Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder

Purpose

An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB).

Methods

We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes.

Results

Within a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071–1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101–2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093).

Conclusions

In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.     

Preoperative Brain Natriuretic Peptide (BNP) Is a Better Predictor of Adverse Cardiac Events Compared to Preoperative Scoring System in Patients Who Underwent Abdominal Surgery

Background  

Cardiovascular disease is the leading cause of perioperative death in surgical patients. A variety of clinical scoring systems have been developed to predict adverse cardiovascular events. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. We present a prospective, single-center, observational cohort study of patients undergoing major abdominal surgery and evaluate the role of BNP in predicting adverse cardiac events.     

Oral administration of docosahexaenoic acid/eicosapentaeinoic acids is not anticonvulsant in rats: implications for translational research

Omega-3 and omega-6 poly-unsaturated fatty acids (PUFAs) are dietary fatty acids that are involved in a myriad of physiological processes in the brain. Although experimental data have shown that PUFAs have anticonvulsant properties, the outcomes of clinical trials have been controversial. Docosahexaenoic acid (DHA) is a PUFA which has been reported to exert anticonvulsant effects. Here we studied anticonvulsant potential of a mixture of enriched n-3 PUFA upon their oral administration in rats. We did not observe an anticonvulsant effect of n-3 PUFA in the i.v. pentylentetrazol threshold test. n-3 PUFA component was increased in the plasma of rats treated with the eicosapentaenoic acid (EPA)/DHA mix (275 mg/kg/d/400 mg/kg/d) due to the increase of both DHA and EPA. We also found modification of PUFA composition in the brain. Despite PUFA profiles modified both in plasma and in the brain, we did not find any anticonvulsant effect of orally administered DHA. Further studies are needed to define the type and the amount of fatty acids that would possess anticonvulsant properties. As the existing literature suggests that the route of administration of PUFA may be crucial, future studies should involve oral administration to provide relevant clinical information.     

The protocol of low-impact laparoscopic cholecystectomy: the combination of mini-laparoscopy and low-pressure pneumoperitoneum

Low-impact laparoscopic (LIL) cholecystectomy is an innovative surgical protocol that combines the use of mini-laparoscopic instruments (3-mm ports) under a low- and stable-pressure pneumoperitoneum (8 mmHg), with the aim of minimizing the surgical invasiveness and the risks related to CO₂ insufflation on the peritoneal environment. In day-surgery settings, LIL may contribute to increase the surgical success due to several potential benefits in terms of postoperative pain intensity and time to full recovery. In 14 consecutive patients requiring cholecystectomy for uncomplicated cholelithiasis, LIL was carried out uneventfully. No conversion, intra-operative or postoperative complications occurred. All patients were discharged the same day of surgery. Postoperative pain was well tolerated with no need of prolonged opioid therapy. Technical aspects and indications for LIL cholecystectomy are detailed.     

Total and partial O2 and CO2 ductances in workers exposed to inhalation of cement-asbestos

The aim of the study was to assess the efficiency of the respiratory system in ensuring the correct dynamics of respiratory gases in subjects chronically exposed to the inhalation of asbestos-cement dust but not yet suffering from parenchymal asbestosis, via measurement of total and partial O2 and CO2 ductance coefficients (Du). Two groups of male workers of working age were selected, the first consisting of 22 workers employed on the manufacture of asbestos-cement products, the second consisting of 26 workers who had never been exposed to the inhalation of significant concentrations of occupational respiratory irritants. The two groups were comparable for age, smoking, and normal spirometric parameters for FVC, FEV1 and PEF, and were free of any type on interstitial lung disease according to ILO standards. In the exposed group, all O2 and CO2 ductance coefficients were significantly lower than in the non-exposed, except DuBCO2 (alveolar-capillary ductance for CO2). Measurement of O2 and CO2 lung ductances at rest thus revealed an impairment of the diffusion and of the interpulmonary exchange of blood and air in subjects chronically exposed to the inhalation of asbestos-cement dust. In the sample under study, such impairment preceded lung damage detectable by spirometric and radiological tests and was an obstacle not only to oxygen intake but also to the elimination of carbon dioxide.