from AT.Methods
We conducted a retrospective review of surgically resected dCCA in the NCDB from 2004 to 2013. Patients who received AT or observation (OB) were matched by propensity score. Log-rank test was used to compare OS.Results
Of 1782 patients with resected dCCA, 840 (47%) were in the OB group and 942 (53%) in the AT group. AT was younger (64.0 vs. 68.7 years, p?<?0.001), had less comorbidities (Charlson Deyo score 0) (74.6 vs. 68.0%, p?<?0.001), and more likely to have private insurance (p?<?0.001). AT was more likely to present with T3/T4 stage (72 vs. 57%, p?<?0.001), N1/N2 disease (58 vs. 37%, p?<?0.001), and positive surgical margins (26 vs. 16%, p?<?0.001). After 1:1 propensity score matching, 500 OB and 500 AT patients were compared. AT was associated with better OS (HR 0.79; 95% CI 0.67–0.93). Median OS was 31 and 25 months for the AT and OB (p?=?0.006). The 1-, 3-, and 5-year survival rates were 87, 46, and 31% for AT; 79, 39, and 24% for OB. Subgroup analysis revealed an associated survival advantage for AT in T3/T4 tumors (HR?=?0.72; 95% CI 0.59–0.89), node positive disease (HR 0.70; 95% CI 0.56–0.87), and positive margins (HR 0.58; 95% CI 0.42–0.81).Conclusion
AT is associated with improved OS in resected dCCA, especially in T3/T4 tumors, node positive disease, and positive margins.5.
H. Bomberg N. Paquet A. Huth S. Wagenpfeil P. Kessler H. Wulf T. Wiesmann T. Standl A. Gottschalk J. Döffert W. Hering J. Birnbaum B. Kutter J. Winckelmann S. Liebl-Biereige W. Meissner O. Vicent T. Koch H. Bürkle D. I. Sessler A. Raddatz T. Volk 《Der Anaesthesist》2018,67(12):922-930
Background
Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown.Objective
This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth.Material and methods
A total of 14,503 epidural catheter insertions including lumbar (L1–L5; n?=?5367), low thoracic (T7–T12, n?=?8234) and upper thoracic (T1–T6, n?=?902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015. The primary outcomes were compared with logistic regression and adjusted (adj) for confounders to determine the risk of complications/events. Results are presented as odds ratios (OR, [95% confidence interval]).Main results
Midline insertion depth depended on body mass index, sex, and spinal level. After adjusting for confounders increased puncture depth (cm) remained an independent risk factor for vascular puncture (adjOR 1.27 [1.09–1.47], p?=?0.002) and multiple skin punctures (adjOR 1.25 [1.21–1.29], p?<?0.001). In contrast, dural punctures occurred at significantly shallower depths (adjOR 0.73 [0.60–0.89], p?=?0.002). Paraesthesia was unrelated to insertion depth. Body mass index and sex had no influence on paraesthesia, dural and vascular punctures. Thoracic epidural insertion was associated with a lower risk of vascular puncture than at lumbar sites (adjOR 0.39 [0.18–0.84], p?=?0.02).Conclusion
Variation in midline insertion depth is an independent risk factor for epidural complications; however, variability precludes use of depth as a reliable guide to insertion in individual patients.6.
Multifactorial Analysis of Prognostic Factors and Survival Rates Among 706 Mucosal Melanoma Patients
ChuanLiang Cui Bin Lian Li Zhou Xin Song XiaoShi Zhang Di Wu ZhiHong Chi Lu Si XiNan Sheng Yan Kong BiXia Tang LiLi Mao Xuan Wang SiMing Li Jie Dai XieQiao Yan Xue Bai Charles M. Balch Jun Guo 《Annals of surgical oncology》2018,25(8):2184-2192
Background
The hypothesis that mucosal melanomas from different anatomic sites would have different prognostic features and survival outcome was tested in a multifactorial analysis.Methods
Complete clinical and pathological information from 706 mucosal melanoma patients from different anatomical sites was compared for overall survival (OS) and prognostic factors.Results
Mucosal melanomas arising from different anatomical sites did not have any significant differences in OS in a multivariate analysis (p?=?0.721). Among all 706 stage I–IV mucosal melanoma patients, depth of tumor invasion (p?<?0.001), number of lymph node metastases (p?<?0.001), and sites of distant metastases (p?<?0.001) were independent prognostic factors for OS; among 543 stage I–III patients, depth of tumor invasion (p?<?0.001) and number of lymph node metastases (p?<?0.001) were independent prognostic factors for OS; and among 547 stage IV patients, depth of tumor invasion (p?=?0.009), number of lymph node metastases (p?<?0.001), and combined distant metastases and elevation of serum lactate dehydrogenase (LDH; p?<?0.001) were independent prognostic factors for OS. The presence of c-KIT or BRAF mutations was not predictive of survival.Conclusions
This is the first large-scale study comparing outcomes of mucosal melanomas from different anatomic sites in a multifactorial analysis. There were no significant survival differences among mucosal melanomas arising at different sites when matched for staging and prognostic and molecular factors, thus rejecting our hypothesis. We concluded that prognostic characteristics of mucosal melanomas can be staged as a single histological group, regardless of the anatomic site of the primary tumor.7.
Camila C. Araujo Suelene S. A. Coelho Natalia Martinho Mariana Tanaka Rodrigos M. Jales Cassia R. T. Juliato 《International urogynecology journal》2018,29(10):1543-1549
Introduction and hypothesis
We used clinical examination and transperineal 3D/4D ultrasound (US) to evaluate pelvic floor muscles (PFM) after different delivery modes.Methods
Women were surveyed using validated questionnaires. PFM were evaluated and classified according to the Modified Oxford Scale following 3D/4D transperineal US. For statistical analysis, Kruskal–Wallis, Mann–Whitney, chi-square, and Fisher exact tests were used.Results
Fifty-three women were evaluated: 32 with previous vaginal delivery (VD) and 21 with cesarean section (CS) (8 nonelective and 13 elective). No significant difference among groups was observed regarding urinary incontinence (UI) after delivery (p?=?0.39), loss of muscle strength referred by the patient (p?=?0.48), or evaluated through digital examination (p?=?0.87). No patient with elective CS had avulsion, with difference between VD and elective CS (p?=?0.008). US evaluation identified no differences in bladder-neck elevation (p?=?0.69) or descent (p?=?0.65) , and no difference in genital hiatus size (p?=?0.35), levator ani thickness (p?=?0.35 –0.44), or presence of major or minor levator ani avulsion (p?=?0.10).Conclusions
We evaluated primiparous women within 12 to 24 months of delivery and found that VD was associated with PFM avulsion. There was no difference among VD and nonelective or elective CS in symptomatology or other anatomic alterations evaluated through 3D/4D transperineal US.8.
Xu-Feng Zhang Qinyu Chen Charles W. Kimbrough Eliza W. Beal Yi Lv Jeffery Chakedis Mary Dillhoff Carl Schmidt Jordan Cloyd Timothy M. Pawlik 《Journal of gastrointestinal surgery》2018,22(4):668-675
Background
Surgical management of intrahepatic cholangiocarcinoma routinely includes resection of the hepatic parenchyma, yet the role of lymphadenectomy (LND) is more controversial. The objective of the current study was to define overall utilization, as well as temporal trends, in the utilization of LND among patients undergoing curative-intent hepatectomy for ICC using a nationwide database.Materials and Methods
One thousand four hundred ninety-six patients who underwent curative-intent resection for ICC were identified using the SEER database from 2000 to 2013. The utilization of LND was assessed over time and by geographic region. LND utilization and the incidence of lymph node metastasis (LNM) were evaluated relative to AJCC T categories.Results
At the time of surgery, slightly over one-half of patients (n?=?784, 52.4%) had at least one LN evaluated. Specifically, 613 (41.0%) patients had 1–5 LNs evaluated, whereas 171 (11.4%) patients had ≥?6 LNs evaluated. The proportion of patients who had at least one LN evaluated at the time of surgery did not change with time (2000–2004: 50.5% vs. 2005–2009: 52.0% vs. 2010–2013: 53.7%) (p?=?0.636). In contrast, the proportion of patients who had ≥?6 LNs examined did increase (2000–2004: 6.9% vs. 2005–2009: 10.6% vs. 2009–2013: 14.3%) (p?=?0.003). The risk of LNM was higher among patients with advanced T category tumors (Referent T1; T2a: OR 4.2, 95% CI 2.0–8.8, p?<?0.001; T2b: OR 2.4, 95% CI 1.1–4.9, p?=?0.018; T3: OR 3.6, 95% CI 1.6–7.9, p?=?0.001; T4: OR 2.2, 95% CI 1.0–4.9, p?=?0.049). In addition, the portion of patients with LNM varied among the different T categories (T1, 23.2%, T2a, 55.3%, T2b, 42.0%, T3, 51.4%, and T4, 39.5%; p?=?0.001).Conclusions
Utilization of LND in the surgical management of ICC across the USA remained relatively low and did not change over the last decade. Selective utilization of LND may be problematic as T-stage was not a reliable predictor of nodal status with almost a quarter of patients with early stage disease having LNM.9.
Teodor Kacso Cosmina Ioana Bondor Crina Claudia Rusu Diana Moldovan Dacian Trinescu Laura Anca Coman Maria Ticala Alexandra Maria Gavrilas Alina Ramona Potra 《International urology and nephrology》2018,50(9):1661-1666
Purpose
Adiponectin an adipokine, produced by mature adipocyte, has an important effect on several aspects of endothelial function, including leukocyte adhesion (mediated by adhesion molecules like intercellular adhesion molecule 1 (ICAM1) endothelial cell selective adhesion molecule ESAM). Recently, it has been linked to vascular endothelial growth factor (VEGF)-modulated angiogenesis. ESAM might also be involved in modulating VEGF-dependent actions. We studied relationship of adiponectin to ESAM, ICAM1, and VEGF in type 2 diabetic patients (T2DP) with or without microvascular complications.Methods
Incident T2DP referred for nephrologic evaluation were included (patients with no nephropathy or stage 1–4 nephropathy). T2DP with stage 5 chronic kidney disease (CKD) were selected from a dialysis center. Clinical, standard laboratory assessment and adiponectin, ESAM, ICAM1, and VEGF (ELISA) were recorded.Results
Eighty-seven patients were included, 15 had no CKD, 30 with stage 1 or 2 CKD, 20 with stage 3 or 4 CKD and 22 patients on dialysis. ESAM was higher in patients with CKD than in those without CKD (p?=?0.02), adiponectin, ICAM1, and VEGF were similar. Adiponectin correlated in univariate analysis to ESAM (r?=?0.32, p?=?0.002), ICAM1 (r?=?0.23, p?=?0.038), and CRP (r?=?0.31, p?=?0.012), and inversely to serum albumin (r?=???0.57, <?0.0001). In predialysis patients, adiponectin also correlated to albuminuria (r?=?0.54, p?<?0.0001) and glomerular filtration rate (r?=???0.46, p?=?0.0001). In multivariate regression ESAM (p?=?0.04), VEGF (p?=?0.03), and albumin (p?<?0.0001) are significant predictors of adiponectin. None of these cytokines were different when comparing patients with and without retinopathy.Conclusion
Adiponectin is directly linked to adhesion molecules and VEGF in T2DP.10.
Sarka Davidkova Timothy D. Prestidge Peter W. Reed Tonya Kara William Wong Chanel Prestidge 《Pediatric nephrology (Berlin, Germany)》2016,31(5):819-826
Background
Anemia is a major complication for patients on chronic dialysis. Erythropoietin is effective if iron is available, however unnecessary iron supplementation results in iron overload. Reticulocyte hemoglobin equivalent (Ret-He) may be useful for assessing iron status.Methods
A national retrospective cohort study including all children on chronic dialysis in New Zealand between 2007 and 2013, pairing Ret-He with demographic information, anemia indices, and markers of iron status.Results
In 606 observations, we found a modest relationship between Ret-He and transferrin saturation (TSAT) (r?=?0.34, p?<?0.001) and a poor correlation between Ret-He and ferritin (r?=?0.09, p?=?0.04). There was a negative correlation between ferritin and hemoglobin (r?=??0.14, p?=?0.002), a weak positive correlation between TSAT and hemoglobin (r?=?0.12, p?=?0.007), and a modest positive correlation between Ret-He and hemoglobin (r?=?0.22, p?<?0.001). The diagnostic performance of Ret-He to detect absolute iron deficiency (cut-off value 28.9 pg, sensitivity 90 %, specificity 75 %, AUC 0.87) was good.Conclusions
Ret-He is a more relevant marker of iron status than ferritin and TSAT. This supports prospectively testing Ret-He to distinguish between iron deficiency and suboptimal erythropoietin dosing as competing causes for anemia. Ferritin is an unhelpful biomarker of iron deficiency in this setting.11.
Hiroshi Juri Mitsuhiro Koyama Haruhito Azuma Yoshifumi Narumi 《International urology and nephrology》2018,50(10):1771-1778
Purpose
The purpose of the study was to retrospectively determine whether there are metastases to the chest in patients with primary non-muscle-invasive urothelial carcinoma in the bladder on the follow-up computed tomography (CT).Methods
We analyzed 328 patients with follow-up chest CT for urothelial carcinoma of the bladder diagnosed between January 2004 and September 2013. We divided patients into four groups: Ta (n?=?74), T1 (n?=?78), carcinoma in situ (CIS, n?=?25), and ≥?T2 (n?=?151). We used the chest CT to determine whether there were positive findings of metastasis. Univariate and multivariate analyses were achieved using categories of T stage, histological grade, multifocal lesions, and recurrence.Results
On univariate analysis, there were significant differences on T stage (p?<?0.001) and histological grade (p?=?0.001), and there was no significant difference on multifocal lesions (p?=?0.11) and recurrence (p?=?0.34). Positive findings of metastases were observed in 1.4% (1/74) of the Ta patients, 0% (0/78) of the T1 patients, 8.0% (2/25) of the patients with carcinoma in situ (CIS), and 27.2% (41/151) of the ≥?T2 patients (p?<?0.001). On multivariate analysis, T staging was independent variable for positive findings of metastasis (Odds ratio; 2.84, 95% Confidence Interval; 1.65–4.89). In contrast, histological grade, multifocal lesions, and recurrence were not independent variables.Conclusions
T stage would affect to metastasis to the chest. It might be appropriate to omit chest CT in patients with Ta or T1 without upstaging in the course of follow-up. We may suggest that the follow-up chest CT in patients with CIS.12.
Georgios Antonios Margonis Kazunari Sasaki Yuhree Kim Mario Samaha Stefan Buettner Neda Amini Efstathios Antoniou Timothy M. Pawlik 《Journal of gastrointestinal surgery》2016,20(11):1821-1829
Introduction
The interplay of tumor biology and surgical margin status after resection for colorectal liver metastasis (CRLM) remains controversial. Consequently, we sought to determine the impact of surgical margin status on overall survival (OS) stratified by KRAS mutational status.Materials and Methods
Four hundred eighty-five patients with known KRAS mutational status were identified. Clinicopathologic and long-term survival data were collected and assessed.Results
On pathology, most patients (n?=?380; 78.3 %) had an R0 margin, while 105 (21.7 %) had an R1. Roughly two thirds of tumors were KRAS wild type (wtKRAS) (n?=?307, 63.3 %), while 36.7 % (n?=?178) had KRAS mutations (mutKRAS). Median and 5-year OS of the entire cohort was 65.8 months and 53.8 %, respectively. An R1 resection was associated with worse 5-year OS compared with R0 (42.4 % vs. 57.1 %; hazard ratio (HR) 1.82, 95 % CI 1.28–2.57; P?=?0.001). After controlling for KRAS status, the survival benefit associated with an R0 resection persisted only among patients with wtKRAS tumors (HR 2.16, 95 % CI 1.42–3.30; P?<?0.001). In contrast, surgical margin had no impact on OS among patients with mutKRAS tumors (5-year OS R0, 40.7 % vs. R1, 46.7 %; HR 1.34, 95 % CI 0.73–2.48; P?=?0.348).Conclusion
The impact of margin status differed by KRAS mutation status. An R0 margin only provided a survival benefit to patients with wtKRAS tumors. Tumor biology and not surgical technique determined prognosis.13.
M. Francesca Monn Joshua D. Roth Richard Bihrle Matthew J. Mellon 《International urology and nephrology》2018,50(8):1375-1380
Purpose
Radiation-induced ureteral stricture disease poses significant surgical challenges. Ureteral substitution with ileum has long been a versatile option for reconstruction. We evaluated outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction due to radiation-induced ureteral stricture versus other causes.Methods
Between July 1989 and June 2013, 155 patients underwent consecutive ileal ureter creation. The study cohort included 104 patients with complete data sets and at least 7 months of follow up. Records were retrospectively reviewed with regard to demographics, indications, complications, and renal deterioration.Results
Surgical indications included radiation-induced stricture in 23 (22%) and non-radiation-induced stricture in 81 (78%). Comparing ileal ureter substitution due to radiation versus other stricture etiologies, no statistical significance was observed in regard to age (45.6 vs. 51.2, p?=?0.141), hospital length of stay in days (8.8 vs. 7.7, p?=?0.216), percent GFR loss (MDRD-4 vs. -5%, p?=?0.670 and CKD-EPI-7 vs. -6%, p?=?0.914), 30-day surgical complications (26.1 vs. 30.1%, p?=?0.658), metabolic acidosis (8.7 vs. 1.2%, p?=?0.059), and renal failure requiring dialysis (4.3 vs. 1.2%, p?=?0.337). Fistula formation (13.0 vs. 3.7%, p?=?0.095), partial small bowel obstructions (21.7 vs. 7.4%, p?=?0.063), and small bowel obstructions requiring reoperation (13.0 vs. 1.2%, p?=?0.033) approached or reached statistical significance. Using Kaplan–Meier methodology, there was no difference in time to worsening renal outcome between the radiation and non-radiation groups (p?>?0.05).Conclusion
Ureteral substitution with ileum is an effective reconstructive option for radiation-induced ureteral strictures in carefully selected patients.14.
J. Paccou M. H. Edwards J. M. Patsch K. A. Jameson K. A. Ward C. Moss E. M. Dennison C. Cooper 《Osteoporosis international》2016,27(11):3279-3287
Summary
In older women, the presence of lower leg arterial calcification assessed by high-resolution peripheral quantitative computed tomography is associated with relevant bone microstructure abnormalities at the distal tibia and distal radius.Introduction
Here, we report the relationships of bone geometry, volumetric bone mineral density (BMD) and bone microarchitecture with lower leg arterial calcification (LLAC) as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods
We utilized the Hertfordshire Cohort Study (HCS), where we were able to study associations between measures obtained from HR-pQCT of the distal radius and distal tibia in 341 participants with or without LLAC. Statistical analyses were performed separately for women and men. We used linear regression models to investigate the cross-sectional relationships between LLAC and bone parameters.Results
The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5)?years in women and men, respectively. One hundred and eleven of 341 participants (32.6 %) had LLAC that were visible and quantifiable by HR-pQCT. The prevalence of LLAC was higher in men than in women (46.4 % (n?=?83) vs. 17.3 % (n?=?28), p?<?0.001). After adjustment for confounding factors, we found that women with LLAC had substantially lower Ct.area (β?=??0.33, p?=?0.016), lower Tb.N (β?=??0.54, p?=?0.013) and higher Tb.Sp (β?=?0.54, p?=?0.012) at the distal tibia and lower Tb.Th (β?=??0.49, p?=?0.027) at the distal radius compared with participants without LLAC. Distal radial or tibial bone parameter analyses in men according to their LLAC status revealed no significant differences with the exception of Tb.N (β?=?0.27, p?=?0.035) at the distal tibia.Conclusion
In the HCS, the presence of LLAC assessed by HR-pQCT was associated with relevant bone microstructure abnormalities in women. These findings need to be replicated and further research should study possible pathophysiological links between vascular calcification and osteoporosis.15.
Background and purpose
Positive surgical margins (PSMs) correlate with adverse outcomes in numerous solid tumours. However, the prognostic value of PSMs in prostate cancer (PCa) patients who underwent radical prostatectomy remains unclear. Herein, we performed a meta-analysis to evaluate the association between PSMs and the prognostic value for biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients.Materials and methods
According to the PRISMA statement, online databases PubMed, EMBASE and Web of Science were searched to identify relevant studies published prior to February 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to evaluate the relationship between PSMs and PCa.Results
Ultimately, 32 cohort studies that met the eligibility criteria and involved 141,222 patients (51–65,633 per study) were included in this meta-analysis. The results showed that PSMs were significantly predictive of poorer BRFS (HR?=?1.35, 95% CI 1.28–1.48, p?<?0.001), CSS (HR?=?1.49, 95% CI 1.16–1.90, p?=?0.001) and OS (HR?=?1.11, 95% CI 1.02–1.20, p?=?0.014). In addition, PSMs were significantly associated with higher risk of CSM (HR?=?1.23, 95% CI 1.16–1.30, p?<?0.001) and OM (HR?=?1.09, 95% CI 1.02–1.16, p?=?0.009) in patients with PCa.Conclusions
Our study suggests that the presence of a histopathologic PSM is associated with the clinical outcomes BRFS, CSS, OS, CSM and OM in patients with PCa, and PSMs could serve as a poor prognostic factor for patients with PCa.16.
Background
Most of the cases of PHPT in developing countries present in symptomatic stage, some even in very advanced stage but in recent years the trend seems to be changing. This has been corroborated from few recently published literature from developing countries. The scope of this study is to further carry out an in-depth analysis of various clinical and biochemical parameters of PHPT patients at a tertiary care center of northern India.Methods
In this retrospective analysis, a total of 333 patients with PHPT from the year 1990 to 2016 were studied. The study population was divided into three subgroups based on the time span; 1990–1999 (n?=?34), 2000–2009 (n?=?112), 2010–2016 (n?=?187), and clinical and biochemical parameters were compared.Results
The clinical presentation has evolved progressively with increase in older age group (35 vs 39 vs 43.85, p?<?0.001), less patients with musculoskeletal symptoms (85.3 vs 76.8 vs 61%, p?=?0.002) and less patients with severe bone disease (29.4 vs 10.7 vs 10.7%, p?=?0.088). Biochemical parameters also showed a changing trend with significant decrease in mean S. Alkaline phosphatase (1393 vs 965 vs 414.8 IU/L, p?<?0.001) and S. iPTH (837.52 vs 812.89 vs 635.74 pg/mL, p?=?0.02). Vitamin D nutrition status is still suboptimal but shows improvement, and more patients are insufficient as compared to previous deficient state (mean S. Vitamin D—10.31 vs 16.16 vs 25.30 ng/mL, p?<?0.001).Conclusions
Our study reveals a change in trend in PHPT which is similar to evolution of this disease in western population and positively corroborated with observations from China, Hong Kong and Turkey.17.
E. Griffo M. Cotugno G. Nosso G. Saldalamacchia A. Mangione L. Angrisani A. A. Rivellese B. Capaldo 《Obesity surgery》2016,26(6):1247-1253
Background
Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients.Methods
A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed.Results
The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p?≤?0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p?<?0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p?<?0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p?<?0.001 for both). Postprandial triglycerides decreased after both procedures (p?<?0.05) while postprandial LDL cholesterol decreased only after RYGB (p?<?0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p?<?0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p?=?0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β?=??0.552, p?=?0.039) while the improvement of HOMA-IR (β?=?0.574, p?=?0.014) and weight loss (β?=?0.418, p?=?0.036) predicted triglycerides reduction.Conclusions
Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.18.
Zachary?A.?Hamilton Robert?G.?Uzzo Alessandro?Larcher Brian?R.?Lane Benjamin?Ristau Umberto?Capitanio Stephen?Ryan Sumi?Dey Andres?Correa Madhumitha?Reddy James?A.?Proudfoot Ryan?Nasseri Kendrick?Yim Sabrina?Noyes Ahmet?Bindayi Francesco?Montorsi Ithaar?H.?Derweesh
Background
We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.Methods
A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥?CKD Stage III [estimated glomerular filtration rate (eGFR) <?60 mL/min/1.73 m2] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4–6), intermediate (7–9), complex (10–12)]. Secondary outcomes included eGFR decline >?50%.Results
728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p?=?0.148) was noted between groups. RPN had lower median estimated blood loss (p?<?0.001), and hospital stay (3 vs. 5 days, p?<?0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p?=?0.089), positive margin (p?=?0.256), transfusion (p?=?0.166), and 30-day complications (p?=?0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p?=?0.328), intermediate (2.1 vs. 2.1, p?=?0.384), and complex (4.9 vs. 6.1, p?=?0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p?=?0.001) and complex RENAL score (OR 5.61, p?=?0.03) were independent predictors for eGFR decline >?50%. Kaplan–Meier analysis demonstrated 5-year freedom from eGFR decline >?50% of 88.6% for OPN and 88.3% for RPN (p?=?0.724).Conclusions
RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.19.
Alexandra?W.?Acher Malcolm?H.?Squires Ryan?C.?Fields George?A.?Poultsides Carl?Schmidt Konstantinos?I.?Votanopoulos Timothy?M.?Pawlik Linda?X.?Jin Aslam?Ejaz David?A.?Kooby Mark?Bloomston David?Worhunsky Edward?A.?Levine Neil?Saunders Emily?Winslow Clifford?S.?Cho Glen?Leverson Shishir?K.?Maithel Sharon?M.?Weber
Background
This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival.Methods
Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted.Results
Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p?<?0.0128), American Society of Anesthesiology status ≥3 (p?=?0.0045), preexisting cardiac disease (p?<?0.0001), hypertension (p?=?0.0142), history of smoking (p?=?0.0254), increased preoperative blood urea nitrogen (BUN; p?=?0.0426), concomitant pancreatectomy (p?=?0.0056), increased operation time (p?=?0.0384), estimated blood loss (p?=?0.0196), 25th percentile length of stay (<7 days, p?=?0.0166), 75th percentile length of stay (>12 days, p?=?0.0256), postoperative complication (p?<?0.0001), and total gastrectomy (p?=?0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p?<?0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p?<?0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p?=?0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p?=?0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p?=?0.0002).Conclusions
Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.20.
Anant Dixit Frank S. Cautela Colin S. Cooper George A. Beyer James C. Messina Jeffrey E. Mait Neil V. Shah Bassel G. Diebo Carl B. Paulino William P. Urban 《Journal of orthopaedics and traumatology》2018,19(1):12