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Objectives
The percentage of free prostate-specific antigen (%fPSA) improves the diagnostic accuracy for prostate cancer when the serum level of total PSA (tPSA) is elevated. Approximately 14% of men with a tPSA below 3 μg/l have prostate cancer on biopsy, but the diagnostic value of %fPSA in such men is rather unknown. The purpose was to estimate the impact of %fPSA on future prostate cancer risk among men with a normal tPSA in prostate cancer screening.Subjects and methods
The first round of the Finnish arm of the European Randomized Trial for Screening of Prostate Cancer in 1996 to 1999 comprised 20,793 men aged 55–67 yr. Screen-negative men (tPSA level below 3.0 μg/l, n = 17,680) were followed up until the end of 2003. Cumulative risk of prostate cancer was calculated as a function of %fPSA.Results
During the median follow-up of 5.8 yr (range, 0–7.7 yr), 327 men were diagnosed with prostate cancer and 25% of them had a Gleason score of 7 or higher. Five years after the first screening, cumulative risk of prostate cancer was 1.7% (95%CI, 1.5–1.9%). Men with a %fPSA in the lowest quartile (<14.2%) showed a 6.9-fold risk compared with those with a level in the highest quartile (>23.7%).Conclusions
In men with a low serum tPSA, a low %fPSA is a strong predictor of later diagnosis of prostate cancer. 相似文献Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS.
MethodsAnalysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 & 2), operated 2010–2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24 months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). Statistical analysis: values as mean ± SD, differences by student’s t-test (significancy a = 0.05), Pearson’s correlation, sub-analysis with sagittal modifier (−, N, +).
ResultsA total of 127 AIS could be identified (63% type 1, 37% type 2). Mean FU 32.2 ± 16.6 months, mean age 14 ± 1.5 years. Mean Correction of MC 73 ± 12%, PC 51 ± 17%, LC 69 ± 21% with a significantly better correction of PC in Lenke 2 curves(p < 0.05). On average, TK (FU-preop) decreased by -2.1 ± 12.1°(p < 0.05) in all AIS. Whereas TK in type 1 was unchanged (p = 0.9), TK significantly decreased by − 6.0 ± 12.7°(p < 0.05) in type 2. No significant difference in LL. TK in hypokyphotic cases increased by 9.5 ± 5.5°(p < 0.05), stayed almost unchanged (− 1.4 ± 9.1°,p = 0.2) in normokyphotic, decreased by − 17.2 ± 14.2°(p < 0.05) in hyperkyphotic cases. Only hypokyphotic cases had a moderately strong correlation between correction of LC (r = 0.6) and PC (r = − 0.4) (frontal plane) and change from pre- to postoperative TK (sagittal plane) (r = 0.6). No relevant correlations for normo- and hyperkyphotic AIS. Postoperative hypokyphosis was significantly more often in Lenke 2 (16.3% vs. 2.6%, p < 0.05). Rod diameter (5,5 mm versus 6 mm) had no significant influence.
ConclusionSignificant correction of hypo- and hyperkyphosis can be achieved with posterior spinal fusion (pedicle screw dual rod systems), whereas normokyphotic spines stay unchanged. However, Lenke 2 curves have a significantly higher risk for a postoperative thoracic hypokyphosis.
相似文献Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood.
ObjectiveA systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL.
MethodsEmbase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized.
ResultsA total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies).
The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies.
ConclusionThere is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.
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