The influence of physical activity level on the length of stay in hospital in older men survivors of COVID-19.

The purpose of this study was to verify the influence of physical activity level on the length of hospital stay in older men recovered from COVID-19. In total, 126 older men diagnosed with COVID-19 were admitted to the hospital between September and December 2020. Among them, 70 survived, of which 39 older men were included in the study. Within 30 days after discharge, patients answered the International Physical Activity Questionnaire to measure their physical activity level through phone contact, with questions corresponding to the week before symptom onset. Clinical and laboratorial data from admission, days between onset of symptoms and admission, length of stay, computed tomography abnormalities, and the need for the intensive care unit were collected. The groups (active × sedentary) were compared using the Student t test or Mann-Whitney test for quantitative data and chi-square test was used for categorical data. There is no difference between the groups in characteristics of admission (p > 0.05), except by potassium level. Active older men had a shorter length of stay (6.50 ± 3.46 vs 11.48 ± 7.63 days; p = 0.03), disease duration (15.71 ± 4.84 vs 21.09 ± 7.69 days; p = 0.02), and lower frequency of lung damage when compared to their sedentary counterparts. In conclusion, being physically active prior to infection can attenuate length of hospital stay in older men with COVID-19.

Efficacy and safety of abiraterone acetate plus prednisolone in patients with early metastatic castration-resistant prostate cancer who failed first-line androgen-deprivation therapy: a single-arm, phase 4 study.

AIM: The aim was to evaluate the efficacy and safety of abiraterone acetate plus prednisolone in patients with chemotherapy-naïve early metastatic castration-resistant prostate cancer who failed first-line androgen deprivation therapy. METHODS: Patients with early metastatic castration-resistant prostate cancer with confirmed prostate-specific antigen progression within 1-year or prostate-specific antigen progression without having normal prostate-specific antigen level (<4.0 ng/mL) during first-line androgen deprivation therapy were enrolled and administered abiraterone acetate (1000 mg) plus prednisolone (10 mg). A minimum of 48 patients were required according to Simon's minimax design. The primary endpoint was prostate-specific antigen response rate (≥50% prostate-specific antigen decline by 12 weeks), secondary endpoints included prostate-specific antigen progression-free survival and overall survival. Safety parameters were also assessed. RESULTS: For efficacy, 49/50 patients were evaluable. Median age was 73 (range: 55-86) years. The median duration of initial androgen deprivation therapy was 32.4 (range: 13.4-84.1) weeks and 48 patients experienced prostate-specific antigen progression within 1-year after initiation of androgen deprivation therapy. prostate-specific antigen response rate was 55.1% (95% confidence interval: 40.2%-69.3%), median prostate-specific antigen-progression-free survival was 24.1 weeks, and median overall survival was 102.9 weeks (95% confidence interval: 64.86 not estimable [NE]). Most common adverse event was nasopharyngitis (15/50 patients, 30.0%). The most common ≥grade 3 adverse event was alanine aminotransferase increased (6/50 patients, 12.0%). CONCLUSIONS: Abiraterone acetate plus prednisolone demonstrated a high prostate-specific antigen response rate of 55.1%, suggesting tumor growth still depends on androgen synthesis in patients with early metastatic castration-resistant prostate cancer. However, prostate-specific antigen-progression-free survival was shorter than that reported in previous studies. Considering the benefit-risk profile, abiraterone acetate plus prednisolone would be a beneficial treatment option for patients with chemotherapy-naive metastatic prostate cancer who show early castration resistance.

Patellofemoral reconstruction for patellar instability with patella alta in middle-aged patients: Clinical outcomes.

INTRODUCTION: Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry. MATERIALS AND METHODS: Twelve middle-aged patients with a mean age of 44 years (range: 40-55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm. Patellar position and clinical outcomes were evaluated postoperatively. The mean follow-up time was 41.5 months (range: 24-72 months). RESULTS: Patellar position altered from 1.31 (1.21-1.53) preoperatively to 0.88 (0.69-1.06) postoperatively on the Caton-Deschamps Index (p<0.01). The tibial tuberosity-trochlear groove (TT-TG) distance altered from 21.8mm (20.1-25.8mm) to 10.3mm (5.1-14.7mm), and patellar tilt ranged from 28.1° (21-40°) to 14.6° (5-28°), respectively (p<0.01). Clinical outcomes on the Lysholm and Kujala scales improved from 43.1 and 38.4 to 86.7 and 78.3, respectively, at final follow-up (p<0.01). Surgical treatment that included trochleoplasty resulted in better outcomes than other surgical combinations without trochleoplasty (p<0.05). Sulcus angle and postoperative patellar tilt improved more in those who underwent trochleoplasty than in those who did not (p<0.05). DISCUSSION: Surgical treatment for patellar instability with patella alta in middle-aged patients resulted in improved clinical outcomes. In particular, a combination surgery including trochleoplasty resulted in the greatest improvement in case of severe trochlear dysplasia. LEVEL OF EVIDENCE: IV. Retrospective case series study.

Reliability of the Heart Rate Variability Threshold using Visual Inspection and Dmax Methods.

The purpose of this study was to compare heart rate variability threshold (HRVT) in 6 incremental tests and test its reproducibility using visual inspection and Dmax methods for root mean square of successive differences between the adjacent normal R-R intervals (RMSSD), standard deviation of the normal RR interval (SDNN) and standard deviation of instantaneous beat-to-beat variability (SD1). 12 adult males performed an incremental test to volitional fatigue on a cycle simulator during 6 visits to the laboratory. The initial test load was 25 W, and the intensity was increased by 25 W every 3 min until volitional fatigue set in. The HRV during the incremental test was analyzed using the RMSSD, SDNN and SD1 indices and the determination of HRVT was performed using 2 methods: visual inspection and Dmax. The results demonstrated that the SD1 and RMSSD indices, determined by the visual inspection method, presented the highest reproducibility of HRVT when compared with the other indices and methods. We concluded that the best method for determining HRVT was the technique using the point of stabilization by visual inspection in the SD1 and RMSSD indices during the incremental test, due to its high reproducibility, lower coefficient of variation and increment size.

Utilization of sludge in building material.

Several thermal solidification processes have been developed mainly in Japan. They are lightweight aggregates, brick, interlocking tile, char, and slag. A full-scale plant of them has been successfully operated for more than 10 years. The quality of the end products is better than the traditional ones. They are all substitutive to existing ones. The Japanese experience proves that all the processes are technically feasible, but not economically. Their manufacturing cost is always higher than market price. In addition, they consume large amounts of energy. However, if they are identified for a process of sludge disposal, all of them are worth considering for a big city where there is no place for the sludge to go. The end products can be reused inside the city. A new alternative is "Portland cement". A Portland cement manufacturer accepts sewage sludge, if being paid some amount of money. An average payment is US$100 each 1,000 kg of ash or sludge cake. The Portland cement manufacturer accepts either cake or ash at the same price. It is about 50 to 30% of the energy cost of thermal solidification. The question is which is the better, dewatered cake or incinerated ash, for the Portland cement application. The answer is "it depends on the distance between the sewage plant and the Portland cement plant."

Reuse of sewage sludge as raw material of Portland cement in Japan.

A potential alternative of sewage sludge reuse is the substitute of raw material for Portland cement. This paper overviews Japanese implementation of this and discusses the best selection of pretreatment for this purpose. The pretreatment includes dewatering, incineration, and lime treatment.

[A case of gastrointestinal stromal tumor of rectum, difficult to differentiate from leiomyosarcoma of prostate].

A 70 year-old male was seen at the hospital with the chief complaints of frequent miction and incomplete urinary retention. A hen's egg-sized firm mass was palpable in anterior wall of rectum by digital rectal examination. Intravenous urography showed severe bilateral hydronephroureter. Transrectal ultrasound, CT scan and MRI revealed a mass with 5 cm in diameter between prostate and rectum, and the margin of them were unclear. On needle biopsy of the tumor, leiomyosarcoma of the prostate was suspected. We performed radical cytectomy and created continent urinary reserver. Because the tumor and rectum could not be lysed, part of the rectum was resected. Histological examination showed gastrointestinal stromal tumor (GIST) of rectum. GIST of rectum is a rare entity, and in case of contact with the prostate, it is difficult to differentiate from leiomyosarcoma of prostate.

Analysis on heterogeneity of squamous cell carcinoma antigen by two-dimensional electrophoresis.

Squamous cell carcinoma (SCC) antigen was separated by two-dimensional electrophoresis combined with immunoblotting into four spots: spot 1 with pI 6.4 and 44.5 kDa, spot 2 with pI 6.3 and 44.5 kDa, spot 3 with pI 6.0 and 44.5 kDa, and spot 4 with pI 5.9 and 45 kDa. In cancer and noncancerous tissues, it was common that spot 1 was the largest spot. In noncancerous tissues, spot 3 was the smallest spot and spot 2 was stained as densely as spot 4. In cancer tissues, however, spot 4 was apparently smaller than spot 2 and 3. Also, spots 2 and 3 in cancer tissues were larger than those in noncancerous tissues. When SCC antigen was treated with alkaline phosphatase prior to isoelectric focusing (IEF), spot 4 disappeared from the immunoblotting pattern. When the SCC antigen was treated with alkaline phosphatase after IEF, spot 4 changed its molecular weight to the same weight as that of the other three spots. These results strongly suggest that spot 4 is phosphorylated SCC antigen.

Effects of restraint stress on luteal function in rats during mid-pregnancy.

This study was undertaken to investigate the relationship between the inhibitory effect of restraint stress and the protective effect of the feto-placental luteotrophic factors on luteal function during mid-pregnancy in rats. The number of conceptuses was adjusted to one (1C group) or more than ten (FC group) on day 7 of pregnancy, and each rat received restraint stress from day 12 to day 17 of pregnancy. Restraint stress consisted of placing a rat individually in a small plastic holder three times a day for 1 h each time. Restraint stress significantly decreased serum progesterone concentration on day 17 of pregnancy in the 1C group, but not in the FC group. Restraint stress also decreased serum progesterone concentration on day 17 of pregnancy in the 1C group which received bilateral adrenalectomy on day 12 of pregnancy. The number of animals with fetal resorption in this group of rats (10 out of 14 animals) was significantly greater than in any other group of rats. The number of animals with fetal resorption in the adrenalectomized 1C group was significantly lower after daily injections of 4 mg progesterone from day 12 to day 17 of pregnancy. In the FC group of rats, even in adrenalectomized rats, restraint stress did not cause any changes in serum progesterone concentration or fetal loss. These data indicate that restraint stress is luteolytic and causes fetal loss during mid-pregnancy; this effect can be blocked by some factors from conceptuses, as occurred in the FC group.

Effects of ovarian ischemia-reperfusion on luteal function in pregnant rats.

An involvement of reactive oxygen species in CL regression has been reported. We have shown that a decrease in serum progesterone concentrations coincides with a decrease in superoxide dismutase (SOD) activities and an increase in lipid peroxide levels in the CL after Day 15 of pregnancy. Recently it has been found that ischemia-reperfusion stimulates reactive oxygen species production and causes tissue damage in various organs. We therefore tested the effect of ischemia-reperfusion in the ovary on CL function in pregnant rats. On Day 15 of pregnancy, after clamping of the bilateral ovarian vessels for 30 min, the ovaries were reperfused for 90 min by declamping. The ischemia-reperfusion decreased serum progesterone concentration and SOD activity in the CL and increased lipid peroxide in the CL 90 min after reperfusion. The effects of ischemia-reperfusion, including the decrease in serum progesterone concentrations, were completely blocked by simultaneous injection of SOD and catalase, but not by indomethacin administration. The present study shows that CL function was inhibited by reactive oxygen species produced by ischemia-reperfusion in the ovary and that the effect was not mediated through prostaglandins.

Expression of mRNA of SCC antigen in squamous cells.

The expression of SCC antigen mRNA was studied by Northern blot analysis and in situ hybridization in human gynecologic tissues. Northern blot analysis revealed that mRNA of SCC antigen was expressed strongly in normal squamous epithelium and columnar epithelium of the uterine cervix, but not in the endometrium, fallopian tube or ovarian tissue. Among gynecologic malignancies, squamous cell carcinoma of the uterine cervix expressed mRNA of SCC antigen, whereas endometrial and ovarian adenocarcinoma were negative. With in situ hybridization, mRNA of SCC antigen is located in the basal and parabasal layers of the normal squamous epithelium, in dysplasia, and also in carcinoma in situ and invasive squamous cell carcinoma. These results confirmed the previous findings by immunohistochemical studies that SCC antigen is closely related to squamous cells, but also raised a new puzzle regarding the different localization of mRNA and its product, SCC antigen, in the normal squamous epithelium.