Effect of intervention on decision making of treatment for disease progression,prostate‐specific antigen biochemical failure and prostate cancer death

Background

Patient preference for the choice of treatment modality for prostate cancer has increasingly gained attention.

Objective

To assess the impact of client‐oriented decision on long‐term mortality, disease progression and biochemical failure compared with standard treatment protocol (TP).

Methods

With data from a Finnish multicentre, randomized controlled trial with two arms [104 in the enhanced patient participation (EPP) arm and 106 in the TP arm], disease‐specific and disease‐free survival, biochemical failure with elevated prostate‐specific antigen (PSA) level and disease progression were compared between the two arms using Wilcoxon test and also Cox proportional hazards regression model.

Results

Patients in the EPP arm had a higher risk of death by 37% [HR, 1.37 (0.87–2.17)] compared with those in the TP arm. Patients in the EPP arm were at increased risk of having biochemical failure by 14% [HR, 1.14 (0.72–1.79)] and for having disease progression by 2% [HR, 1.02 (0.61–1.70)] compared with those in the TP arm. All the differences were non‐significant.

Conclusions

Patients actively involved in the choice of treatment had higher risk of prostate cancer death but only slightly increased risk of biochemical failure and clinical disease progression. These findings would provide a good reference when patient autonomy for the choice of treatment modality is addressed.     

Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma

Backgroundimmunotherapy became the first line treatment of metastatic renal cell carcinoma (mRCC). Nevertheless, a better understanding of the specificities of targeted therapies (TT) in the elderly population could be helpful in order to improve the management of mRCC in this population. The aim of this retrospective study was to assess efficacy and safety of sunitinib and sorafenib used as first-line TT in 70 years older patients compared to younger patients.MethodsData were retrospectively collected for all consecutive mRCC patients receiving first line TT treatment by sunitinib or sorafenib for mRCC from January 2006 to November 2017. Patients were divided into two groups according to the age using a cut-off at 70 years old. Median progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared using log-rank test.ResultsIn total, 147 patients were included; 94 (63.9%) were <70 and 53 (36.1%) were 70 years old or more. First line TT used was sunitinib in 123 (83.7%) patients or sorafenib in 24 (16.3%) patients. Median PFS was 8 months for elderly patients vs. 6 in younger group (P=0.68). Median OS were 26 vs. 36 months (P=0.08). Severe induced toxicity was more frequent among elderly patients: 34 (64.2%) vs. 46 patients (48.9%) (P=0.07). Rate of treatment discontinuation due to toxicity was 22 patients (23.4%) in younger group vs. 28 patients (52.8%) in the elderly group (P=0.0005). Results were similar in the 2 groups regarding the type of toxicities.ConclusionsOur results suggest similar efficacy of anti-vascular endothelial growth factor (VEGF) agents as first-line treatment for mRCC among younger and older patients with an age cut-off of 70 years. Safety results suggest that these drugs can be safely used for older patients with a need of caution regarding toxicity prevention.     

Outcomes of Sleeve Gastrectomy in Septuagenarians

Background

Few previous studies have assessed the safety of bariatric surgery in septuagenarians.

Methods

A retrospective analysis of all patients 70 years or older who underwent laparoscopic sleeve gastrectomy at our institution between 2012 and 2017 was performed. This group was compared to a matched cohort of younger LSG patients (18–50 years) who were operated during the same time period.

Results

Thirty septuagenarian LSG patients were compared to 60 younger patients. Gender distribution, preoperative weight, and preoperative body mass index (BMI) were comparable, although patients in the older age group suffered from more preoperative comorbidities (100 vs. 51.7%, p?<?0.001). Operative time was longer (77.2 vs. 57.3 min, p?=?0.005) and more hiatal hernias were repaired (46.7 vs. 8.3%, p?<?0.001) in the older age group. Intraoperative complications occurred more in the older age group (6.7 vs. 0%, p?=?0.04) but the overall complication rate (13.3 vs. 5.0%, p?=?0.17) and the postoperative complication rate (10.0 vs. 5.0%, p?=?0.38) were comparable. After a mean follow-up period of 31.3 and 33.5 months, the percentage of total body weight loss was 24.6 and 28.3% for the older and younger patients, respectively (p?=?0.11). Rates of improvement/remission of comorbidities were comparable between the groups.

Conclusions

In a carefully selected group of severely obese patients ≥?70 years old, LSG may be safe, with acceptable postoperative complication rates, weight loss results, and improvement in comorbidities.

     

Comparison of microwave-polymerized denture base resins

Three denture base resins, two designed for microwave polymerization and one for host-water-bath-processing, were compared. Results indicated that all four tested thicknesses (3, 6, 11.6, and 17.7 mm) of the water-bath-polymerized samples and one of the microwave-polymerized resins were porosity-free. When the water-bath-polymerized material was microwave processed, porosity was found when resin thickness exceeded 3 mm. When one resin designed for microwave polymerization was irradiated using the high-wattage (513 W), shorter cycle (4 minutes 52 seconds), porosity also occurred when the thickness exceeded 3 mm. Porosity did not occur until there was 9 mm of thickness when the lower-wattage (75.9 W), longer cycle (15 minutes 26 seconds) was used. No significant differences in transverse strength or hardness were noted between the materials.     

Blood exchanged in ritual ceremonies as a possible route for infection with hepatitis C virus.

Of 52 blood donors (25 men and 27 women) counselled because their donation tested positive for hepatitis C virus antibody, seven (13.5%) gave a history of practising the ritual of blood exchange in their childhood or early adult life. This practice can cause transmission of blood borne infections or alloimmunisation, or both.     

Hypoxia/reoxygenation stimulates endothelial cells to promote interleukin-1 and interleukin-6 production. Effects of free radical scavengers.

Vascular endothelium produces and/or interferes with various cytokines. Previous studies have demonstrated interactions of these inflammatory and immunological mediators with oxygen-derived free radicals. The present work examines the relationship between hypoxia/reoxygenation (H/R) and cytokine production by cultured endothelial cells. Human umbilical vein endothelial cell (HUVEC) monolayers were incubated for 24 h in normoxia or submitted to 5 h hypoxia/19 h reoxygenation. Then, interleukin-1 (IL-1) alpha and beta, and interleukin-6 (IL-6), were measured in culture supernatants by specific enzyme immunoassays and bioassays, respectively. Under these conditions, the spontaneous production of IL-1 and IL-6, detected in normoxic HUVEC, greatly increased after H/R treatment. The observed enhancement was cycloheximide-sensitive and, consequently, reflected a de novo protein synthesis. Superoxide dismutase and glutathione peroxidase prevented H/R-induced IL-1 and IL-6 increase. These results constitute the first demonstration that H/R stimulates HUVEC to promote IL-1 and IL-6 production and strongly suggest a role for oxygen-derived free radicals in the cytokine synthesis.     

The relationship between the photoplethysmographic waveform and systemic vascular resistance

Objective The objective of this study was to determine the relationship between systemic vascular resistance (SVR), finger & ear photoplethysmographic measurements in 14 adult patients undergoing coronary artery bypass grafting (CABG). Methods Patients were monitored with photoplethysmographs of the finger and ear and continuous cardiac output (Q_T) via thermodilution catheter. The relationship between SVR, finger plethysmographic amplitude, width and ear plethysmographic amplitude, width was assessed with linear regression. Results The finger plethysmographic amplitude had a low correlation r value = −0.15, while finger plethysmographic width had a better correlation r value = 0.56. The correlation between SVR and ear plethysmographic amplitude and width were −0.24 and 0.62 respectively. Using receiver operating characteristic analysis the ear plethysmographic width had both better sensitivity and specificity than the finger plethysmographic width in identifying high and low SVR. Using a multiple regression analysis, SVR was estimated from the pulse oximeter waveforms: SVR calculated = 27.27 + (3978.53 × Ear pulse oximeter width) − (8.91 × Ear pulse oximeter area) + (1986.3 × Finger pulse oximeter width). Bland–Altman analysis was used the bias was 29.8 dynes s cm⁻⁵, standard deviation was 587.3, upper and lower limit of agreement were 1204.45, and −1144.8 dynes s cm⁻⁵ respectively. Conclusion The data indicate that pulse width of finger and ear plethysmographic tracing are more sensitive to changes in SVR than the other indices. An appreciation of changes in pulse width may provide valuable evidence with respect to changes in peripheral vascular tone. Awad AA, Haddadin AS, Tantawy H, Badr TM, Stout RG, Silverman DG, Shelley KH. The relationship between the photoplethysmographic waveform and systemic vascular resistance.