Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 45
Filter
Add more filters

Country/Region as subject
Publication year range
1.
J Urol ; 211(3): 415-425, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38147400

ABSTRACT

PURPOSE: Less invasive decision support tools are desperately needed to identify occult high-risk disease in men with prostate cancer (PCa) on active surveillance (AS). For a variety of reasons, many men on AS with low- or intermediate-risk disease forgo the necessary repeat surveillance biopsies needed to identify potentially higher-risk PCa. Here, we describe the development of a blood-based immunocyte transcriptomic signature to identify men harboring occult aggressive PCa. We then validate it on a biopsy-positive population with the goal of identifying men who should not be on AS and confirm those men with indolent disease who can safely remain on AS. This model uses subtraction-normalized immunocyte transcriptomic profiles to risk-stratify men with PCa who could be candidates for AS. MATERIALS AND METHODS: Men were eligible for enrollment in the study if they were determined by their physician to have a risk profile that warranted prostate biopsy. Both training (n = 1017) and validation cohort (n = 1198) populations had blood samples drawn coincident to their prostate biopsy. Purified CD2+ and CD14+ immune cells were obtained from peripheral blood mononuclear cells, and RNA was extracted and sequenced. To avoid overfitting and unnecessary complexity, a regularized regression model was built on the training cohort to predict PCa aggressiveness based on the National Comprehensive Cancer Network PCa guidelines. This model was then validated on an independent cohort of biopsy-positive men only, using National Comprehensive Cancer Network unfavorable intermediate risk and worse as an aggressiveness outcome, identifying patients who were not appropriate for AS. RESULTS: The best final model for the AS setting was obtained by combining an immunocyte transcriptomic profile based on 2 cell types with PSA density and age, reaching an AUC of 0.73 (95% CI: 0.69-0.77). The model significantly outperforms (P < .001) PSA density as a biomarker, which has an AUC of 0.69 (95% CI: 0.65-0.73). This model yields an individualized patient risk score with 90% negative predictive value and 50% positive predictive value. CONCLUSIONS: While further validation in an intended-use cohort is needed, the immunocyte transcriptomic model offers a promising tool for risk stratification of individual patients who are being considered for AS.


Subject(s)
Prostate-Specific Antigen , Prostatic Neoplasms , Male , Humans , Leukocytes, Mononuclear/pathology , Watchful Waiting , Prostatic Neoplasms/pathology , Biopsy , Risk Assessment
2.
Mol Psychiatry ; 27(8): 3417-3424, 2022 08.
Article in English | MEDLINE | ID: mdl-35487966

ABSTRACT

Serotonin transporter (5-HTT) binding deficits are reported in major depressive disorder (MDD). However, most studies have not considered serotonin system anatomy when parcellating brain regions of interest (ROIs). We now investigate 5-HTT binding in MDD in two novel ways: (1) use of a 5-HTT tract-based analysis examining binding along serotonergic axons; and (2) using the Copenhagen University Hospital Neurobiology Research Unit (NRU) 5-HT Atlas, based on brain-wide binding patterns of multiple serotonin receptor types. [11C]DASB 5-HTT PET scans were obtained in 60 unmedicated participants with MDD in a current depressive episode and 31 healthy volunteers (HVs). Binding potential (BPP) was quantified with empirical Bayesian estimation in graphical analysis (EBEGA). Within the [11C]DASB tract, the MDD group showed significantly lower BPP compared with HVs (p = 0.02). This BPP diagnosis difference also significantly varied by tract location (p = 0.02), with the strongest MDD binding deficit most proximal to brainstem raphe nuclei. NRU 5-HT Atlas ROIs showed a BPP diagnosis difference that varied by region (p < 0.001). BPP was lower in MDD in 3/10 regions (p-values < 0.05). Neither [11C]DASB tract or NRU 5-HT Atlas BPP correlated with depression severity, suicidal ideation, suicide attempt history, or antidepressant medication exposure. Future studies are needed to determine the causes of this deficit in 5-HTT binding being more pronounced in proximal axon segments and in only a subset of ROIs for the pathogenesis of MDD. Such regional specificity may have implications for targeting antidepressant treatment, and may extend to other serotonin-related disorders.


Subject(s)
Depressive Disorder, Major , Serotonin Plasma Membrane Transport Proteins , Humans , Serotonin Plasma Membrane Transport Proteins/metabolism , Depressive Disorder, Major/drug therapy , Serotonin/metabolism , Bayes Theorem , Positron-Emission Tomography , Brain/diagnostic imaging , Brain/metabolism , Antidepressive Agents/therapeutic use
3.
Int J Mol Sci ; 24(3)2023 Feb 01.
Article in English | MEDLINE | ID: mdl-36769093

ABSTRACT

Immune checkpoint inhibitors (ICIs) have changed how we think about tumor management. Combinations of anti-programmed death ligand-1 (PD-L1) immunotherapy have become the standard of care in many advanced-stage cancers, including as a first-line therapy. Aside from improved anti-tumor immunity, the mechanism of action of immune checkpoint inhibitors (ICIs) exposes a new toxicity profile known as immune-related adverse effects (irAEs). This novel toxicity can damage any organ, but the skin, digestive and endocrine systems are the most frequently afflicted. Most ICI-attributed toxicity symptoms are mild, but some are severe and necessitate multidisciplinary side effect management. Obtaining knowledge on the various forms of immune-related toxicities and swiftly changing treatment techniques to lower the probability of experiencing severe irAEs has become a priority in oncological care. In recent years, there has been a growing understanding of an intriguing link between the gut microbiome and ICI outcomes. Multiple studies have demonstrated a connection between microbial metagenomic and metatranscriptomic patterns and ICI efficacy in malignant melanoma, lung and colorectal cancer. The immunomodulatory effect of the gut microbiome can have a real effect on the biological background of irAEs as well. Furthermore, specific microbial signatures and metabolites might be associated with the onset and severity of toxicity symptoms. By identifying these biological factors, novel biomarkers can be used in clinical practice to predict and manage potential irAEs. This comprehensive review aims to summarize the clinical aspects and biological background of ICI-related irAEs and their potential association with the gut microbiome and metabolome. We aim to explore the current state of knowledge on the most important and reliable irAE-related biomarkers of microbial origin and discuss the intriguing connection between ICI efficacy and toxicity.


Subject(s)
Antineoplastic Agents, Immunological , Drug-Related Side Effects and Adverse Reactions , Gastrointestinal Microbiome , Melanoma , Neoplasms , Humans , Antineoplastic Agents, Immunological/therapeutic use , Immune Checkpoint Inhibitors/adverse effects , Neoplasms/drug therapy , Melanoma/drug therapy , Drug-Related Side Effects and Adverse Reactions/etiology , Immunotherapy/adverse effects , Immunotherapy/methods , Biomarkers
4.
Monaldi Arch Chest Dis ; 93(3)2022 Nov 02.
Article in English | MEDLINE | ID: mdl-36325916

ABSTRACT

Coronavirus disease 2019 (COVID-19) continues to be a disease of global importance, with an increasing array of sequelae attributed to infection by the severe acute respiratory syndrome coronavirus-2. One such complication that has been rarely documented thus far is diaphragmatic dysfunction. Here, we report the cases of 2 individuals who developed diaphragmatic paralysis post COVID-19, which failed to respond to conservative management. Both patients proceeded to undergo robot-assisted thoracoscopic plication of the diaphragm reinforced with a bovine acellular dermal matrix. In both cases, there was significant improvement in symptomatology, namely dyspnoea and fatigue. We conclude that robot-assisted diaphragmatic plication should be considered for the treatment of refractory diaphragmatic paralysis post COVID-19.


Subject(s)
Acellular Dermis , COVID-19 , Respiratory Paralysis , Robotics , Humans , Animals , Cattle , Respiratory Paralysis/surgery , Respiratory Paralysis/complications , COVID-19/complications , Diaphragm/surgery
5.
BMC Med Inform Decis Mak ; 20(1): 89, 2020 05 13.
Article in English | MEDLINE | ID: mdl-32404086

ABSTRACT

BACKGROUND: Systematic, automated methods for monitoring physician performance are necessary if outlying behavior is to be detected promptly and acted on. In the Michigan Urological Surgery Improvement Collaborative (MUSIC), we evaluated several statistical process control (SPC) methods to determine the sensitivity and ease of interpretation for assessing adherence to imaging guidelines for patients with newly diagnosed prostate cancer. METHODS: Following dissemination of imaging guidelines within the Michigan Urological Surgery Improvement Collaborative (MUSIC) for men with newly diagnosed prostate cancer, MUSIC set a target of imaging < 10% of patients for which bone scan is not indicated. We compared four SPC methods using Monte Carlo simulation: p-chart, weighted binomial CUSUM, Bernoulli cumulative sum (CUSUM), and exponentially weighted moving average (EWMA). We simulated non-indicated bone scan rates ranging from 5.9% (within target) to 11.4% (above target) for a representative MUSIC practice. Sensitivity was determined using the average run length (ARL), the time taken to signal a change. We then plotted actual non-indicated bone scan rates for a representative MUSIC practice using each SPC method to qualitatively assess graphical interpretation. RESULTS: EWMA had the lowest ARL and was able to detect changes significantly earlier than the other SPC methodologies (p < 0.001). The p-chart had the highest ARL and thus detected changes slowest (p < 0.001). EWMA and p-charts were easier to interpret graphically than CUSUM methods due to their ability to display historical imaging rates. CONCLUSIONS: SPC methods can be used to provide informative and timely feedback regarding adherence to healthcare performance target rates in quality improvement collaboratives. We found the EWMA method most suited for detecting changes in imaging utilization.


Subject(s)
Guideline Adherence , Physicians , Diagnostic Imaging , Humans , Male , Monte Carlo Method , Prospective Studies
6.
J Urol ; 197(5): 1222-1228, 2017 05.
Article in English | MEDLINE | ID: mdl-27889418

ABSTRACT

PURPOSE: We implemented a statewide intervention to improve imaging utilization for the staging of patients with newly diagnosed prostate cancer. MATERIALS AND METHODS: MUSIC (Michigan Urological Surgery Improvement Collaborative) is a quality improvement collaborative comprising 42 diverse practices representing approximately 85% of the urologists in Michigan. MUSIC has developed imaging appropriateness criteria (prostate specific antigen greater than 20 ng/ml, Gleason score 7 or higher and clinical stage T3 or higher) which minimize unnecessary imaging with bone scan and computerized tomography. After baseline rates of radiographic staging were established in 2012 and 2013, we used multidimensional interventions to deploy these criteria in 2014. Imaging utilization was then remeasured in 2015 to evaluate for changes in practice patterns. RESULTS: A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p <0.0001). The use of computerized tomography when not indicated decreased from 14.7% at baseline to 7.7% after interventions (p <0.0001). Variability among practices decreased substantially after the interventions as well. The use of recommended imaging remained stable during these periods. CONCLUSIONS: An intervention aimed at appropriate use of imaging was associated with decreased use of bone scans and computerized tomography among men at low risk for metastases.


Subject(s)
Diagnostic Imaging/statistics & numerical data , Neoplasm Staging/methods , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Quality Improvement , Unnecessary Procedures/statistics & numerical data , Adult , Aged , Aged, 80 and over , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Health Services , Humans , Male , Men's Health , Michigan/epidemiology , Middle Aged , Neoplasm Staging/standards , Prostate/pathology , Prostatic Neoplasms/pathology , Quality Improvement/statistics & numerical data , Radionuclide Imaging/statistics & numerical data , Registries , Tomography, X-Ray Computed/statistics & numerical data , Young Adult
7.
J Urol ; 194(5): 1253-7, 2015 Nov.
Article in English | MEDLINE | ID: mdl-25981805

ABSTRACT

PURPOSE: We used data from MUSIC (Michigan Urological Surgery Improvement Collaborative) to evaluate the performance of published selection criteria for active surveillance in diverse urology practice settings. MATERIALS AND METHODS: For several active surveillance guidelines we calculated the proportion of men meeting each set of selection criteria who actually entered active surveillance, defined as the sensitivity of the guideline. After identifying the most sensitive guideline for the entire cohort we compared demographic and tumor characteristics between patients who met this guideline and entered active surveillance, and those who received initial definitive therapy. RESULTS: Of 4,882 men with newly diagnosed prostate cancer 18% underwent active surveillance. When applied to the entire cohort, the sensitivity of published guidelines ranged from 49% in Toronto to 62% at Johns Hopkins. At a practice level the sensitivity of Johns Hopkins criteria varied widely from 27% to 84% (p <0.001). Compared with men undergoing active surveillance, those meeting Johns Hopkins criteria who received definitive therapy were younger (p <0.001) and more likely to have a positive family history (p = 0.003), lower prostate specific antigen (p <0.001), a greater number of positive cores (2 vs 1) on biopsy (p <0.001) and a higher cancer volume in positive core(s) (p = 0.002). CONCLUSIONS: The sensitivity of published active surveillance selection criteria varies widely across diverse urology practices. Among patients meeting the most stringent criteria those who received initial definitive therapy had characteristics suggesting greater cancer risk, underscoring the nuanced clinical factors that influence treatment decisions.


Subject(s)
Patient Selection , Population Surveillance/methods , Prostatic Neoplasms/therapy , Risk Assessment/methods , Urology/methods , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Humans , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies
8.
Angew Chem Int Ed Engl ; 54(5): 1490-3, 2015 Jan 26.
Article in English | MEDLINE | ID: mdl-25504807

ABSTRACT

Tin is a promising anode candidate for next-generation lithium-ion batteries with a high energy density, but suffers from the huge volume change (ca. 260 %) upon lithiation. To address this issue, here we report a new hierarchical tin/carbon composite in which some of the nanosized Sn particles are anchored on the tips of carbon nanotubes (CNTs) that are rooted on the exterior surfaces of micro-sized hollow carbon cubes while other Sn nanoparticles are encapsulated in hollow carbon cubes. Such a hierarchical structure possesses a robust framework with rich voids, which allows Sn to alleviate its mechanical strain without forming cracks and pulverization upon lithiation/de-lithiation. As a result, the Sn/C composite exhibits an excellent cyclic performance, namely, retaining a capacity of 537 mAh g(-1) for around 1000 cycles without obvious decay at a high current density of 3000 mA g(-1) .

9.
Front Surg ; 11: 1395884, 2024.
Article in English | MEDLINE | ID: mdl-38952439

ABSTRACT

Background: TNM staging is the most important prognosticator for non-small cell lung cancer (NSCLC) patients. Staging has significant implications for the treatment modality for these patients. Lymph node dissection in robot-assisted thoracoscopic (RATS) surgery remains an area of ongoing evaluation. In this study, we aim to compare lymph node dissection in RATS and VATS approach for lung resection in NSCLC patients. Methods: We retrospectively compiled a database of 717 patients from July 31, 2015-July 7, 2022, who underwent either a wedge resection, segmentectomy or lobectomy. We analysed the database according to lymph node dissection. The database was divided into RATS (n = 375) and VATS (n = 342) procedures. Results: The mean number of lymph nodes harvested overall with RATS was 6.1 ± 1.5 nodes; with VATS approach, it was 5.53 ± 1.8 nodes. The mean number of N1 stations harvested was 2.66 ± 0.8 with RATS, 2.36 ± 0.9 with VATS. RATS approach showed statistically higher lymph node dissection rates compared to VATS (p = 0.002). Out of the 375 RATS procedures, 26 (6.4%) patients undergoing a RATS procedure were upstaged from N0/N1 staging to N2. N0/N1-N2 upstaging was reported in 28 of 342 (8.2%) patients undergoing a VATS procedure. The majority of upstaging was seen in N0-N2 disease: 19 of 375 (5%) for RATS and 23 of 342 (6.7%) for VATS. Conclusions: We conclude that in RATS procedures, there is a higher rate of lymph node dissection compared to VATS procedures. Upstaging was mostly seen in N0-N2 disease, this was observed at a higher rate with VATS procedures.

10.
Heliyon ; 10(12): e32443, 2024 Jun 30.
Article in English | MEDLINE | ID: mdl-38975157

ABSTRACT

Thoracic surgery in the context of complex multimorbidity and clinical deterioration presents a unique set of challenges when balancing risk and benefit. Advances in anaesthesia, surgical technique, and imaging, have allowed for operative options for patients that were once deemed too high-risk. An effective proactive multi-disciplinary approach is essential for successful outcomes. We report the case of a 65-year-old patient with a background of severe aortic stenosis who underwent lung resection for stage IIIA lung cancer, where pivotal multi-disciplinary team input from the anaesthetic, surgery, critical care and radiology teams, clarified the cause of his clinical deterioration, contributed to decisions over his management and ensured a good clinical outcome.

11.
BMC Psychiatry ; 13: 119, 2013 Apr 20.
Article in English | MEDLINE | ID: mdl-23601273

ABSTRACT

BACKGROUND: This mixed-methods study was designed to explore young Australian men's attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men. METHODS: National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24). RESULTS: Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men. CONCLUSIONS: The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men's views and everyday technology practices, and leverage the influence of peers.


Subject(s)
Attitude to Health , Health Behavior , Men/psychology , Mental Health Services , Mental Health , Adolescent , Australia , Focus Groups , Humans , Internet , Male , Patient Acceptance of Health Care/psychology , Technology , Young Adult
12.
Int J Urol ; 20(11): 1144-6, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23600850

ABSTRACT

Vaginal mesh erosion into the bladder after midurethral sling procedure or cystocele repair is uncommon, with only a few cases having been reported in the literature. The ideal surgical management is still controversial. Current options for removal of eroded mesh include: endoscopic, transvaginal or abdominal (either open or laparoscopic) approaches. We, herein, present the first case of robotic removal of a large eroded vaginal mesh into the bladder and discuss potential benefits and limitations of the technique.


Subject(s)
Device Removal/methods , Surgical Mesh/adverse effects , Urinary Bladder/surgery , Aged , Female , Humans , Robotics , Urinary Tract Infections/etiology
13.
Med Dosim ; 48(4): 286-292, 2023.
Article in English | MEDLINE | ID: mdl-37666707

ABSTRACT

Multiple trials have shown that dose-escalation of radiation for prostate cancer provides a biochemical progression-free survival benefit (bPFS); however, rectal constraints are often limiting. In this dosimetric study, we hypothesized that a well-placed rectal hydrogel (RH) would permit improved dose-escalation and target coverage. We selected patients with good-quality RH and created plans with and without RH, prescribing 70 Gy in 28 fractions to the prostate and proximal seminal vesicles (PSV), and a peripheral zone (PZ) boost to 84 Gy, 98 Gy, or 112 Gy. We then compared plans with and without RH, prescribing a 112 Gy boost to 1 to 2 cm simulated dominant intraprostatic lesions (DIL). In the 18 plans created with a PZ boost, the PTV_boost D95% was higher in RH plans compared to non-RH plans (median 98.5 Gy vs 75.53 Gy, p < 0.01). The PSV planning target volume (PTV_PSV) D95% was also marginally higher with RH (71.87 Gy vs 71.04 Gy, p < 0.01). All rectal metrics were improved with RH. For the 32 plans created for simulated DILs treated to 112 Gy, the PTV_boost coverage (median D95% 112.48 Gy vs 102.63 Gy, p < 0.01) and rectal metrics were improved with RH. Four non-RH plans with at least a 4 mm rectal-PTV_boost gap achieved D95% > 98% of the prescription dose for the PTV_boost. Our study showed that placement of a high-quality RH allowed for GEDE-EBRT up to 112 Gy in 28 fractions (EQD2 160 Gy with α/ß = 2.5). This concept should be tested prospectively, particularly to assess for increases in nonrectal toxicities.


Subject(s)
Hydrogels , Prostatic Neoplasms , Male , Humans , Radiotherapy Dosage , Hydrogels/therapeutic use , Radiotherapy Planning, Computer-Assisted , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/pathology , Rectum
14.
Global Spine J ; : 21925682231163812, 2023 Mar 20.
Article in English | MEDLINE | ID: mdl-36939636

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Magnetic Resonance Imaging (MRI) is often regarded as the gold standard for spinal pathology, as it provides good structural visualisation. SPECT-CT, however, provides combined structural and functional information. There is a paucity of literature comparing SPECT-CT with MRI in the spine. Our aim was to determine whether SPECT-CT provides additional information to MRI in individuals with complex spinal pathology, including deformity, which altered management. METHODS: We conducted a retrospective review of all individuals seen at our tertiary spinal unit that were investigated with both MRI and SPECT-CT of the spine between 2007-2020. We reviewed imaging reports, and collated diagnoses, surgical treatment and the relative contributions of MRI and SPECT-CT to management decisions. RESULTS: 104 individuals identified, with a mean age of 30 years (89 females and 15 males). Diagnostic categories were adolescent, adult, and congenital deformity, degenerative pathology, and miscellaneous pathology. MRI returned positive findings in 58 (55.8%), and SPECT-CT in 41 (39.4%) cases. SPECT-CT identified 10 cases of facet joint degeneration, 5 of increased uptake around metalwork suggestive of loosening, 1 pseudoarthrosis, 1 partial failure of fusion and 1 osteoid osteoma which were not reported on MRI, all in individuals who had previously undergone spinal instrumentation. Despite this, SPECT-CT only altered management for 6 individuals (5.8%). CONCLUSIONS: MRI is less useful in the setting of previous instrumentation due to metal artefact. Where MRI is inconclusive, particularly in individuals with previous spinal instrumentation, SPECT-CT may provide a diagnosis, but is not recommended as primary imaging.

15.
J Med Primatol ; 41(3): 158-62, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22296111

ABSTRACT

BACKGROUND: Focus on the placenta as an agent of fetal development and offspring health outcomes is growing. Primate research facilities or zoos may collect and fix placental tissue for long-term storage, but little is known about the effects of formalin fixation on the non-human primate placenta. METHODS: We obtained 48 vervet monkey placentas from the St. Kitts Biomedical Research Foundation. We investigated via correlation coefficients and ANOVAs the effects of gestational age and original fresh weight on weight change due to fixation. We also used linear regression models to determine whether fixed tissue weight was predictive of fresh weight and gestational age. RESULTS: Although the vervet monkey placenta is described as bidiscoid, 14.6% of the placentas in this sample were fused into a single mass. A decrease in weight was the most common response to formalin fixation, with the greatest degree of loss experienced by the heaviest placentas (ANOVA, F=5.99, P=0.005). Gestational age was unrelated to weight change. Those placentas that increased in weight had the lowest fresh weights. Fixed weights significantly predicted both fresh weight and gestational age (r(2) =0.78, P<0.00001; r(2) =0.76, P<0.00001, respectively). CONCLUSIONS: This paper adds to a sparse literature on the vervet monkey placenta. That fixed placentas are excellent predictors of both fresh weight and gestational age suggests that banked tissue may be a valuable resource for reconstructing aspects of individual life history, although caution must be exercised given the variability of weight change as a function of original placental size.


Subject(s)
Chlorocebus aethiops/anatomy & histology , Placenta/anatomy & histology , Tissue Preservation/veterinary , Animals , Chlorocebus aethiops/physiology , Female , Gestational Age , Organ Size , Pregnancy
16.
J Med Internet Res ; 14(6): e160, 2012 Nov 22.
Article in English | MEDLINE | ID: mdl-23171827

ABSTRACT

BACKGROUND: Young men are particularly vulnerable to suicide, drug, and alcohol problems and yet fail to seek appropriate help. An alternative or adjunct to face-to-face services has emerged with widespread uptake of the Internet and related communication technologies, yet very little evidence exists that examines the capacity of the Internet to engage young men and promote help seeking. OBJECTIVE: To explore young people's attitudes and behaviors in relation to mental health and technology use. The aim was to identify key gender differences to inform the development of online mental health interventions for young men. METHODS: A cross-sectional online survey of 1038 young people (aged 16 to 24 years) was used. RESULTS: Young men are more likely than young women to play computer games, access online video/music content, and visit online forums. More than half of young men and women reported that they sought help for a problem online, and the majority were satisfied with the help they received. Significant gender differences were identified in relation to how young people would respond to a friend in need, with young men being less likely than young women to confront the issue directly. CONCLUSIONS: Online interventions for young men need to be action-oriented, informed by young men's views and everyday technology practices, and leverage the important role that peers play in the help-seeking process.


Subject(s)
Computers , Internet , Mental Health , Adolescent , Adult , Cell Phone , Cross-Sectional Studies , Female , Humans , Male , Stress, Psychological , Young Adult
17.
Cureus ; 14(8): e28529, 2022 Aug.
Article in English | MEDLINE | ID: mdl-36185841

ABSTRACT

Bronchopleural fistula (BPF) is a feared and potentially life-threatening complication of pneumonectomy. Clinical features such as a productive cough and subcutaneous emphysema raise suspicion of BPF with CT imaging and bronchoscopy providing a definitive diagnosis. In light of the significant morbidity and mortality associated with the condition, a significant proportion of cases necessitate surgical repair of the bronchial stump. Currently, there is no consensus on optimal surgical strategy. Traditionally, various vascularised tissue flaps, including pericardial fat pad, omentum, and muscle, have been used to buttress the repaired stump, with varying success rates. In light of this, novel approaches have been devised with the aim of achieving more consistent surgical outcomes. In this case report, we describe a novel approach to reinforcing the suture repair using porcine dermal collagen matrix (Permacol, Medtronic, Minneapolis, MN) and hydrogel sealant (Progel, BD, Franklin Lakes, NJ) to achieve successful closure of a BPF in an adult male patient following pneumonectomy for squamous cell carcinoma. The use of porcine dermal collagen matrix covered with hydrogel sealant is a viable alternative to traditional BPF closure strategies and can achieve good patient outcomes. This technique has several benefits including cost-effectiveness and sparing of native tissues, and it is technically straightforward. Further studies are required to compare the clinical outcomes of this and other novel techniques with traditional BPF closure approaches.

18.
Brachytherapy ; 21(3): 300-307, 2022.
Article in English | MEDLINE | ID: mdl-35125329

ABSTRACT

BACKGROUND: Though some techniques that facilitate rectal sparing such as brachytherapy and intensity modulated radiotherapy (IMRT) have been examined in detail, technical aspects of hydrogel spacer (HS) have been studied less exhaustively. We examined HS quality metrics and approaches to placement for superior dosimetric outcomes. MATERIALS AND METHODS: A single site retrospective review of radiation plans was conducted for patients who received combination-brachytherapy (CBT) with 90 Gy low-dose-rate implant followed by external beam radiotherapy (45 Gy/25 fractions) with operating room (OR) placed HS (2017-2021). A randomly selected set of patients that received CBT without HS over the same time period was used for comparison. Dosimetric outcomes included D1cc and D5% rectum. Dose gradients were quantified. Student's t-test was used for statistical comparisons. RESULTS: Sixty patients (30 with and 30 without HS) who received CBT for prostate cancer were examined. Those with HS had lower mean D1cc [65.31 Gy (SD = 13.53)] and D5% [53.20 Gy (SD = 10.18)] compared to those treated without HS [91.67 Gy (SD = 8.31) and 75.00 Gy (SD = 8.45), respectively, p < 0.001]. Patients with superior HS (average thickness ≥1 cm; n = 12) had lower mean D1cc [58.49 Gy (SD = 13.25, p = 0.026)] and D5% [48.69 Gy (SD = 9.85, p = 0.049)] than those with thinner HS. When dose gradients were considered, HS spanning the interface between the prostate and perirectal tissues to a thickness ≥1 cm can reduce rectal maximum dose to 50-60 Gy. CONCLUSIONS: Through effective use of CBT and HS, extreme rectal dose restriction is possible. The goal for HS placement should be thickness ≥1 cm from base to apex.


Subject(s)
Brachytherapy , Prostatic Neoplasms , Radiotherapy, Intensity-Modulated , Brachytherapy/methods , Humans , Hydrogels , Male , Organs at Risk , Prostate , Prostatic Neoplasms/radiotherapy , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/methods , Rectum
19.
Prostate Cancer Prostatic Dis ; 25(4): 677-683, 2022 04.
Article in English | MEDLINE | ID: mdl-34285350

ABSTRACT

BACKGROUND: Decipher Biopsy is a commercially available gene expression classifier used in risk stratification of newly diagnosed prostate cancer (PCa). Currently, there are no prospective data evaluating its clinical utility. We seek to assess the clinical utility of Decipher Biopsy in localized PCa patients. METHODS: A multi-institutional study of 855 men who underwent Decipher Biopsy testing between February 2015 and October 2019. All patients were tracked through the prospective Michigan Urological Surgery Improvement Collaborative and linked to the Decipher Genomics Resource Information Database (GRID®; NCT02609269). Patient matching was performed by an independent third-party (ArborMetrix Inc.) using two or more unique identifiers. Cumulative incidence curves for time to treatment (TTT) and time to failure (TTF) were constructed using Kaplan-Meier estimates. Multivariable Cox proportional hazard models were used to evaluate the independent association of high-risk Decipher scores with the conversion from AS to radical therapy and treatment failure (biochemical failure or receipt of salvage therapy). RESULTS AND LIMITATIONS: Eight hundred fifty-five patients underwent Decipher Biopsy testing during the study period. Of the 855 men, 264 proceeded to AS (31%), and 454 (53%) received radical therapy. In men electing AS, after adjusting for NCCN risk group, age, PSA, prostate volume, body mass index, and percent positive cores, a high-risk Decipher score was independently associated with shorter TTT (HR 2.51, 95% CI 1.52-4.13 p < 0.001). Similarly, in patients that underwent radical therapy, a high-risk Decipher score was independently associated with TTF (HR 2.98, 95% CI 1.22-7.29, p = 0.01) on multivariable analysis. Follow-up time was a limitation. CONCLUSION: In a prospective statewide registry, high-risk Decipher Biopsy score was strongly and independently associated with conversion from AS to definitive treatment and treatment failure. These real-world data support the clinical utility of Decipher Biopsy. An ongoing phase 3 randomized trial (NCT04396808) will provide level 1 evidence of the clinical impact of Decipher biopsy testing.


Subject(s)
Prostatic Neoplasms , Humans , Male , Biopsy , Proportional Hazards Models , Prostate-Specific Antigen , Prostatectomy/adverse effects , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/therapy , Risk Factors
20.
Bone Joint J ; 103-B(5): 971-975, 2021 May.
Article in English | MEDLINE | ID: mdl-33934648

ABSTRACT

AIMS: The aim of this study was to assess the reliability of using MRI scans to calculate the Spinal Instability Neoplastic Score (SINS) in patients with metastatic spinal cord compression (MSCC). METHODS: A total of 100 patients were retrospectively included in the study. The SINS score was calculated from each patient's MRI and CT scans by two consultant musculoskeletal radiologists (reviewers 1 and 2) and one consultant spinal surgeon (reviewer 3). In order to avoid potential bias in the assessment, MRI scans were reviewed first. Bland-Altman analysis was used to identify the limits of agreement between the SINS scores from the MRI and CT scans for the three reviewers. RESULTS: The limit of agreement between the SINS score from the MRI and CT scans for the reviewers was -0.11 for reviewer 1 (95% CI 0.82 to -1.04), -0.12 for reviewer 2 (95% CI 1.24 to -1.48), and -0.37 for reviewer 3 (95% CI 2.35 to -3.09). The use of MRI tended to increase the score when compared with that using the CT scan. No patient having their score calculated from MRI scans would have been classified as stable rather than intermediate or unstable when calculated from CT scans, potentially leading to suboptimal care. CONCLUSION: We found that MRI scans can be used to calculate the SINS score reliably, compared with the score from CT scans. The main difference between the scores derived from MRI and CT was in defining the type of bony lesion. This could be made easier by knowing the site of the primary tumour when calculating the score, or by using inverted T1-volumetric interpolated breath-hold examination MRI to assess the bone more reliably, similar to using CT. Cite this article: Bone Joint J 2021;103-B(5):971-975.


Subject(s)
Joint Instability/diagnostic imaging , Joint Instability/pathology , Magnetic Resonance Imaging , Spinal Cord Compression/diagnostic imaging , Spinal Cord Compression/pathology , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/secondary , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed
SELECTION OF CITATIONS
SEARCH DETAIL