Looking back at PCPT: looking forward to new paradigms in prostate cancer screening and prevention

OBJECTIVES: Provide a critical summary of the latest interpretation of findings from the Prostate Cancer Prevention Trial (PCPT). METHODS: Findings from PCPT and recently published post-hoc analyses are reviewed. RESULTS: PCPT demonstrated that finasteride can reduce the prevalence of prostate cancer, permitted the first large-scale assessment of the performance characteristics of prostate-specific antigen for prostate cancer screening, and identified new-onset erectile dysfunction as an early predictor of cardiovascular events. CONCLUSIONS: PCPT has and will continue to yield valuable information regarding future strategies for prostate cancer prevention and detection, benign prostatic hyperplasia, and other matters of public health importance.     

BioFoot in-shoe system: Normal values and assessment of the reliability and repeatability

BackgroundBioFoot^® is an in-shoe system to measure plantar pressures at the interface between the shoe and the sole of the foot. Since reliability and good repeatability are necessary to ensure the consistency of measurements on which clinical judgements are based, the aim of the study was to assess the reliability and repeatability of the BioFoot^® system and identify normal values for healthy subjects.Materials and methodsThirty subjects, 18 women and 12 men, were measured twice, with a 7–10 day interval between the sessions, wearing the same kind of shoes. In each session, three trials were recorded. The foot was divided into ten areas: heel, midfoot, whole forefoot, 1st–5th metatarsal heads, hallux, and lesser toes.ResultsThe intra-class correlation coefficients were between 0.76 and 0.96 for all four variables evaluated. The coefficient of variation between two sessions was around 7% (range: 4.6–9%). The mean contact time was 0.81 s, and walking cadence was 101.5 steps per minute. The pressure measurements showed the greatest peak and mean pressures under the second metatarsal head, and the second peak and mean pressures under the third metatarsal head.ConclusionThe plantar pressure measurements showed good to excellent consistency, and it was concluded that the BioFoot^® in-shoe system has good reliability and is repeatable. The highest values were found beneath the forefoot, which is consistent with the literature.     

The generalized quadratic knapsack problem. A neuronal network approach.

The solution of an optimization problem through the continuous Hopfield network (CHN) is based on some energy or Lyapunov function, which decreases as the system evolves until a local minimum value is attained. A new energy function is proposed in this paper so that any 0-1 linear constrains programming with quadratic objective function can be solved. This problem, denoted as the generalized quadratic knapsack problem (GQKP), includes as particular cases well-known problems such as the traveling salesman problem (TSP) and the quadratic assignment problem (QAP). This new energy function generalizes those proposed by other authors. Through this energy function, any GQKP can be solved with an appropriate parameter setting procedure, which is detailed in this paper. As a particular case, and in order to test this generalized energy function, some computational experiments solving the traveling salesman problem are also included.     

Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario

Introduction

The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).

Patients and methods

A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up.

Results

A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001).

Conclusion

The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.     

Endoscopic-assisted colopexy and push percutaneous colostomy in the transverse colon for refractory chronic intestinal pseudo-obstruction

Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy.     

Cross-linked ultra-high-molecular weight polyethylene liner and ceramic femoral head in total hip arthroplasty: a prospective study at 5 years follow-up

Background  

Recent data indicate that enhanced wear resistance can be obtained with new cross-linked ultra-high-molecular weight polyethylene (CL-UHMWPE) liners, in comparison with previous-generation liners. The current prospective, cohort study was undertaken to analyse whether the use of a new CL-UHMWPE (Rexpol) results in a lower wear rate than ultra-high-molecular weight polyethylene (UHMWPE) in a group of similar patients undergoing total hip arthroplasty (THA). This study provides the first clinical data with this particular CL-UHMWPE.     

Leveraging social capital: multilevel stigma,associated HIV vulnerabilities,and social resilience strategies among transgender women in Lima,Peru

Introduction : In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community‐level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Methods : Using qualitative methodology to provide an in‐depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community‐level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV‐related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18–44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Results : Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency‐based strategies included peer‐to‐peer and intergenerational knowledge sharing, supportive clinical services (e.g. group‐based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). Conclusion : This study highlights the importance of TW communities as support structures that create and deploy social resiliency‐based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.     

Recurrent collapse of a Gore TAG endograft in treating an aortoesophageal fistula

As the utility of the Gore TAG endograft expands in an off-label fashion to include various aortic pathologies like aortoesophageal fistulas (AEFs), more TAG endograft collapses are being described in the literature. We report a case of a recurrent endograft collapse in a patient with a right-sided aortic arch, who was treated for a hemorrhage from an AEF. One month following the initial endograft placement, angiography detected infolding of the endograft, which was then re-expanded with another endograft. Four months later, the patient developed an acute biventricular dysfunction with an ejection fraction (EF) less than 20%. Cardiac catheterization revealed that the patient had an 80 mmHg pressure gradient across the endograft suggesting another collapse. A balloon-expandable stent was used to re-expand the endografts and restore the EF. On follow-up, the patient's endograft has remained patent without evidence of further collapse.     

Venous outflow obstruction after orthotopic liver transplantation: use of a breast implant to maintain graft position

Hepatic venous outflow obstruction (HVOO) is a rare complication after orthotopic liver transplantation (OLT) usually related to technical issues or to malposition or kinking of the hepatic graft. When HVOO is diagnosed during the early post-transplant period, surgical options are technically very demanding and outcomes discouraging. Therefore, angioplasty and stent placement have been indicated to avoid a chronic lesion of the graft. Three cases of HVOO after OLT are reported. HVOO was diagnosed during the early post-transplant period and was due to graft malposition in two patients and kinking of the vena cava anastomosis in one. All patients were successfully treated with a 300-cc gel-filled breast implant surgically placed in the right hepatic fossa with the liver graft resting on it. Massive ascites in all three patients disappeared and renal impairment resolved within two wk post-implant placement. No prosthesis-related complications have been observed after a follow-up ranging from 30 to 58 months. We describe a simple and effective method of maintaining the liver graft in an adequate position to achieve prolonged relief of the outflow obstruction for the whole graft and discuss the advantages of a breast implant over stent placement or the use of different balloon catheters.     

Pain after mastectomy and breast reconstruction

Breast cancer is a potentially deadly disease affecting one in eight women. With the trend toward minimally invasive therapies for breast cancer, such as breast conserving therapies, sentinel node biopsies, and early treatments of radiation and chemotherapy, life expectancy after breast cancer has increased. However, pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience postoperative pain syndromes in approximately one-half of all cases. Patients post mastectomy and breast reconstruction can suffer from acute nociceptive pain and chronic neuropathic pain syndromes. Several preventative measures to control acute post operative pain and chronic pain states such as post mastectomy pain and phantom pain have been tried. This review focuses on the recent research done to control acute and chronic pain in patients receiving minimally invasive therapies for breast cancer, such as breast conserving therapies of mastectomies and breast reconstruction, sentinel node biopsies, and early treatments of radiation and chemotherapy.