Association of intraoperative hypothermia with oncologic outcomes following radical cystectomy

IntroductionIntraoperative hypothermia (IOH) has been suggested to adversely impact outcomes following surgery. The objective of this study was to evaluate the association between IOH and survival following radical cystectomy (RC).MethodsPatients who underwent RC for bladder cancer from 2003 to 2018 were identified in our cystectomy registry. Intraoperative temperatures were extracted from the anesthesia record. IOH was defined as a median intraoperative temperature <36°C, and severe IOH as ≤ 35°C. Time under 36°C was assessed as a continuous variable. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Associations between IOH and outcomes were assessed with multivariable Cox proportional hazards models.ResultsA total of 852 patients were identified, among whom 274 (32%) had IOH. Median follow up among survivors was 4.9 years (IQR 2.4–8.7), during which time 483 patients died, including 343 from bladder cancer. Two-year survival was not significantly different between patients with and without IOH (CSS: 74% vs. 71%, P= 0.31; OS: 68% vs. 67%, P= 0.13). Following multivariable adjustment, neither IOH nor time under 36°C was significantly associated with survival. A total of 37 patients (4.3%) had severe IOH. These patients were observed to have significantly lower 2-year OS (56% vs. 68%, P= 0.005); however, this association did not remain statistically significant after multivariable adjustment (P= 0.92).ConclusionIOH was not independently associated with survival following RC. These data do not support IOH as a prognostic factor for cancer outcomes among patients undergoing RC.     

The association of salvage intravesical therapy following BCG with pathologic outcomes and survival after radical cystectomy for patients with high-grade non-muscle invasive bladder cancer: A multi-institution analysis

IntroductionWhile numerous current clinical trials are testing novel salvage therapies (ST) for patients with recurrent nonmuscle invasive bladder cancer (NMIBC) after bacillus Calmette-Guérin (BCG), the natural history of this disease state has been poorly defined to date. Herein, we evaluated oncologic outcomes in patients previously treated with BCG and ST who subsequently underwent radical cystectomy (RC).MethodsWe identified 378 patients with high-grade NMIBC who received at least one complete induction course of BCG (n = 378) with (n = 62) or without (n = 316) additional ST and who then underwent RC between 2000 and 2018. Oncologic outcomes were compared using the Kaplan-Meier method and Cox proportional hazards models. Sensitivity analyses were conducted stratifying by presenting tumor stage, matched 1:3 for receipt vs. no receipt of ST.ResultsPatients receiving ST were more likely to initially present with CIS (26% vs. 17%) and less likely with T1 disease (34% vs. 50%, P = 0.06) compared to patients not treated with ST. Receipt of ST was not associated with increased risk of adverse pathology (≥pT2 or pN+) at RC (31% vs. 41%, P = 0.14). Likewise, 5-year cancer-specific survival did not significantly differ between groups on univariable Kaplan-Meier analysis (73% for ST and 74% for no ST, P = 0.7). Moreover, on multivariable analysis, receipt of ST was not significantly associated the risk of death from bladder cancer (HR 1.12; 95% CI 0.60–2.09, P = 0.7). Results were unchanged on sensitivity analysis.ConclusionsThese data suggest that, in carefully selected patients, ST following BCG for high grade NMIBC does not compromise oncologic outcomes for patients who ultimately undergo RC.     

Risk factors for cooking-related burn injuries in children,WHO Global Burn Registry

ObjectiveTo assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry.MethodsOn 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns.FindingsOf the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4–5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3–6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3–3.4), kerosene (OR: 1.9; 95% CI: 1.0–3.6) or natural gas (OR: 1.5; 95% CI: 1.0–2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2–25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9–25.7), charcoal (OR: 4.6; 95% CI: 2.0–10.5), kerosene (OR: 3.9; 95% CI: 1.4–10.8), natural gas (OR: 3.0; 95% CI: 1.5–6.1) or wood (OR: 2.8; 95% CI: 1.1–7.1).ConclusionPreventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.     

A factor analysis of the Klein sexual orientation Grid in two disparate samples

Many researchers interested in sexual orientation can be separated into two camps: The lumpers, who try to reduce sexual classifications to as small a number of categories as possible, and the splitters, who try to show differences among groups and individuals that make classification schemes increasingly difficult and/or intricate. We report factor analyses of the Klein Grid (a questionnaire with 21 sexual orientation items) to see how many factors emerge in two samples of strikingly different origins. In both samples, the first factor to emerge loaded substantially on all of the Klein Grid's 21 items. This factor accounted for a majority of the variance. In both samples, a second, correlated factor emerged which indexed a separation between most of the items and those having to do with social and/or emotional preferences. In both samples, a third correlated factor also emerged, but this factor differed between the two populations: one refined the social/emotional distinction and the other distinguished ideal behavior from past and current behavior. We conclude on the basis of our analysis that both the lumpers and the splitters are correct.Supported by NIMH grants IP50 MH 45294 and R01 MH 43298.