Sex-Specific Differences in Heart Failure: Pathophysiology,Risk Factors,Management, and Outcomes

Heart failure (HF) is a leading cause of hospitalisation, morbidity, and mortality in Canada. There are sex-specific differences in the etiology, epidemiology, comorbidities, treatment response, and treatment adverse effects that have implications on outcomes in HF. Sex-specific analyses of some HF trials indicate that optimal doses of drug therapies and benefit of device therapies may differ between male and female patients, but the trials were not designed to test sex differences. The under-representation of female participants in HF randomised controlled trials (RCTs) is a major limitation in assessing the sex-specific efficacy and safety of treatments. To ensure that female patients receive safe and effective HF therapies, RCTs should include participants proportionate to the sex-specific distribution of disease. This review outlines the sex-specific differences in HF phenotype and treatment response, and highlights disparities in services and gaps in knowledge that merit further investigation.     

Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system

The biological significance of occult metastases in axillary lymph nodes of breast cancer patients is controversial. The purpose of the study was to determine the prognostic significance of occult micrometastases using the current American Joint Committee on Cancer (AJCC) staging system in a cohort of women with node-negative breast cancer, of whom 5% received adjuvant systemic therapy and who all had long-term follow-up. We studied a cohort of 214 consecutive histologically node-negative breast cancer patients with a median follow-up of 8 years. Blocks of the axillary lymph nodes were assessed for occult micrometastases by examination of an additional hematoxylin-eosin-stained slide and by immunohistochemical staining using an antibody to low molecular weight keratin. Occult metastases were classified according to the sixth edition of the AJCC cancer staging manual. We examined the prognostic effects of occult micrometastases and other clinicopathologic features on recurrence outside the breast with disease-free interval (DFI) and survival from breast cancer with disease-specific survival (DSS). Cytokeratin-positive tumor cells were identified in the lymph nodes in 29 of 214 cases (14%). Two cases had isolated tumor cells and no cluster larger than 0.2 mm [pN0(i+)], whereas 27 of 214 (13%) had micrometastases (larger than 0.2 mm and 相似文献   

Female urethral diverticula

Surgical excision is the definitive treatment of urethral diverticulum (UD) and the only reasonable surgical option for treating midurethral and proximal UD. Success depends on proper staging by determining the extent and number of diverticula and attention to surgical technique. This article offers practical guidance in adjusting technique to accommodate commonly encountered difficult clinical scenarios.     

Assessment of the impact on compliance of a new CPAP system in obstructive sleep apnea

Background

Despite the efficacy of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA), compliance with therapy remains suboptimal. The aim of this study was to determine whether the use of S9^TM increased compliance in established CPAP users.

Methods

Subjects with OSA (50) were recruited into the study. When subjects entered the study, 28 days of respective compliance data were downloaded from the patient's usual CPAP device. Subjects trialled the S9 CPAP for 28 days. Subjects then resumed use of their usual CPAP for 28 days. Compliance data from the patient's usual CPAP pre- and post-trialling S9 were compared with data from the S9 CPAP.

Results

Patients were significantly more compliant when using the S9 than their usual CPAP device both pre- and post-S9 based on average daily usage. CPAP pre-S9?=?6.58?±?1.95 (mean hours?±?SD), S9?=?7.08?±?1.18 h and CPAP post-S9?=?6.71?±?1.72 h. The difference between CPAP pre-S9 and S9 was 0.5 h (p?=?0.003). The difference between S9 and CPAP post-S9 was 0.35 h (p?=?0.01). There was no significant difference between CPAP pre-S9 and CPAP post-S9 (p?=?0.34). Patients also completed questionnaires comparing the S9 system to their usual device. Subjective feedback showed a strong preference for the S9.

Conclusions

Participants were significantly more compliant when using the S9 than their usual CPAP device both pre- and post-S9 use.