Erratum: Egg Quality, Sensory Attributes, and Protein Metabolites of Laying Hens Fed Whole Flaxseed, Fish Oil, and Different Sources of Trace Elements.

[This corrects the article DOI: 10.2141/jpsa.2024021.].

The relationship between phytoestrogen-rich supplements and breast cancer: A multicenter case-control study in Saudi Arabia.

Objectives: The prospective effect of phytoestrogen-rich supplements has been explored by many researchers in an attempt to reduce breast cancer (BC) risk worldwide. In Saudi Arabia, some widely used supplements have high phytoestrogen content. Therefore, we aimed to (1) assess the relationship between phytoestrogen supplements (PSs) that are widely used among women of Saudi Arabia and BC and (2) assess the relationship based on the menstrual status. Methods: The study took place during 2020-2022 to assess several PSs using a case-control design that included five centers from different provinces around the country. A questionnaire was answered by the participants that included 381 (46%) cases (diagnosed with BC) and 449 (54%) controls (free of BC). The PS items were assessed individually and on the multivariant analysis model. Results: Of the 12 phytoestrogen-rich supplements, soy milk showed a significant decrease in BC risk. However, Echinacea showed an increased risk of BC among its users. A subgroup analysis based on the menstrual status demonstrated an increased risk of BC among licorice root and green tea users on premenopausal and postmenopausal women, respectively. Conclusion: Soy isoflavones continue to show a significant risk reduction that could be used for a modified approach to reduce the risk of BC. However, Echinacea, licorice root, and green tea have shown to increase the risk of BC.

Unraveling the Potential of Saccharum officinarum and Chlorella vulgaris towards 5-Fluorouracil-Induced Nephrotoxicity in Rats.

5-Fluorouracil (5-FU) is often used as a chemotherapeutic agent in treating tumors and is said to have adverse effects, including nephrotoxicity. Therefore, the present study aimed to evaluate the protective effects of Chlorella vulgaris (VL) and Saccharum officinarum L. (SOL) against 5-FU-induced nephrotoxicity in rats through the measurement of renal histology, kidney damage indicators, and antioxidant measures. A total of forty-eight male rats were allotted into six groups: group 1 acted as a control negative group (control), group 2 received 5-FU and worked as a control positive group (FU), group 3 received SOL 15 mL/kg (SOL), group 4 received VL 400 mg/kg (VL), group 5 received 5-FU+SOL (5-FU+SOL), and group 6 received 5-FU+VL (5-FU+VL). After fifteen days, blood and renal tissue specimens were collected for hematological, biochemical, molecular, and histopathological examinations. Findings of the current investigation showed that 5-FU leads to hematological alterations and kidney injury evinced by elevated serum concentrations of uric acid, creatinine, and urea (p < 0.01), and a marked increase in kidney MDA and NO levels with a reduction in kidney CAT, SOD and GSH activities (p < 0.05). Alterations of the histopathological structure of kidney tissue in the FU group were noticed compared to the other groups. 5-FU administration elevated expression levels of TNF-α, lipocalin 2, and KIM1 (p < 0.01) compared to the control ones. 5-FU-induced nephrotoxicity was ameliorated after treatment with SOL and VL via their free radical scavenging, potent antioxidant, and anti-inflammatory effects. In conclusion, our findings demonstrate that the treatment with SOL and VL significantly improved nephrotoxicity induced by 5-FU in rats.

Egg Quality, Sensory Attributes, and Protein Metabolites of Laying Hens Fed Whole Flaxseed, Fish Oil, and Different Sources of Trace Elements.

This study evaluated the effects of whole flaxseed (WFS), fish oil (FO), and different sources of Se, Zn, and Fe (inorganic, organic, and nano-source) on egg production, quality, sensory attributes, and serum protein metabolites in laying hens. A total of 144 hens were divided into six groups with six replicates of four hens each. Hens were fed six diets as follows: 1) control diet; 2) 7.5%WFS+1.5%FO; 3) 7.5%WFS+1.5%FO+175 mg/kg vitamin E (VE); 4) 7.5%WFS+1.5%FO+175 mg/kg VE + inorganic sources of Se, Zn, and Fe (ISeZnFe); 5) 7.5%WFS+1.5%FO+175 mg/kg VE + organic sources of Se, Zn, and Fe (OSeZnFe); 6) 7.5%WFS+1.5%FO+175 mg/kg VE + nano-source of Se, Zn, and Fe (NSeZnFe) from 40-50 weeks of age. Laying hens fed 7.5% WFS, 1.5% FO, and different sources of trace elements in their diets had no negative effects on laying rate, egg weight, egg mass, feed intake, feed conversion ratio, body weight change, or survival rate compared to that of hens fed the control diet. Dietary treatments did not negatively affect the external and internal egg characteristics or egg sensory attributes. Feeding 7.5%WFS+1.5%FO+VE+ISeZnFe positively influenced yolk color in fresh eggs. Dietary treatments had a significant impact on egg nutritional composition, with the highest levels of macronutrients found in eggs from hens fed the 7.5%WFS+1.5%FO+VE+NSeZnFe treatment. The highest plasma globulin concentrations were observed in hens fed organic and nano-source trace elements. The same diets reduced plasma uric acid levels. Based on these findings, the inclusion of organic or nano-source trace minerals in diets containing WFS and FO positively affected egg quality and hen protein metabolites.

Effect of dietary electrolyte balance and arginine to lysine ratio on hematological, antioxidant and immunological traits in dual-purpose breeding hens under cyclic heat stress condition.

A total of 245 hens and 35 cocks (32 weeks age) were assigned to seven treatment groups (five replicates with seven hens and one cock) to investigate the effect of dietary electrolyte balance (DEB) and arginine to lysine ratio (Arg/Lys) on birds' physiological and biochemical traits under cyclic heat stress (CHS) condition. Birds were housed in an environmentally controlled facility having four sectors. The first group (positive control, PC) was kept under thermoneutral conditions and fed diet with DEB of 180 mEq and Arg/Lys of 1.25, whereas the other six treatments were kept in the second sector under CHS and fed diet with DEB and Arg/Lys equal to: 180 mEq and 1.25 (negative control, NC); 250 mEq and 1.25; 320 mEq and 1.25; 180 mEq and 1.37; 250 mEq and 1.37; 320 mEq and 1.37, respectively. Hens on NC group had significantly decreased red blood cells (RBCs), white blood cells (WBCs) and its fractions. The groups fed different DEB and Arg/Lys in diet significantly enhanced the blood parameters and plasma lipid profile compared NC group. Hens under CHS fed on 250 and 320 DEB with 1.37 Arg/Lys recorded the lowest concentration of low-density lipoprotein (LDL) compared with the other groups. Triiodothyronine (T3) activity was not differed among groups, while T4 activity in layer exposed to CHS (NC group) recorded the highest activity compared to PC. From findings, it can be concluded that laying hens fed a diet having DEB 250 mEq with 1.37 Arg/Lys could be successfully applied to counteract the adverse effect of CHS and to improve blood hematological and biochemical traits, antioxidants, and immunity response.

Advancements in Varicose Vein Treatment: Anatomy, Pathophysiology, Minimally Invasive Techniques, Sclerotherapy, Patient Satisfaction, and Future Directions.

Varicose veins are a common vascular condition known for causing discomfort and cosmetic concerns. This comprehensive narrative review delves into their anatomy, pathophysiology, and modern treatment options, with a focus on endovenous techniques and sclerotherapy. The review starts by emphasizing the intricate anatomy of lower extremity venous circulation, underlining the significance of both superficial and deep venous networks in venous return. It also addresses how changes in the venous wall, including valvular insufficiency, contribute to the development of varicose veins. Endovenous techniques like endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and mechanochemical endovenous ablation (MOCA) are explored in detail. These minimally invasive procedures have revolutionized varicose vein treatment, offering high success rates and quicker recovery compared to traditional surgery. The review also highlights their efficacy and safety profiles, aiding clinicians in informed decision-making. Sclerotherapy, a vital modality for varicose veins, is thoroughly examined, covering both liquid and foam sclerotherapy. Foam sclerotherapy, in particular, is recognized for its improved outcomes. The review provides a comprehensive comparison of these treatment modalities, highlighting differences in technical success, recurrence rates, and cost-effectiveness. Patient preferences and satisfaction play a significant role in choosing the right treatment. Safety and potential complications associated with these treatments are explored, with a focus on minor issues and rare adverse events. This review also emphasizes the positive impact of varicose vein interventions on patients' quality of life.

Protective influence of supplementary betaine against heat stress by regulating intestinal oxidative status and microbiota composition in broiler chickens.

To assess the impact of supplementing betaine (BT) under heat stress (HS) conditions on broiler performance and intestinal health from 21 to 42 days of age, a total of 150 male Ross 308 broilers were indiscriminately allotted to 3 treatments with 10 replications of 5 birds each. The control (CON) group was given a basal ration and accommodated at a thermoneutral condition (22 ± 1 °C), whereas the HS and HS + BT groups were raised under cyclic HS (33 ± 1 °C for 8 h and 22 ± 1 °C for 16 h per day) and received the basal ration without or with 1000 mg/kg BT, respectively. The HS reduced average daily gain (ADG); average daily feed intake; villus height (VH); VH to crypt depth (CD) ratio (VCR); activities of trypsin, lipase, glutathione peroxidase (GPX), and catalase; and enumeration of Lactobacillus and Bifidobacterium (P < 0.05) and augmented feed conversion ratio (FCR), CD, malondialdehyde (MDA) accumulation, and enumeration of Escherichia coli, Clostridium, and coliforms (P < 0.05). Conversely, BT supplementation heightened ADG, VH, VCR, trypsin activity, GPX activity, and populations of Lactobacillus and Bifidobacterium (P < 0.05) and lowered FCR, MDA accumulation, and Clostridium population (P < 0.05). Furthermore, the FCR value, trypsin and GPX activities, MDA content, and Bifidobacterium and Clostridium populations in the HS + BT group were nearly equivalent to those in the CON group. To conclude, feeding BT under HS conditions could improve broiler performance through improving intestinal health by specifically mitigating oxidative damage and enhancing the colonization of beneficial bacteria.

Yucca schidigera Extract Mitigates the Oxidative Damages, Inflammation, and Neurochemical Impairments in the Brains of Quails Exposed to Lead.

The present study explored the neurotoxic impacts of lead (Pb) and the potential alleviating effect of Yucca schidigera extract (YSE) in Japanese quails. About 360 adult Japanese quails (8 weeks old) were used. Quails were randomly distributed to six groups with 4 replicates each: the control group (fed basal diet, BD), the BD + YSE1 and BD + YSE2 groups (BD + 100 and 200 mg/kg diet of YSE, respectively), the Pb group (BD + 100 mg/kg Pb), and the Pb + YSE1 and Pb + YSE2 groups (BD + Pb + 100 and 200 mg/kg YSE, respectively). This feeding trial lasted for 8 weeks. The exposure to Pb in the diet induced oxidative damage stress in the brain of exposed quails reflected by the significant increase in the oxidative markers including malonaldehyde (MDA) and protein carbonyl (PC) and the significant reduction in the activities of antioxidants including catalase (CAT), superoxide dismutase (SOD), and the reduced glutathione (GSH). Brain neurochemistry and enzyme activities were also altered following Pb exposure. Pb significantly reduced serotonin, dopamine, norepinephrine, GABA, Ach, and Na + /K + -ATPase activities. Pb dietary intoxication markedly increased brain inflammatory biomarkers, including tumor necrosis factor (TNF-α), myeloperoxidase, and nitric oxide. Peripherally, Pb toxicity decreased the amino acid neurotransmitters (glutamic acid, glycine, and aspartic acid) in the serum of birds. At the transcriptomic level, Pb exposure upregulated the transcription patterns of CASP3, TNF-α, HSP70, and IL-1ß. The single effect of YSE maintained that all the assessed parameters were not changed compared to the control. Interestingly, the YSE co-supplementation with Pb alleviated the Pb-induced neuro-oxidative damages by lowering the lipid, protein, and DNA damage, and the inflammatory biomarkers.

Effect of dietary supplementation of betaine and organic minerals on growth performance, serum biochemical parameters, nutrients digestibility, and growth-related genes in broilers under heat stress.

Global warming and climate changes have a detrimental impact on poultry production, causing substantial economic losses. This study investigated the effects of incorporating dietary betaine (BT) and organic minerals (OMs) on broilers' performance as well as their potential to mitigate the negative impacts of heat stress (HS). Six hundred 1-day-old Ross 308 chicks were randomly allocated to 12 experimental treatments with 5 replicates of 10 birds each (5 male + 5 female). The birds were provided with diets containing BT (0 and 2,000 ppm) and OMs (0, 250, and 500 ppm), either individually or in combination, under both thermoneutral and HS-inducing temperatures. The HS conditions involved exposing the birds to cyclic periods of elevated temperature (35°C ± 2°C) for 6 h daily, from 10:00 am to 4:00 pm, starting from d 10 and continuing until d 35. The exposure to HS deteriorated birds' growth performance; however, dietary BT and OMs inclusion improved the growth performance parameters bringing them close to normal levels. Carcass traits were not affected by dietary supplementation of BT, OMs, HS, or their interaction. Interestingly, while HS led to increased (P < 0.05) levels of total cholesterol, LDL-cholesterol, and hepatic malondialdehyde (MDA), these adverse effects were mitigated (P < 0.05) by the addition of BT and OMs. Moreover, dietary BT supplementation led to elevated serum total protein and globulin concentrations. Cyclic HS did not alter Mn, Zn, and Cu contents in the pectoral muscle. However, the incorporation of OMs at both levels increased concentrations of these minerals. Notably, the combination of 500 ppm OMs and 2,000 ppm BT improved Mn, Zn, Cu, and Fe digestibility, which has been compromised under HS conditions. Cyclic HS upregulated gene expression of interleukin-1ß, heat shock protein 70, and Toll-like receptor-4 while downregulated the expression of claudin-1, uncoupling protein, growth hormone receptor, superoxide dismutase 1, glutathione peroxidase 1 and insulin-like growth factor 1. The aforementioned gene expressions were reversed by the combination of higher dietary levels of BT and OMs. In conclusion, the dietary supplementation of 500 ppm OMs along with 2,000 ppm BT yielded significant improvements in growth performance and mineral digestibility among broiler chickens, regardless of thermal conditions. Moreover, this combination effectively restored the expression of growth-related genes even under heat-stress conditions.

Betaine and nano-emulsified vegetable oil supplementation for improving carcass and meat quality characteristics of broiler chickens under heat stress conditions.

Introduction: This research aimed to examine the effects of water-added betaine (BET) and/or nano-emulsified vegetable oil (MAGO) on carcass and meat quality characteristics of broilers raised under thermoneutral (TN) and heat stress (HS) conditions. Methods: On day 21, 640 birds (Ross 308) were randomly assigned to one of two thermal conditions (thermoneutral 22 ± 1°C and heat stress 32 ± 1°C) each containing four treatment groups: Control, BET, MAGO, and a mixture of both (BETMAGO) in a 2 × 4 factorial arrangement (eight groups). Each group has eight replicates, with ten birds each. The birds' carcass and meat quality characteristics were evaluated at 35 days. Results and discussion: The dressing percentage, breast, leg, wing, heart, initial pH, color change, cooking loss (CL), water-holding capacity (WHC), shear force (SF), and texture profile with exception of springiness significantly affected by the treatments. The results showed that HS had negative effects on carcass weight and relative weights of the breast, spleen, and heart. Moreover, HS increased dressing percentage, wing, initial pH, final core temperature, initial lightness, WHC, and hardness. Significant differences in interactions between treatments and temperature were observed in the spleen, WHC, and SF. Conclusion: Water supplemented with BET effectively improved carcass dressing percentage, breast weight, and meat quality in terms of water-holding capacity and tenderness under HS conditions. More studies on the use of BET and/or MAGO at different levels were recommended.

Medication Adherence Among Multimorbid Patients With Polypharmacy and Its Relation to Social Support at National Guard Primary Health Care Centers, Riyadh.

OBJECTIVE: The aim of the present study was to estimate the prevalence of nonadherence to medication in multimorbid patients with polypharmacy and its relationship to social support in primary healthcare centers in Riyadh, Saudi Arabia. METHODS: We conducted a cross-sectional, convenience-sample, non-randomized study in three primary healthcare centers managed by National Guard Health Affairs. The participants included 417 adult patients - (a) with two or more chronic illnesses and (b) who were taking two or more medications. The primary outcome variable was the prevalence of medication nonadherence in multimorbid patients with polypharmacy as measured by the modified Morisky Medication Adherence Scale (MMAS-8). The second main variable was the impact of functional social support, as measured by the Duke-UNC Functional Social Support Questionnaire (FSSQ), on medication adherence. RESULTS: The level of medication adherence was low for 194 (46.5%) of the 417 patients, medium for 127 (30.5%), and high for 96 (23%). There were 256 (61.4%) male participants and 161 (38.6%) females, and their mean age was 59.15 (SD ± 11.186) years. Additionally, 171 (41%) participants used two or three medications, 127 (30.5%) used four or five medications, and 119 (28.5%) used more than five medications; 178 (42.7%) of the patients had two comorbidities, 136 (32.9%) had three comorbidities, 69 (16.5%) had four comorbidities, and 31 (7.5%) had five comorbidities. Some social support data from the Duke-UNC Functional Social Support Questionnaire (FSSQ) was missing for 58 (13.9%) of the participants. Among the rest of the sample, reported levels of social support levels were high for 246 (59%) patients, medium for 101 (24.2%), and low for 12 (2.9%) patients. None of the differences between social support and medication adherence were statistically significant. However, 61 (24.8%) patients reported both high social support and high medication adherence; 173 (48.2%) had low social support and low medication adherence (p = 0.470). CONCLUSION: We found that medication nonadherence in multimorbid patients with polypharmacy was high (46.5%). Although there were no statistically significant relationships between social support and medication adherence, certain patient characteristics were associated with low medication adherence - age over 60 years, male gender, and number of medications.

A Case of a Female Patient Presenting With Idiopathic Granulomatous Mastitis With Superimposed Enterococcus Avium Infection.

Idiopathic granulomatous mastitis (IGM) is defined as an uncommon, benign, chronic inflammatory disease of unknown etiology that affects the breast and can mimic breast cancer. It usually manifests as a solid, ill-defined breast lump in postpartum women of reproductive age. Furthermore, because it lacks a particular radiographic finding, core biopsy and histology are the only ways to make a conclusive diagnosis. There is no agreement on the best way to treat IGM. Ideally, a multidisciplinary approach should be used to weigh the benefits and drawbacks of each treatment option, with options such as observation, antibiotics, surgery, and medication therapy being examined (steroids and immunosuppressants). In this report, we review a case of a patient who had IGM with superimposed Enterococcus avium infection. To our knowledge, such a report is considered unprecedented in the Middle East. A literature review on IGM will be presented, as well as the clinical presentation, association with bacterial infection, treatment, and pathological and radiographic findings.

Radiographic changes in ribs following clipping of patent ductus arteriosus in preterm infants.

Objectives: There are no published reports on the rib abnormalities on the plain chest radiograph in preterm infants following surgical clipping of isolated patent ductus arteriosus. The purpose of this study was to describe changes in the ribs on the plain chest radiograph following surgical clipping of patent ductus arteriosus (surgery groups) in preterm infants compared to non-surgical closure of patent ductus arteriosus (control group). Methods: Data from preterm infants with patent ductus arteriosus clipping (surgery) via a left postero-lateral thoracotomy were compared with infants in whom the patent ductus arteriosus closed: spontaneously, with medications or use of an occlusive device (controls). Serial pre- and post-closure plain chest radiographs were randomly reviewed by a reader blinded to the route of closure and up to 1 year following the patent ductus arteriosus closure. Results: Of the total of 196 cases included in the study: 45 of the patent ductus arteriosus closed following treatment with medications, 8 cases closed with an occlusion device, 38 were closed surgically, and in 105 cases, the patent ductus arteriosus closed spontaneously. Compared to the pre-operative period, 36/38 (95%) infants in the surgery group had one or more of the following rib abnormalities: ipsilateral fourth and fifth rib fusion, narrowing of the ipsilateral fifth intercostal space, thinning of the ipsilateral fourth or fifth rib, or a combination of the above on the chest radiograph compared to 0% in the control group (p < 0.001). Conclusion: Radiographic rib abnormalities are common and appear in infancy following surgical clipping of patent ductus arteriosus in preterm infants. Further studies are needed to clarify the natural history of these abnormalities on thoracic cage and cardiopulmonary functions.

Soybean Oil Replacement by Poultry Fat in Broiler Diets: Performance, Nutrient Digestibility, Plasma Lipid Profile and Muscle Fatty Acids Content.

Continuous genetic improvements of commercial broiler strains has led to the necessity of using fats in their rations to fulfill a large portion of the energetic requirements. Several fat sources have been introduced in poultry nutrition, such as rendering poultry fat (PF) an available and cheap lipid source compared to conventional sources such as soybean oil (SO). The present study investigated the effect of partial or full replacement of SO by PF on performance, nutrient digestibility, blood lipids, and fatty acids (FAs) content of pectoral muscle. Four hundred and eighty one-day-old male Ross-308 chicks were distributed into four experimental groups (12 replicates each): the first group (control) was fed a diet formulated with soybean oil as a fat source while the second to fourth groups (PF25, PF50, and PF100) were fed diets formulated with 25, 50 and 100% of PF as a fat source instead of SO. Results revealed no synergistic effect between SO and PF in any of the studied parameters. Replacing SO by PF did not alter birds' growth, carcass characteristics, and plasma indices of birds. Abdominal fat% was increased (p < 0.01) in PF50 and PF100. Dry matter digestibility was improved (p < 0.05) in PF50 and PF100, while crude fat and protein digestibility was not affected. Contents of palmitic and docosahexaenoic acids in the pectoral muscle of PF50 and PF100 were reduced (p < 0.01) while concentrations of oleic and linolenic acids, total unsaturated FAs, and polyunsaturated FAs/Saturated FAs ratio were elevated (p < 0.05) in the same groups. Liver thiobarbituric acid reactive substances (TBARS) and muscle vitamin E contents were not altered. The dietary addition of PF greatly improved economic parameters. In conclusion, PF can be used as a lipid source in broiler diets to produce inexpensive meat while maintaining its growth performance.

Protective influence of betaine on intestinal health by regulating inflammation and improving barrier function in broilers under heat stress.

This research was executed to study the impacts of adding betaine (BT) to broiler diets on intestinal inflammatory response and barrier integrity under heat stress (HS). At 21 d of age, 150 male broilers (Ross 308) were randomly assigned to 3 treatment groups: control (CON) group, in which broilers were provided standard finisher feed under thermoneutral condition (22 ± 1°C); HS group and HS + BT group, in which broilers were given the standard feed supplied with 0 and 1,000 mg/kg BT, respectively, under cyclic HS condition (33 ± 1°C for 8 h from 08:00 to 16:00 h and the thermoneutral temperature for the residual hours). Each treatment was replicated ten times with 5 broilers per replicate. The HS group showed an elevation (P < 0.05) in serum corticosterone (CORT) concentration, D-lactate acid (D-LA) content, and diamine oxidase (DAO) activity, mucosal interleukin-1ß (IL-1ß) level, and expression of heat shock protein 70 (HSP70) gene, and a reduction (P < 0.05) in mucosal interleukin-10 (IL-10) level and secretory immunoglobulin A (SIgA) content and relative abundance of mRNA for occludin (OCLN), zonula occludens-1 (ZO-1), claudin-1 (CLDN1), and claudin-4 (CLDN4). In contrast, broilers in the HS + BT group exhibited a raise (P < 0.05) in mucosal IL-10 level and SIgA content and relative expression of OCLN and ZO-1 genes, and a decline (P < 0.05) in serum CORT concentration and DAO activity, mucosal IL-1ß level, and expression of HSP70 mRNA. These results indicate that supplemental BT can ameliorate intestinal injury in heat-challenged broilers by suppressing inflammatory responses and enhancing mucosal barrier function.

Predictive model for systemic recurrence following cisplatin-based neoadjuvant chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma.

INTRODUCTION: Neoadjuvant chemotherapy (NAC) is increasingly used prior to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Systemic recurrence (SR) carries a dismal prognosis. We sought to determine risk factors associated with SR in this setting. METHODS: We evaluated a multi-center database of patients with UTUC who received cisplatin-based NAC before RNU. Final pathology at RNU was dichotomized into ypT<2 vs ypT≥2. Univariable and multivariable analyses were performed to identify risk factors associated with SR. Three groups were defined based on the number of significant risk factors (groups 1, 2, 3 for 0-1, 2, 3 risk factors, respectively) and evaluated for recurrence-free survival (RFS) using the Kaplan-Meier method. RESULTS: 106 patients were identified between 2004 and 2018. Median age was 67.0 years [IQR = 61-73.3]; 57 (54%) and 49 (46 %) patients received MVAC and GC, respectively. Final pathological stage was ypT<2 in 57 (54%); 23% (24/106) had SR. On univariable analysis, pathological variables on final specimen including ypT≥2, lymphovascular invasion (ypLVI), and nodal involvement were associated with SR. On multivariable analysis, ypLVI OR = 4.1 (95% CI 1.2-13.6; P = 0.024) and pathological nodal involvement OR = 4.5 (95% CI 1.3-15.7; P = 0.017) were predictive of recurrence. Stratifying by the number of risk factors, the 2-year RFS was 95%, 55%, and 18% for groups 1, 2, and 3 respectively (log-rank <0.001). CONCLUSION: This model evaluates the risk of SR following NAC and RNU to guide counseling and decision-making after surgery. Adverse pathological variable including ypLVI and nodal involvement, in combination with ypT-stage, are strongly associated with SR.

Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital.

BACKGROUND: The objective of this study was to determine whether standardized treatment of germ cell tumors (GCTs) could overcome sociodemographic factors limiting patient care. METHODS: The records of all patients undergoing primary treatment for GCTs at both a public safety net hospital and an academic tertiary care center in the same metropolitan area were analyzed. Both institutions were managed by the same group of physicians in the context of multidisciplinary cancer care. Patients were grouped by care center; clinicopathologic features and outcomes were analyzed. RESULTS: Between 2006 and 2018, 106 and 95 patients underwent initial treatment for GCTs at the safety net hospital and the tertiary care center, respectively. Safety net patients were younger (29 vs 33 years; P = .005) and were more likely to be Hispanic (79% vs 11%), to be uninsured (80% vs 12%; P < .001), to present via the emergency department (76% vs 8%; P < .001), and to have metastatic (stage II/III) disease (42% vs 26%; P = .025). In a multivariable analysis, an absence of lymphovascular invasion (odds ratio [OR], 0.30; P = .008) and an embryonal carcinoma component (OR, 0.36; P = .02) were associated with decreased use of adjuvant treatment for stage I patients; hospital setting was not (OR, 0.67; P = .55). For patients with stage II/III nonseminomatous GCTs, there was no difference in the performance of postchemotherapy retroperitoneal lymph node dissection between the safety net hospital and the tertiary care center (52% vs 64%; P = .53). No difference in recurrence rates was observed between the cohorts (5% vs 6%; P = .76). CONCLUSIONS: Sociodemographic factors are often associated with adverse clinical outcomes in the treatment of GCTs; they may be overcome with integrated, standardized management of testicular cancer.

Does grossly complete transurethral resection improve response to neoadjuvant chemotherapy?

INTRODUCTION: There is controversy regarding the benefit of a grossly complete transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC) in patients prior to neoadjuvant chemotherapy (NAC). Advocates for this approach suggest a higher response rate to NAC, while others suggest this can increase the surgical risk for no clear benefit. METHODS: We retrospectively reviewed our institutional radical cystectomy (RC) database from 2011 to 2018 for patients who received an adequate course of cisplatin-based NAC for nonmetastatic MIBC. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complete response [ypT0] or no residual muscle invasive bladder cancer [ypT < 2] following NAC based on clinicopathologic characteristics and grossly complete or incomplete TURBT. RESULTS: A total of 167 patients received NAC followed by RC for MIBC during the study period and 100 patients were included in the analysis due to known status of the completeness of TURBT-of these 49 patients underwent complete resection while 51 patients underwent incomplete resection prior to NAC. There were no significant differences in baseline clinicopathologic characteristics between patients who had complete vs. incomplete TURBT. At the time of RC, the overall ypT0 rate was 24% (n = 24), while the overall rate of ypT < 2 was 45%. On logistic regression, there was no association between completeness of TURBT and ypT0 or ypT < 2. Age, histology, and organ-confined disease were not significantly associated with response to NAC. Only smoking status (current or prior history) was negatively associated with ypT0 on univariable and multivariable analysis (odds ratio = 0.36, 95% confidence interval: [0.14-0.91], P = 0.031). CONCLUSION: We found no association between response to cisplatin-based NAC and completeness of TURBT in a cohort of MIBC patients. The study is limited by its retrospective nature and lack of ability to predict response to NAC based on TURBT tissue evaluation.

Pathologic stage as a surrogate for oncologic outcomes after receipt of neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma.

OBJECTIVE: Whether pathologic stage at radical nephroureterectomy (RNU) can serve as an appropriate surrogate for oncologic outcomes in patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) treated with neoadjuvant chemotherapy (NAC) is not defined. We sought to determine whether patients who achieve pathologically non-muscle-invasive (ypT0, ypTa, ypT1, ypTis) HG UTUC after receipt of NAC exhibit oncologic outcomes comparable to those who are inherently low stage without chemotherapy. METHODS: We identified 647 UTUC patients who underwent RNU among 3 institutions from 1993to2016. Patients with low or unknown grade, pathologic muscle invasion, or receipt of adjuvant chemotherapy were excluded. We compared clinicopathologic data and oncologic outcomes between pT0-1 and ypT0-1 patients. Kaplan-Meier analysis was used to assess overall (OS), cancer-specific (CSS), and systemic recurrence-free (RFS) survival. Predictors of these endpoints were identified using Cox regression. RESULTS: 234 (43 ypT0-1, 191 pT0-1) patients with HG UTUC were included. Two patients exhibited pathologic complete response after NAC. OS (P = 0.055), CSS (P = 0.152), and RFS (P = 0.098) were similar between ypT0-1 and pT0-1 patients. Predictors of worse outcomes included African-American race (RFS, CSS, and OS), Charlson score (OS), and systemic recurrence (OS and CSS). CONCLUSIONS: Patients with HG UTUC who achieve ypT0-1 stage after NAC exhibit favorable oncologic outcomes comparable to those inherently non-muscle-invasive who do not receive chemotherapy. Improvements in clinical staging will play an important role in better defining candidacy for NAC in treating HG UTUC while minimizing overtreatment. Furthermore, pathologic stage may serve as an appropriate early surrogate for oncologic endpoints in designing clinical trials.

TP53 genetic polymorphisms and susceptibility to cervical cancer in Bangladeshi women: a case-control study.

Pharmacogenetic study of TP53 gene polymorphisms has not been conducted extensively in cervical cancer. The aim of this study was to assesses the TP53 codon 72 and codon 47 polymorphisms and their relation to cervical cancer risk in Bangladeshi women. 134 cervical cancer patients and 102 age matched healthy controls were included from two institutions in Bangladesh. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used for genotyping two TP53 single nucleotide polymorphisms (codon 72 and codon 47) in patients and controls. The results indicate that the TP53 Arg/Pro heterozygosity (adjusted OR 2.32, 95% CI 1.28-4.34, p = 0.01), Pro/Pro mutant homozygosity (adjusted OR 4.15, 95% CI 1.75-9.86, p = 0.001), along with the combined genotype (Arg/Pro + Pro/Pro) (adjusted OR 2.83, 95% CI 1.61-4.97, p < 0.001) significantly increases the risk of cervical cancer. Moreover, the cervical cancer patients with a first-degree relative cancer patient possesses 4.45 folds more risk (p = 0.019) of carrying a proline allele in codon 72 of the TP53 gene compared to those patients who do not have any first-degree relative with cancer. Finally, polymorphism in the codon 47 of the TP53 gene did not significantly increase the risk of cervical cancer in Bangladeshi women. To conclude, this is the first study to identify that polymorphism in the TP53 codon 72 significantly increases the risk of cervical cancer in a female population in Bangladesh.