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1.
Brent K. Hollenbeck Samuel R. Kaufman Phyllis Yan Lindsey A. Herrel Tudor Borza Florian R. Schroeck Bruce L. Jacobs Ted A. Skolarus Vahakn B. Shahinian 《European urology》2018,73(4):491-498
Background
Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.Objective
To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.Design, setting, and participants
A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.Intervention
Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.Outcome measurements and analysis
Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.Results
Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.Conclusions
Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.Patient summary
We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient. 相似文献2.
Ilana Sebbag Raymond Tang Vit Gunka JagPaul Sahota Himat Vaghadia Andrew Sawka 《Brazilian Journal of Anesthesiology》2018,68(3):280-284
Study objective
The purpose of this study was to assess whether application of dorsal table tilt and body rotation to a parturient seated for neuraxial anesthesia increased the size of the paramedian target area for neuraxial needle insertion.Setting
Labor and Delivery Room.Patients
Thirty term pregnant women, ASA I–II, scheduled for an elective C‐section delivery.Interventions
Lumbar ultrasonography was performed in four seated positions: (F) lumbar flexion; (FR) as in position F with right shoulder rotation; (FT) as in position F with dorsal table‐tilt; (FTR) as in position F with dorsal table‐tilt combined with right shoulder rotation.Measurements
For each position, the size of the ‘target area’, defined as the visible length of the posterior longitudinal ligament was measured at the L3‐L4 interspace.Main results
The mean posterior longitudinal ligament was 18.4 ± 4 mm in position F, 18.9 ± 5.5 mm in FR, 19 ± 5.3 mm in FT, and 18 ± 5.2 mm in FTR. Mean posterior longitudinal ligament length was not significantly different in the four positions.Conclusions
These data show that the positions studied did not increase the target area as defined by the length of the posterior longitudinal ligament for the purpose of neuraxial needle insertion in obstetric patients. The maneuvers studied will have limited use in improving spinal needle access in pregnant women. 相似文献3.
David F. Friedlander Quoc-Dien Trinh Anna Krasnova Stuart R. Lipsitz Maxine Sun Paul L. Nguyen Adam S. Kibel Toni K. Choueiri Joel S. Weissman Mani Menon Firas Abdollah 《European urology》2018,73(3):445-451
Background
The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races.Objective
To examine facility level variation in the use of definitive therapy among Black and White men for localized PCa.Design, setting, and participants
Using data from the National Cancer Data Base, we identified 223 873 White and 59 262 Black men ≥40 yr of age receiving care within the USA with biopsy confirmed localized intermediate/high-risk PCa diagnosed between January 2004 and December 2013.Outcome measurements and statistical analysis
Multilevel logistic regression was fitted to predict the odds of receiving definitive therapy for PCa. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences when appropriate.Results and limitations
Eighty-three percent (n = 185 647) of White men received definitive therapy compared with 74% (n = 43 662) of Black men between 2004 and 2013. Overall rates of definitive therapy during that time increased for both White (81% vs 83%, p < 0.001) and Black (73% vs 75%, p = 0.001) men. However, 39% of treating facilities demonstrated significantly higher rates of definitive therapy in White men, compared with just 1% favoring Black men. Our study is limited by potential selection bias and effect modification.Conclusions
After adjusting for sociodemographic and clinical factors, we found that most facilities favored definitive therapy in Whites. Health care providers should be aware of these inherit biases when counseling patients on treatment options for localized PCa. Our study is limited by the retrospective nature of the cohort.Patient summary
We found significant differences in rates of radiation and surgical treatment for prostate cancer among White and Black men, with most facilities favoring Whites. Nonclinical factors such as treatment facility type and location influenced rates of therapy. 相似文献4.
Armin Soave Roland Dahlem Hans O. Pinnschmidt Michael Rink Jessica Langetepe Oliver Engel Luis A. Kluth Birte Loechelt Philip Reiss Sascha A. Ahyai Margit Fisch 《European urology》2018,73(6):910-922
Background
Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial.Objective
To analyze in detail intensity and quality of pain as well as oral morbidity following closure (C) versus nonclosure (NC) of the donor site.Design, setting, and participants
Randomized controlled trial on 135 patients treated with BMGU between October 15, 2014 and December 18, 2015.Intervention
Following computer-based randomization, 63 and 72 patients, respectively, received C and NC of the donor site at the inner cheek. Preoperatively, on days 1, 5, and 21 as well as at 3 and 6 mo postoperatively, patients completed standardized questionnaires, including validated questions on intensity and quality of pain as well as oral morbidity.Outcome measurements and statistical analysis
The coprimary end points were intensity and quality of oral pain. Secondary end points included oral morbidity and intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of various covariates on intensity and quality of oral pain, oral morbidity, as well as intensity of pain of the perineogenital region.Results and limitations
There was noninferiority for NC versus C in intensity and affective quality of oral pain at every time point following BMGU. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, whistling, diet, and speech. Time from BMGU had significant effects on intensity (p < 0.001) and quality of oral pain (sensory pain: p < 0.001, affective pain: p < 0.001, total pain: p < 0.001). Length of buccal mucosa graft had significant effects on intensity (p = 0.001) and quality of oral pain (sensory pain: p = 0.020, total pain: p = 0.042).Conclusions
NC is noninferior to C of the donor site in intensity and quality of oral pain, and offers a treatment alternative. Time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications.Patient summary
We investigated pain, morbidity, and complications following closure (C) versus nonclosure (NC) of the buccal mucosa harvest site in patients undergoing buccal mucosa graft urethroplasty (BMGU). We found that NC is not worse than C regarding oral pain. In addition, time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications. 相似文献5.
Matthew D. Galsky Huan Wang Noah M. Hahn Przemyslaw Twardowski Sumanta K. Pal Costantine Albany Mark T. Fleming Alexander Starodub Ralph J. Hauke Menggang Yu Qianqian Zhao Guru Sonpavde Michael J. Donovan Vaibhav G. Patel John P. Sfakianos Josep Domingo-Domenech William K. Oh Nicholas Akers Andrew V. Uzilov 《European urology》2018,73(5):751-759
Background
Chemotherapy may exert immunomodulatory effects, thereby combining favorably with the immune checkpoint blockade. The pharmacodynamic effects of such combinations, and potential predictive biomarkers, remain unexplored.Objective
To determine the safety, efficacy, and immunomodulatory effects of gemcitabine and cisplatin (GC) plus ipilimumab and explore the impact of somatic DNA damage response gene alterations on antitumor activity.Design, setting, and participants
Multicenter single arm phase 2 study enrolling 36 chemotherapy-naïve patients with metastatic urothelial cancer. Peripheral blood flow cytometry was performed serially on all patients and whole exome sequencing of archival tumor tissue was performed on 28/36 patients.Intervention
Two cycles of GC followed by four cycles of GC plus ipilimumab.Outcome measurements and statistical analysis
The primary endpoint was 1-yr overall survival (OS). Secondary endpoints included safety, objective response rate, and progression-free survival.Results and limitations
Grade ≥3 adverse events occurred in 81% of patients, the majority of which were hematologic. The objective response rate was 69% and 1-yr OS was 61% (lower bound 90% confidence interval: 51%). On exploratory analysis, there were no significant changes in the composition and frequency of circulating immune cells after GC alone. However, there was a significant expansion of circulating CD4 cells with the addition of ipilimumab which correlated with improved survival. The response rate was significantly higher in patients with deleterious somatic DNA damage response mutations (sensitivity = 47.6%, specificity = 100%, positive predictive value = 100%, and negative predictive value = 38.9%). Limitations are related to the sample size and single-arm design.Conclusions
GC + ipilimumab did not achieve the primary endpoint of a lower bound of the 90% confidence interval for 1-yr OS of >60%. However, within the context of a small single-arm trial, the results may inform current approaches combining chemotherapy plus immunotherapy from the standpoint of feasibility, appropriate cytotoxic backbones, and potential predictive biomarkers. Trial registration: ClinicalTrials.gov NCT01524991.Patient summary
Combining chemotherapy and immune checkpoint blockade in patients with metastatic urothelial cancer is feasible. Further studies are needed to refine optimal combinations and evaluate tests that might identify patients most likely to benefit. 相似文献6.
Holger J. Klein Fabienne Lehner Riccardo Schweizer Barbara Rüsi-Elsener Jakob Nilsson Jan A. Plock 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1330-1335
Background
Since the inception of clinical VCA almost two decades ago, burn victims have been identified as immunologically complex patients owing to preformed HLA antibodies. However, it remains unclear whether the detected HLA antibodies are the result of former alloantigenic events or if their de novo formation occurs during primary burn care.Methods
Patients with burns >20% of total body surface area (TBSA) admitted to Zurich Burn Centre between May 2015 and September 2016 were screened for HLA antibodies at admission and 6 months post trauma. The influence of glycerol-preserved donor skin and red blood cell transfusion on HLA antibody formation was investigated.Results
Thirty-seven patients (7 females and 30 males) with an average age of 45.2 ± 19.1 years and average affected TBSA of 38.5% ± 18.9% were screened for HLA antibodies. Five patients (13.5%) showed preformed HLA antibodies at admission. Only 3 patients demonstrated verified de novo sensitization during acute burn care. Six patients treated with donor skin and blood transfusions showed no occurrence of HLA antibodies after 6 months. One patient died after 2 weeks due to infectious and thromboembolic complications – however, HLA antibodies were already detected.Conclusion
Formation of HLA antibodies during acute burn care might be lower than that previously expected by using glycerol-preserved donor skin and restrictive administration of blood products. Modern concepts of burn care may contribute to a revised outlook on burn patients as potential candidates for VCA. 相似文献7.
Liqing Yue Xuegong Fan Huan Peng 《Burns : journal of the International Society for Burn Injuries》2018,44(2):397-404
Objective
To explore the abilities and barriers of practicing evidence-based nursing (EBN) for burn specialist nurses so as to provide rationales for its clinical training and practice.Methods
From January 2016 to March 2016, a cross-sectional survey was conducted with a self-designed questionnaire among burn specialist nurses in Hunan Province. Data analysis was performed with SPSS software (version 20).Results
Burn specialist nurses in Hunan Province had diminished EBN abilities. The three procedures of EBN with the lowest score were “summarizing evidence through systematic reviews”, “rigorous evaluations of evidence” and “systematic literature searches”. And the three procedures of “clarifying problems”, “disseminating evidence” and “introducing evidence” scored the highest. The systematic literature retrieval ability of nurses at class III general hospitals was higher than that of class II counterparts (P = 0.001). Thus EBN ability was positively correlated with barriers to practicing EBN, English proficiency, research experiences and educator status.Conclusion
Burn specialist nurses at classes III & II general hospitals in Hunan Province had poor EBN abilities. Influencing factors of EBN ability included barriers to practicing EBN, English proficiency, research experiences and educator status. Therefore it is imperative to implement targeted trainings and integrated managements for improved ability of practicing EBN. 相似文献8.
Boris Gershman Holly K. Van Houten Jeph Herrin Daniel M. Moreira Simon P. Kim Nilay D. Shah R. Jeffrey Karnes 《European urology》2017,71(1):55-65
Background
Prostate biopsy and postbiopsy complications represent important risks of prostate-specific antigen (PSA) screening. Although landmark randomized trials and updated guidelines have challenged routine PSA screening, it is unclear whether these publications have affected rates of biopsy or postbiopsy complications.Objective
To evaluate whether publication of the 2008 and 2012 US Preventive Services Task Force (USPSTF) recommendations, the 2009 European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or the 2013 American Urological Association (AUA) guidelines was associated with changes in rates of biopsy or postbiopsy complications, and to identify predictors of postbiopsy complications.Design, setting, and participants
This quasiexperimental study used administrative claims of 5 279 315 commercially insured US men aged ≥40 yr from 2005 to 2014, of whom 104 584 underwent biopsy.Interventions
Publications on PSA screening.Outcome measurements and statistical analysis
Interrupted time-series analysis was used to evaluate the association of publications with rates of biopsy and 30-d complications. Logistic regression was performed to identify predictors of complications.Results and limitations
From 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100 000 person-months, with immediate reductions following the 2008 USPSTF recommendations (?10.1; 95% confidence interval [CI], ?17.1 to ?3.0; p < 0.001), 2012 USPSTF recommendations (?13.8; 95% CI, ?21.0 to ?6.7; p < 0 .001), and 2013 AUA guidelines (?8.8; 95% CI, ?16.7 to ?0.92; p = 0.03). Concurrently, complication rates decreased 10% from 8.7 to 7.8 per 100 000 person-months, with a reduction following the 2012 USPSTF recommendations (?2.5; 95% CI, ?4.5 to ?0.45; p = 0.02). However, the proportion of men undergoing biopsy who experienced complications increased from 14% to 18%, driven by nonsepsis infectious complications (p < 0.001). Predictors of complications included prior fluoroquinolone use (odds ratio [OR]: 1.27; 95% CI, 1.22–1.32; p < 0.001), anticoagulant use (OR: 1.14; 95% CI, 1.04–1.25; p = 0.004), and age ≥70 yr (OR: 1.25; 95% CI, 1.15–1.36; p < 0.001). Limitations included the retrospective design.Conclusions
Although there has been an absolute reduction in rates of biopsy and 30-d complications, the relative morbidity of biopsy continues to increase. These observations suggest a need to reduce the morbidity of biopsy.Patient summary
Absolute rates of biopsy and postbiopsy complications have decreased following landmark publications about prostate-specific antigen screening; however, the relative morbidity of biopsy continues to increase. 相似文献9.
K.A. Gautam A.N. Singh A.N. Srivastav S.N. Sankhwar 《The African Journal of Urology》2018,24(2):98-103
Introduction
Prostate carcinoma is still a dreaded disease wanting more effective treatment and definitive early detection for a better prognosis and cure of life.Objective
The present study was planned to investigate the correlation of vascular endothelial growth factor (VEGF) expression level and microvessel density (MVD) between the BPH and prostate cancer subjects to analyze their diagnostic and prognostic value.Subjects and methods
Freshly diagnosed histopathologically confirmed 50 cases of prostate cancer and 50 cases of BPH were included. Expression level of VEGF was measured using Immunohistochemistry (IHC), while MVD was determined via CD34 endothelium-specific antibodies. In the case group, we have also recorded the Gleason's score of prostate cancer and investigated its correlation with angiogenic factor VEGF and MVD CD34.Results
The study showed a statistically significant difference value of VEGF expression level between the prostate cancer and BPH group (p < 0.001). The mean MVD CD34 in the prostate cancer and BPH groups were 29.66 ± 0.21 and 9.96 ± 0.25, respectively. The difference of MVD CD34 expression between the groups was also found significant (p < 0.001). VEGF scoring was significantly correlated with Gleason's scores of prostate cancer (p = 0.005).Conclusions
The present findings may support the assumption that VEGF and CD34 expression level might have an important role in the prediction of prostate cancer as it was significantly differed with BPH. In addition, VEGF expression level showed intense staining in the tissue samples with higher grading of prostate cancer which reveals its importance as prognostic marker. 相似文献10.
11.
Introduction
Tamsulosin is an α-1A-specific blocker inducing selective relaxation of ureteral smooth muscle and inhibition of ureteral spasms leading to ureteral dilatation that can facilitates retrograde ureterorenoscopy (URS).Objective
To assess the efficacy of tamsulosin in improving the outcome of URS management of lower ureteral stones.Patients and methods
This prospective, randomised, controlled, clinical trial was carried out between June 2011 and December 2014. It included 98 patients with lower ureteral stones scheduled for treatment with URS. Before URS, patients were randomly divided into 2 groups; study group including 51 patients, in which pre-URS daily oral dose of tamsulosin 0.4 mg tab, for 1 week, was given and control group including 47 patients who received no additional therapy rather than standard analgesic on demand. The URS outcomes were evaluated and compared between both groups.Results
The demographic and stone characteristics were comparable between both groups. The mean URS time was significantly shorter in study group than in control group (52.0 ± 14.9 min vs. 71.0 ± 17.3 min; p = 0.039). Of the 98 patients, 89 (90.81%) had a successful URS procedures. The success rate was 94.1% (98/51) in study group compared 89.2% (58/65) in the control group, with statistically significant difference (p = 0.045). The major complications occurred in 4.25% of patients in control group but in only 1.96% of those received tamsulosin (p = 0.034).Conclusion
Post-tamsulosin ureteroscopy was easier and safer; leading to significantly increased stone-free rates and fewer complications. 相似文献12.
M. Luque-Oliveros 《Revista espa?ola de anestesiología y reanimación》2018,65(2):74-80
Objective
There are studies that declare blood recovered with the autotransfusion system that is potentially heparinised and mixed with other drugs, can cause haematological alterations in the patient, according to existing evidence. The proposal was to compare the haematological values of the patients before reinfusing red blood cells from the cell saver and 12 h after reinfusion.Material and methods
Observational analytical study of 479 patients who underwent cardiac surgery where the cell saver was used. Haematological variables were collected before reinfusion and 12 h after reinfusion.Results
Statistically significant haematological values before reinfusion and 12 h after reinfusion were: haemoglobin (9.5 to 12.5 g/dL), haematocrit (26 to 38%), platelets (214.2 to 164.2 10^3/μL), total proteins (7.6 to 5.1 g/dL), PCR (8.5 to 22.1 mg/L) and D-dimer (493.3 to 875.5μg/L) with P < .05.Conclusions
With the use of the cell saver an increase was observed of haemoglobin, haematocrit, PCR and D-dimer values together with a decrease in platelet and total protein numbers. 相似文献13.
14.
Sarah-Claude Provençal Suzie Bond Elie Rizkallah Ghassan El-Baalbaki 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1870-1881
Background
Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications.Objective
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury.Data sources
Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients.Data synthesis
Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3.Results
For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD = ?8.90, 95% CI ?16.28, ?1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD = ?21.78, 95% CI ?35.64, ?7.93) and no difference in medication usage (MD = ?0.07, 95% CI ?0.32, 0.17).Conclusion
These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature. 相似文献15.
Background
This study compared outcomes after treatment of acute Achilles tendon (AT) rupture via percutaneous suturing, with those after chronic AT rupture treated via open reconstruction.Methods
This retrospective study included 30 patients who underwent either percutaneous suturing for acute AT rupture (group AR, n = 16) or open reconstruction for chronic AT rupture (group CR, n = 14). Function was evaluated by calf muscle circumference, and endurance through isokinetic measurement and single-leg heel-rise test. Score evaluation included AT Total Rupture Score, Victorian Institute of Sports Assessment-Achilles questionnaire, and visual analogue scale pain score. Postoperative tendon thickness was measured using ultrasonography and MRI.Results
Follow-up was conducted 4.97 ± 1.79 years postoperatively. The groups were similar in age and body mass index. There was no significant difference between groups in calf circumference, isokinetic measurement, heel-rise test, and score evaluation. There was significantly less mediolateral tendon thickening in group AR compared with group CR on ultrasonography (p = 0.01) and MRI (p = 0.001).Conclusions
Open reconstruction for chronic AT rupture may result in comparable clinical and functional outcomes, but a thicker tendon compared with percutaneous suturing after acute AT rupture. 相似文献16.
Sarah B. Lieber Mary Louise Fowler Clara Zhu Andrew Moore Robert H. Shmerling Ziv Paz 《Joint, bone, spine : revue du rhumatisme》2018,85(4):469-473
Objectives
Septic polyarthritis is rarer than septic monoarthritis, but associated with higher mortality. Septic polyarthritis may be difficult to distinguish clinically from noninfectious inflammatory arthritis. We describe one of the largest samples of septic polyarthritis with the aim of distinguishing septic monoarthritis from polyarthritis.Methods
We conducted a retrospective study of adults admitted to tertiary care with septic monoarthritis and polyarthritis. Baseline characteristics, microbial profiles, joint involvement, length of stay, and 60-day readmission rates were determined.Results
We identified 464 and 42 cases of septic monoarthritis and polyarthritis, respectively, including 7 cases of septic polyarthritis with comorbid rheumatoid arthritis. Compared to those with septic monoarthritis, patients with septic polyarthritis were more likely to have rheumatoid arthritis (P < 0.01), sepsis (P < 0.01), and higher peripheral (P < 0.001) and synovial (P < 0.001) white blood cell counts. Operative intervention rates were similar, but mean length of stay was longer in polyarticular septic arthritis (P < 0.001). Patients with septic polyarthritis with/without underlying rheumatoid arthritis were similar in terms of presenting features and outcomes, except for more frequent immunosuppressive therapy in rheumatoid arthritis (P < 0.01).Conclusions
In this sample of patients with septic arthritis, patients with septic polyarthritis were more likely to have systemic infection at presentation than those with septic monoarthritis. Despite this difference, patients with septic monoarthritis and polyarthritis tended to have similar outcomes. While rheumatoid arthritis was observed more frequently among patients with septic polyarthritis, those with/without underlying rheumatoid arthritis had similar presenting features and outcomes. 相似文献17.
Thomas Seisen Malte W. Vetterlein Patrick Karabon Tarun Jindal Akshay Sood Luigi Nocera Paul L. Nguyen Toni K. Choueiri Quoc-Dien Trinh Mani Menon Firas Abdollah 《European urology》2018,73(3):452-461
Background
There is limited evidence supporting the use of local treatment (LT) for prostate cancer (PCa) patients with clinically pelvic lymph node-positive (cN1) disease.Objective
To examine the efficacy of any form of LT ± androgen deprivation therapy (ADT) in treating these individuals.Design, setting, and participants
Using the National Cancer Database (2003–2011), we retrospectively identified 2967 individuals who received LT ± ADT versus ADT alone for cN1 PCa. Only radical prostatectomy (RP) and radiation therapy (RT) were considered as definitive LT.Intervention
LT ± ADT versus ADT alone.Outcome measurements and statistical analysis
Instrumental variable analyses (IVA) were performed using a two-stage residual inclusion approach to compare overall mortality (OM)-free survival between patients who received LT ± ADT versus ADT alone. The same methodology was used to further compare OM-free survival between patients who received RP ± ADT versus RT ± ADT.Results and limitations
Overall, 1987 (67%) and 980 (33%) patients received LT ± ADT and ADT alone, respectively. In the LT ± ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP ± ADT and RT ± ADT, respectively. In IVA, LT ± ADT was associated with a significant OM-free survival benefit (hazard ratio = 0.31, 95% confidence interval [CI] = 0.13–0.74, p = 0.007), when compared with ADT alone. At 5 yr, OM-free survival was 78.8% (95% CI: 74.1–83.9%) versus 49.2% (95% CI: 33.9–71.4%) in the LT ± ADT versus ADT alone groups. When comparing RP ± ADT versus RT ± ADT, IVA showed no significant difference in OM-free survival between the two treatment modalities (hazard ratio = 0.54, 95% CI = 0.19–1.52, p = 0.2). Despite the use of an IVA, our study may be limited by residual unmeasured confounding.Conclusions
Our findings show that PCa patients with clinically pelvic lymph node-positive disease may benefit from any form of LT ± ADT over ADT alone. While not necessarily curative by itself, the use of RP or RT could be the first step in a multi-modality approach aiming at providing the best cancer control outcomes for these individuals.Patients summary
We examined the role of local treatment for clinically pelvic lymph node-positive prostate cancer. We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone. 相似文献18.
S. Young J. Wong M. Rosenberg J. Golzarian N. Frank 《Diagnostic and interventional imaging》2018,99(12):793-799
Purpose
The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding.Materials and methods
Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44–84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred.Results
No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P = 0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04 g/dL in the sclerotherapy group and 2.95 g/dL in theTIPS group; P = 0.04) and worse liver function (mean total bilirubin serum level of 4.9 mg/dL in the sclerotherapy group and 1.6 mg/dL in the TIPS group; P = 0.07).Conclusion
While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients. 相似文献19.
Sam J. Egger Ross J. Calopedos Dianne L. O’Connell Suzanne K. Chambers Henry H. Woo David P. Smith 《European urology》2018,73(6):859-867
Background
Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.Objective
To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.Design, setting, and participants
The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.Outcome measurements and statistical analysis
Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.Results and limitations
At 9–11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD = 5.9; 95% confidence interval or CI [0.5, 11.3] and AMD = 5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD = 5.3; 95% CI [0.2, 10.3] and AMD = 7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD = –9.1; 95% CI [–16.3, –2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD = –16.8; 95% CI [–27.6, –6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.Conclusions
Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.Patient summary
This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes. 相似文献20.
Chan Kang Gi-Soo Lee Sang-Bum Kim You-Gun Won Jeong-Kil Lee You-Sun Jung Hyung-June Cho 《Foot and Ankle Surgery》2018,24(6):521-524