Insurance Status and Differences in Treatment and Survival of Testicular Cancer Patients.

OBJECTIVE: To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS: Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations. RESULTS: Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND. CONCLUSION: UI testicular cancer patients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminoma patients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.

A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients.

OBJECTIVES: Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods (open, laparoscopic and robotic assisted) in obese (≥30 Kg/m(2)) patients with renal tumors. MATERIALS AND METHODS: Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open (n = 21), laparoscopic (n = 31) and robotic (n = 14). The outcome variables of blood loss, length of hospital stay, and complications were assessed. RESULTS: Mean blood loss in the laparoscopic group (100 mls) was significantly less than open group (300 mls) and no difference between laparoscopic and robotic groups (150 mls). We observed a shorter median hospital stay in the laparoscopic group (two days) than open group (four days) and no difference between laparoscopic and robotic groups (three days). Three patients in the laparoscopic group had complications: Two grade II and one with grade III (based on Clavien-Dindo classification). Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups (P > 0.05). The mean tumor size in the laparoscopic group (2.70 cms) was significantly smaller than that of the open group (4.22 cm) (P < 0.05), but not statistically different from that of the robotic group (2.99 cm). CONCLUSIONS: Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention.

A Cohort Mortality Study of Workers in a Second Soup Manufacturing Plant.

The authors previously reported on mortality among workers in a Baltimore soup plant. Increased mortality was observed for cancers of the floor of the mouth, rectosigmoid colon/rectum/anus, epilepsy, and chronic nephritis. Here, the authors report on mortality on a second soup plant in the same locality. Excess mortality was similarly recorded for cancers of the tonsils/oropharynx, rectosigmoid colon/rectum/anus, and lung and myelofibrosis. Excess risk from cardiovascular, cerebrovascular, kidney, and infectious diseases was also observed. These 2 studies are important because firstly, to the authors' knowledge, they are the only reports of mortality in this occupational group in spite of their having a potential for exposure to hazardous carcinogenic agents. Secondly, there is no information on any exposure assessment in this industry. These 2 reports will draw attention to the need to conduct more detailed exposure and mortality investigations in this little-studied group.

Environmental lead exposure is associated with visit-to-visit systolic blood pressure variability in the US adults.

PURPOSE: The association between environmental lead exposure and blood pressure variability, an important risk factor for cardiovascular disease, is unexplored and unknown. The objective of the study was to test the hypothesis that lead exposure is associated with blood pressure variability. METHODS: American participants 17 years of age or older from National Health and Nutrition Examination Survey III were included in the analysis. Participants' blood lead concentrations expressed as micrograms per deciliter were determined. The standard deviations of visit-to-visit systolic and diastolic blood pressure were calculated to determine blood pressure variability. Multivariable regression analyses adjusted for age, gender, race, smoking and socioeconomic status were employed. RESULTS: The participants' mean age and mean blood lead concentration were 42.72 years and 3.44 mcg/dl, respectively. Systolic blood pressure variability was significantly associated with environmental lead exposure after adjusting for the effect of the confounders. The unadjusted and adjusted means of visit-to-visit systolic blood pressure variability and the ß coefficient of lead exposure were 3.44, 3.33 mcg/dl, ß coefficient = 0.07, P < 0.01. CONCLUSIONS: This study documents a positive linear relationship between environmental lead exposure and systolic blood pressure variability. Screening adults with fluctuating blood pressure for lead exposure could be warranted.

Metabolic syndrome is associated with visit-to-visit systolic blood pressure variability in the US adults.

Epidemiological studies have shown that blood pressure is not a constant variable. Evidence has accumulated showing that the blood pressure variability is associated with organ damage. A substantial increase in the prevalence of the metabolic syndrome has been documented globally. We examined the association of visit-to-visit blood pressure variability with the metabolic syndrome and its components, using data collected in the Third National Health and Nutrition Examination Survey. A multivariable generalized linear model was performed. The metabolic syndrome and its components, particularly hypertension, increased waist circumference and hyperglycemia, were significantly associated with systolic blood pressure variability across study visits (P<0.05). After adjusting for the effect of age, gender, race and antihypertensive medication, the multivariable analyses did not show significant relationships between the metabolic syndrome and diastolic blood pressure variability (P-values >0.05). Additional research is required to verify the observed results in prospective studies and evaluate approaches to reduce blood pressure variability observed in clinical settings among persons with the metabolic syndrome to reduce its subsequent complications.

Polyketide synthesis in tobacco plants transformed with a Plumbago zeylanica type III hexaketide synthase.

A type III polyketide synthase from Plumbago zeylanica (PzPKS) was cloned and expressed in tobacco plants to study whether the transgenic tobacco plants expressing PzPKS synthesize the pharmacologically important polyketide, plumbagin. High resolution mass spectrometry based metabolite profiling of two transgenic events and wild type tobacco plants was carried out to investigate changes in polyketides, including plumbagin. Ten polyketides, which included six pyrones and four naphthalene derivatives, were identified in PzPKS transgenic plants. While one pyrone, styryl-2-pyranone, was detected in both, wild type and transgenic tobacco plants, three pyrones were expressed only in the leaves of transgenic tobacco plants. The transgenic tobacco plants did not accumulate plumbagin, but showed accumulation of isoshinanolone in the roots, which is postulated to be the reduction product of plumbagin. In addition, leaves of transgenic tobacco plants accumulated 3-methyl-1,8-naphthalenediol, a postulated precursor of plumbagin. The results indicated the requirement of additional Plumbago-specific components in the biosynthetic pathway of this polyketide.