Lower plasma adiponectin levels are associated with larger tumor size and metastasis in clear-cell carcinoma of the kidney

OBJECTIVES: To examine a possible relationship between plasma adiponectin levels and renal cell carcinoma (RCC). Adiponectin, a cytokine secreted by adipocytes, is a potent antiangiogenic factor. Plasma levels of adiponectin in patients with RCC and tumor adiponectin receptors R1 and R2 (AdipoR1&2) expression levels were measured and correlated with disease characteristics. METHODS: Preoperative plasma samples from 42 patients were analyzed in triplicate for adiponectin levels with a specific ELISA assay. All patients had clear-cell RCC, including 15 with metastatic disease. Diabetic patients were excluded; all had normal renal function. The RCC and surrounding normal renal tissue were comparatively analyzed for AdipoR1&2 expressions (immunoblotting) in 15 patients. RESULTS: Mean, median, and range of plasma adiponectin levels were 6.33, 5.84, and 1-25.2 microg/ml, respectively. A strong inverse correlation was found between plasma adiponectin levels and tumor size with significantly lower levels of adiponectin in tumors > or =4 cm (p<0.01). The median adiponectin levels in metastatic and nonmetastatic patients were 4.08 and 7.4 microg/ml, respectively (p=0.029). A trend toward significant lower adiponectin levels in high versus low Fuhrman grade (3 and 4 vs. 1 and 2) was noted (p=0.057). Expression of AdipoR1&R2 was found to be lower in tumor tissue compared with the patient's normal surrounding kidney tissues in 40% of the cases. Metastatic tumors expressed lower levels of AdipoR2. Body mass index was not inversely correlated with adiponectin levels. CONCLUSIONS: Lower blood levels of adiponectin are positively associated with clear-cell RCC aggressiveness and could potentially be used as a biomarker.     

The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer

Background

The study's aim was to identify technical factors that are predictive of negative margins after breast-conserving surgery (BCS).

Methods

This was a retrospective, cohort study of patients who underwent BCS for early-stage cancer from 2000 to 2002. Pathological and specific surgical factors were compared with margin status. Univariate and multivariate regression analyses were performed.

Results

Four hundred eighty-nine cases were reviewed. The positive margin rate after the initial surgery was 26%. In univariate analysis, lobular histology, size, grade, multifocality, and the presence of EIC and LVI were associated with positive margins (P < .05). The absence of cavity margin dissection and specimen orientation labeling, the absence of a confirmed diagnosis, and smaller volumes of excision were also associated with positive margins (P < .05). In multivariate analysis, confirmed diagnosis, small tumor size, ductal histology, absence of LVI and multifocality, palpability, cavity margin dissection, and larger volumes of excision were predictors of negative margins.

Conclusions

This study shows that specific surgical factors are predictive of margin status. Both tumor and technical factors should be considered when planning BCS.     

Evaluation of the effect of Benson's relaxation technique on pain and quality of life of haemodialysis patients: A randomized controlled trial

Background

Haemodialysis patients may suffer from pain and impairment of quality of life. Some complementary interventions, such as relaxation therapy, might affect the pain and quality of life. The present study aimed to identify the effectiveness of Benson's relaxation technique in relieving pain and improving the quality of life in haemodialysis patients.

Study design

The study was a randomized controlled trial.

Setting and participants

The data were collected in two haemodialysis units affiliated to Shiraz University of Medical Sciences. A total of 86 haemodialysis patients were randomly assigned to either the intervention (receiving Benson's relaxation technique) or the control group (routine care) from 2011 to 2012.

Intervention

The patients in the intervention groups listened to the audiotape of relaxation technique twice a day each time for 20 min for eight weeks.

Measurements and outcomes

The pain numeric rating scale and Ferrans and Powers Quality of Life Index-dialysis version questionnaire were completed at baseline and 8 weeks after the intervention. The data were analyzed using independent t-test and ANCOVA.

Results

The results of ANCOVA showed a significant difference between the intervention and the control group concerning the mean score of the intensity of pain (F = 6.03, p = 0.01). Moreover, a significant difference was found between the intervention and the control group regarding the total quality of life (F = 10.20, p = 0.002) and health-functioning (F = 8.64, p = 0.004), socioeconomic (F = 12.45, p = 0.001), and family (F = 8.52, p = 0.005) subscales of quality of life.

Conclusion

These findings indicated that Benson's relaxation technique might relieve the intensity of pain and improve the quality of life in haemodialysis patients. Thus, Benson's relaxation technique could be used as part of the care practice for relieving the pain intensity and improvement of the quality of life in haemodialysis patients.     

Escherichia coli strains belonging to phylogenetic group B2 have superior capacity to persist in the intestinal microflora of infants

Escherichia coli strains segregate into 4 phylogenetic groups, designated "A," "B1," "B2," and "D." Pathogenic strains belong to group B2 and, to a lesser extent, group D, which more frequently carry virulence-factor genes than do group A strains and group B1 strains. This study investigated whether the capacity of E. coli to persist in the human intestine is related to its phylogenetic type. Resident (n=58) and transient (n=19) commensal E. coli strains isolated during a longitudinal study of 70 Swedish infants and previously tested for virulence-factor-gene carriage were tested for phylogenetic type. Of the strains resident in the intestinal microflora, 60% belonged to group B2, compared with only 21% of the transient strains (P=.004). In logistic regression, group B2 type predicted persistence in the intestinal microflora, independent of carriage of all investigated virulence-factor genes, including genes for P fimbriae (P=.03). Thus, group B2 strains appear to possess yet unidentified traits that enhance their survival in the human intestine.     

A cost comparison of off-pump CABG versus on-pump CABG at one-year: The Canadian off-pump CABG registry

BACKGROUND: Evidence suggests that off-pump coronary artery bypass graft surgery (CABG) is as safe and effective as on-pump CABG, and the cost of initial hospitalization for off-pump CABG is less expensive than on-pump CABG. However, it is uncertain whether the cost savings are sustained over a longer period of time. OBJECTIVE: To assess in-hospital and one-year direct medical costs of off-pump CABG versus on-pump CABG in the context of the Canadian health care system. METHODS AND RESULTS: From March 2001 to December 2002, 1657 consecutive patients enrolled in the Canadian Off-Pump CABG Registry were compared with 1693 consecutive on-pump patients from Hamilton Health Sciences CABG database. At one year, patients of both groups were followed by telephone interview. An economic analysis was conducted from the perspective of the Ontario Ministry of Health and Long-Term Care, and the data analysis was based on propensity score-matched registry patients (1233 pairs) to ensure the comparability of the two study groups. Clinical event and resource use information was collected from all patients. Unit costs from the Hamilton Health Sciences case-costing system were used to estimate hospital costs; all costs were reported in 2003 Canadian dollars. Sensitivity analyses were performed to account for uncertainties. The cost of initial hospitalization for off-pump CABG was significantly less than on-pump CABG (11,744 dollars versus 13,720 dollars, P < 0.001). Although follow-up costs were similar between the groups, the one-year total cost per patient for off-pump CABG remained significantly less than on-pump CABG (12,063 dollars versus 14,141 dollars, P < 0.001). CONCLUSION: Off-pump CABG offers significant savings during initial hospitalization that are also sustained after one year.     

The Canadian off-pump coronary artery bypass graft registry: a one-year prospective comparison with on-pump coronary artery bypass grafting

BACKGROUND: The authors sought to examine in-hospital and one-year outcomes of off-pump coronary artery bypass grafting (CABG) and to determine the subgroups of patients most likely to benefit from the off-pump procedure in a regular surgical practice. METHODS: From March 2001 to December 2002, 1657 consecutive patients were treated with off-pump CABG and 1693 consecutive patients were treated with on-pump CABG. Propensity score modelling was performed to control for treatment and selection bias. A propensity-matched analysis was performed to identify factors associated with survival benefit from the off-pump procedure. RESULTS: The mortality was similar postoperatively and at one year after surgery. The rate of stroke was decreased in the off-pump group postoperatively (OR=0.49, 95% CI 0.23 to 1.06) and significantly at one year after surgery (OR=0.49, 95% CI 0.27 to 0.90). A significant reduction in acute renal dialysis and a significant increase in myocardial infarction rates were seen in off-pump patients during the initial hospitalization but these differences disappeared during the follow-up period. The number of grafts completed was significantly lower in off-pump CABG than in on-pump CABG (2.62+/-1.00 versus 3.36+/-0.92, respectively; P<0.001). Hospital length of stay and the percentage of patients who required mechanical ventilation were significantly lower in the off-pump group than in the on-pump group. At one year after surgery, the adjusted rate of coronary angiogram and revascularization was similar between the two groups, and the adjusted rate of self-reported angina and memory status was significantly better in the off-pump CABG group. Almost all subgroups of patients had a neutral effect or a survival benefit with the off-pump technique. CONCLUSIONS: The results from a Canada-wide multicentre registry showed the safety and effectiveness of off-pump CABG in most subgroups of patients in a regular surgical practice.     

Association of Plasma Retinol Binding Protein-4 (RBP4) and Sonographic Grading of Fatty Liver in Obese Iranian Children

Background

The prevalence of obesity and its related comorbidities, such as fatty liver, in children is increasing worldwide mostly due to changes in diet and life-style. Many serological markers have been suggested for screening of fatty liver but investigations for finding more reliable factors are still in progress.

Objectives

This study aimed to investigate the correlation between the level of retinol binding protein-4 (RBP4) in the serum and sonographic grading of fatty-liver severity in obese Iranian children.

Patients and Methods

This case-control, double-blind study involved 51 obese children aged between five and 17 years as the case group. In addition, 35 healthy lean children with no liver problems were selected as the control group. Plasma RBP4 (using an ELISA), serum triglycerides (TG), low-density-lipoproteins (LDL), high-density-lipoproteins (HDL), total-cholesterol (Chol), and body mass index (BMI) were measured. Grading the severity of the fatty liver condition was done by an expert radiologist in the case group.

Results

RBP4 levels in obese children (19 482.9 ± 3 302.2 pg/ml) were higher than those found in the lean control group (14 295.68 ± 2 381.3 pg/ml) (P < 0.05). In the obese patients, RBP4 levels showed a significant correlation with the grade of fatty liver and BMI (P < 0.05).

Conclusions

It was found that the level of RBP4 had a strong correlation with the severity of fatty liver. Therefore, RBP4 may be considered as a useful, noninvasive predictive biomarker of intrahepatic lipid content in obese children prior to using radiological investigations. In particular, abdominal sonography, for the evaluation of intrahepatic lipid content in obese patients, as the sensitivity of a sonography is decreased due to the increased thickness of the abdominal wall as a result of fat deposits.     

Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection

ObjectiveTo determine the recurrence rates of basal cell carcinoma of the periocular skin in patients who were in the following 3 groups after pathologic analysis: Mohs frozen sections (negative margins); permanent sections with positive tumor margins; and permanent sections with negative tumor margins at the time of primary surgical removal.DesignThe study is a retrospective chart review.ParticipantsWe identified 385 patients who underwent surgery for basal cell carcinoma. The surgery was performed by a single surgeon between January 1, 1995 and January 1, 2005.MethodsThe patients were divided into 3 groups: (i) Mohs frozen sections with margins negative for tumor; (ii) permanent sections with margins negative for tumor; (iii) permanent sections with margins positive for tumor. The recurrence rates of basal cell carcinoma were compared.ResultsThe recurrence-free rate was 92% for the group that had had Mohs frozen-section, 87% for the group that had had permanent sections with negative margins, and 80% for the group that had had permanent sections with positive margins at 170 months follow-up time. We found that the only predictor of recurrence rate was younger age (hazards ratio (HR) = 0.97 95%; CI 0.94, 0.99; p = 0.021).ConclusionsThe results showed a statistically significant difference in the recurrence-free rate in the 3 groups. A minimum of a 3-year follow-up is recommended in patients who have had basal cell carcinomas removed; the average time to recurrence was approximately 3 years.