Enhanced clinical decisions for management of benign prostatic hyperplasia using patient-reported outcomes: protocol for a prospective observational study.

BACKGROUND: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) significantly impact quality of life among older men. Despite the prevalent use of the American Urological Association Symptom Index (AUA-SI) for BPH, this measure overlooks key symptoms such as pain and incontinence, underscoring the need for more comprehensive patient-reported outcome (PRO) tools. This study aims to integrate enhanced PROs into routine clinical practice to better capture the spectrum of LUTS, thereby improving clinical outcomes and patient care. METHODS: This prospective observational study will recruit men with LUTS secondary to BPH aged ≥ 50 years from urology clinics. Participants will be stratified into medical and surgical management groups, with PRO assessments scheduled at regular intervals to monitor LUTS and other health outcomes. The study will employ the LURN Symptom Index (SI)-29 alongside the traditional AUA-SI and other non-urologic PROs to evaluate a broad range of symptoms. Data on comorbidities, symptom severity, and treatment efficacy will be collected through a combination of electronic health records and PROs. Analyses will focus on the predictive power of these tools in relation to symptom trajectories and treatment responses. Aims are to: (1) integrate routine clinical tests with PRO assessment to enhance screening, diagnosis, and management of patients with BPH; (2) examine psychometric properties of the LURN SIs, including test-retest reliability and establishment of clinically meaningful differences; and (3) create care-coordination recommendations to facilitate management of persistent symptoms and common comorbidities measured by PROs. DISCUSSION: By employing comprehensive PRO measures, this study expects to refine symptom assessment and enhance treatment monitoring, potentially leading to improved personalized care strategies. The integration of these tools into clinical settings could revolutionize the management of LUTS/BPH by providing more nuanced insights into patient experiences and outcomes. The findings could have significant implications for clinical practices, potentially leading to updates in clinical guidelines and better health management strategies for men with LUTS/BPH. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov (NCT05898932).

Formation of new stellar populations from gas accreted by massive young star clusters.

Stars in clusters are thought to form in a single burst from a common progenitor cloud of molecular gas. However, massive, old 'globular' clusters--those with ages greater than ten billion years and masses several hundred thousand times that of the Sun--often harbour multiple stellar populations, indicating that more than one star-forming event occurred during their lifetimes. Colliding stellar winds from late-stage, asymptotic-giant-branch stars are often suggested to be triggers of second-generation star formation. For this to occur, the initial cluster masses need to be greater than a few million solar masses. Here we report observations of three massive relatively young star clusters (1-2 billion years old) in the Magellanic Clouds that show clear evidence of burst-like star formation that occurred a few hundred million years after their initial formation era. We show that such clusters could have accreted sufficient gas to form new stars if they had orbited in their host galaxies' gaseous disks throughout the period between their initial formation and the more recent bursts of star formation. This process may eventually give rise to the ubiquitous multiple stellar populations in globular clusters.

A mass transfer origin for blue stragglers in NGC 188 as revealed by half-solar-mass companions.

In open star clusters, where all members formed at about the same time, blue straggler stars are typically observed to be brighter and bluer than hydrogen-burning main-sequence stars, and therefore should already have evolved into giant stars and stellar remnants. Correlations between blue straggler frequency and cluster binary star fraction, core mass and radial position suggest that mass transfer or mergers in binary stars dominates the production of blue stragglers in open clusters. Analytic models, detailed observations and sophisticated N-body simulations, however, argue in favour of stellar collisions. Here we report that the blue stragglers in long-period binaries in the old (7 × 10(9)-year) open cluster NGC 188 have companions with masses of about half a solar mass, with a surprisingly narrow mass distribution. This conclusively rules out a collisional origin, as the collision hypothesis predicts a companion mass distribution with significantly higher masses. Mergers in hierarchical triple stars are marginally permitted by the data, but the observations do not favour this hypothesis. The data are highly consistent with a mass transfer origin for the long-period blue straggler binaries in NGC 188, in which the companions would be white dwarfs of about half a solar mass.

A binary star fraction of 76 per cent and unusual orbit parameters for the blue stragglers of NGC 188.

Blue straggler stars lie on or near the main sequences of star clusters (all members of which formed around the same time), but typically are more luminous than the turn-off stars and therefore long ago should have evolved off the main sequence to become giants and white dwarfs. They are thought to derive from normal main-sequence stars that have undergone a recent increase in mass. Statistical evidence indicates that in globular star clusters the blue stragglers probably form from binary stars. The specific formation processes, such as mass transfer, mergers or stellar collisions during dynamical encounters of binary stars, remain unresolved. Here we report that 16 of the 21 blue stragglers (76 per cent) in the old (7-Gyr; ref. 2) open cluster NGC 188 are currently in binary systems, a frequency three times that found among normal solar-type main-sequence stars. These blue straggler binaries have a remarkable period-eccentricity distribution, with all but three having orbital periods of approximately 1,000 days. Moreover, these stars are rotating faster than normal main-sequence stars of the same surface temperatures. These data show that most, and possibly all, blue stragglers derive from multiple-star systems, and indicate that the several formation processes operate simultaneously. We suggest that rapid rotation of blue stragglers may place upper limits on their ages.

Enhanced Clinical Decisions for Management of Benign Prostatic Hyperplasia using Patient-Reported Outcomes: Protocol for a Prospective Observational Study.

Background: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) significantly impact quality of life among older men. Despite the prevalent use of the American Urological Association Symptom Index (AUA-SI) for BPH, this measure overlooks key symptoms such as pain and incontinence, underscoring the need for more comprehensive patient-reported outcome (PRO) tools. This study aims to integrate enhanced PROs into routine clinical practice to better capture the spectrum of LUTS, thereby improving clinical outcomes and patient care. Methods: This prospective observational study will recruit men with LUTS secondary to BPH aged ≥ 50 years from urology clinics. Participants will be stratified into medical and surgical management groups, with PRO assessments scheduled at regular intervals to monitor LUTS and other health outcomes. The study will employ the LURN Symptom Index (SI)-29 alongside the traditional AUA-SI and other non-urologic PROs to evaluate a broad range of symptoms. Data on comorbidities, symptom severity, and treatment efficacy will be collected through a combination of electronic health records and PROs. Analyses will focus on the predictive power of these tools in relation to symptom trajectories and treatment responses. Aims are to: (1) integrate routine clinical tests with PRO assessment to enhance screening, diagnosis, and management of patients with BPH; (2) examine psychometric properties of the LURN SIs, including test-retest reliability and establishment of clinically meaningful differences; and (3) create care-coordination recommendations to facilitate management of persistent symptoms and common comorbidities measured by PROs. Discussion: By employing comprehensive PRO measures, this study expects to refine symptom assessment and enhance treatment monitoring, potentially leading to improved personalized care strategies. The integration of these tools into clinical settings could revolutionize the management of LUTS/BPH by providing more nuanced insights into patient experiences and outcomes. The findings could have significant implications for clinical practices, potentially leading to updates in clinical guidelines and better health management strategies for men with LUTS/BPH. Trial registration: This study is registered in ClinicalTrials.gov (NCT05898932).