Further evidence of relationship between thiamine blood level and cognition in chronic alcohol-dependent adults: Prospective Pilot Study of an inpatient detoxification with oral supplementation protocol.

BACKGROUND: The relationship between thiamine blood level (TBL) and cognition remains uncertain, including among alcohol-dependent persons (ADP). AIM: To evaluate this relationship during protocol-driven inpatient alcohol detoxification treatment including thiamine supplementation (AD + Th). METHODS: Prospective 3-week study with 100 consecutively admitted detoxification-seeking ADP (47.7 ± 11 years old, 21% females) without superseding comorbidities requiring treatment. TBL and Montreal Cognitive Assessment (MoCA) were measured at admission (t1, pre-AD + Th) and discharge (t3, post-AD + Th). Frontal Assessment Battery (FAB) was performed at t1. AD + Th included abstinence, pharmacological alcohol withdrawal syndrome treatment, and oral thiamine supplementation (200 mg/day for 14 days). Regression and mediation analyses assessed TBL-cognition relationships. RESULTS: We found no cases of Wernicke Encephalopathy (WE) and only one case of thiamine deficiency. Both MoCA and TBL significantly improved across AD + Th (with medium-to-large effect sizes). At t1, TBL significantly predicted MoCA and FAB sum scores (medium effect sizes; extreme and very strong evidence, respectively). The clear TBL-MoCA association disappeared at t3. In multivariate regression and mediation analyses exploring key influential factors of cognition (identified by LASSO regression), the TBL-MoCA interactions did not relevantly change at t1 and t3. Age, serum transaminases, vitamin D levels, drinking-years, and depression score weakly modified the relationship. CONCLUSION: TBL was a robust predictor of pre-detoxification cognitive impairment, and both TBL and cognition improved significantly during AD + Th (including abstinence) in our ADP population, supporting routine thiamine supplementation for ADP, even those at low WE-risk. The TBL-cognition relationship was minimally confounded by age, alcohol-toxicity proxies, mood, and vitamin D levels.

120-W 2-µm thulium:yttrium-aluminium-garnet vapoenucleation of the prostate: 12-month follow-up.

UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Thulium VapoEnucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment modality of benign prostate obstruction (BPO). This study reports the largest series of patients with symptomatic BPO undergoing ThuVEP. Efficacy of this procedure was confirmed by prostate volume and PSA measurements at 12-month follow up, which have not been reported after ThuVEP so far. OBJECTIVE: To evaluate the safety and efficacy of 120-W 2-µm thulium:yttrium-aluminium-garnet (YAG) vapoenucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction. METHOD: In total, 207 consecutive patients undergoing ThuVEP at our institution were evaluated prospectively. ThuVEP was carried out using the 120-W 2-µm continuous-wave Tm:YAG laser. The enucleated tissue was then morcellated within the bladder. Patient demographic, perioperative and 12-month follow-up data were analysed. The complications were assessed. RESULTS: Mean preoperative prostate volume was 57.8 ± 31.5 mL. Total operation duration averaged 64.9 ± 29.9 min, and the enucleation time was 36.5 ± 20.1 min. The mean catheter time was 2.2 ± 0.6 days. Thirteen (6.28%) patients required a second-look operation in the immediate postoperative course (failed morcellation n= 1, clot retention n= 4, residual tissue at the apex of the prostate n= 8). Four patients needed blood transfusions (1.93%) postoperatively. In all, 147 (71%) patients were available for review at the 12-month follow-up mark. Quality of life (4.4 ± 1.3 vs 1.2 ± 1.1), international prostate symptom score (21.9 ± 7.2 vs 5.1 ± 4), maximum urinary flow rate (9.4 ± 3.8 vs 23.5 ± 10.9 mL/s), postvoiding residual urine (159.2 ± 153.2 vs 26.7 ± 38.3 mL), prostate-specific antigen (5.0 ± 5.2 vs 0.6 ± 0.5 ng/mL) and prostate volume (57.8 ± 31.5 vs 10.7 ± 4.4 mL) changed significantly (P= 0.000). Median prostate-specific antigen reduction and prostate volume reduction were 87% and 80% respectively at follow-up. Urethral stricture and bladder neck contracture developed in 1.45% and 1.93% respectively of the patients. CONCLUSION: 120-W ThuVEP is a safe and efficacious procedure for the treatment of symptomatic benign prostatic obstruction. The incidence of complications with ThuVEP was low.

Comparison of 120-200 W 2 µm thulium:yttrium-aluminum-garnet vapoenucleation of the prostate.

PURPOSE: To evaluate efficacy and safety of 200 W 2 µm thulium:yttrium-aluminum-garnet vapoenucleation of the prostate (ThuVEP) for patients with benign prostatic obstruction (BPO). PATIENTS AND METHODS: Twenty-eight consecutive patients with symptomatic BPO were treated with 200 W ThuVEP. Patients were matched for age and preoperative prostate volume with 28 patients from our 120 W ThuVEP database. Patient data and postoperative outcome at 12-month follow-up were compared. RESULTS: Mean prostate volume (65.39 vs 68.62 cc) and resected weight (40.72 vs 53.18 g) differed not significantly between 200 and 120 W ThuVEP. The percentage of resected tissue was lower with 200 W compared with 120 W (58.48 vs 72.93%, P=0.047) because of the higher rate of ablated tissue. There were no differences in mean operative (69.21 vs 78.67 min), laser (45.43 vs 48.58 min), morcellation (16.52 vs 20.48 min), and catheter (2.2 vs 2.1 d) time between the devices. Three patients needed immediate re-treatment (hemorrhage necessitating coagulation 1=200 W, secondary apical resection 2 120/200 W). One (1.79%) patient (120 W) needed a blood transfusion postoperatively. Fifty-one (91%) patients completed 12-month follow-up. Quality of life, International Prostate Symptom Score, peak urinary flow rate, postvoid residual urine, prostate-specific antigen level, and prostate volume improved significantly (P≤0.019) and were not different between the devices. At follow-up, two (3.57%) patients (120/200 W) had a bladder neck contracture. CONCLUSIONS: ThuVEP is a safe and efficacious procedure for patients with symptomatic BPO. 120 and 200 W ThuVEP had an equivalent clinical outcome at 12-month follow-up.

Thulium:YAG vapoenucleation in large volume prostates.

PURPOSE: Tm:YAG vapoenucleation was introduced as a minimally invasive treatment in patients with benign prostatic obstruction. The efficiency and safety of Tm:YAG vapoenucleation must still be confirmed in large volume prostates to prove the size independence of this promising treatment option. We evaluated the safety and efficiency of Tm:YAG vapoenucleation in patients with a prostate volume of 80 cc or greater and benign prostatic obstruction during a 12-month followup. MATERIALS AND METHODS: Included in this trial were 90 consecutive patients undergoing 90 W Tm:YAG vapoenucleation. Vapoenucleation was done using the 2 µm continuous wave Tm:YAG laser combined with a mechanical tissue morcellator. We analyzed patient demographic, perioperative and 12-month followup data. Complications were assessed. RESULTS: Mean preoperative prostate volume was 108.6 cc (range 80 to 200), mean International Prostate Symptom Score was 23.5 (range 8 to 35) and mean quality of life score was 4.3 (range 1 to 6). There was an 86% reduction (range 67% to 99%) in prostate volume on transrectal ultrasound by 12 months and an 88% decrease (range 58% to 100%) in prostate specific antigen. International Index of Erectile Function score remained stable. Peak urinary flow rate, International Prostate Symptom Score and quality of life improved significantly (p <0.001), as did post-void residual urine. The overall complication rate was manageable. Two patients required blood transfusion and 10 experienced early postoperative stress incontinence. During followup 7% of patients had symptomatic urinary tract infection and 2 had persistent grade I stress urinary incontinence. The reoperation rate due to urethral stricture was 1.8% during the 12-month followup. CONCLUSIONS: Tm:YAG vapoenucleation is a safe, effective and size independent treatment option for benign prostatic obstruction. As shown by reductions in transrectal ultrasound prostate volume and prostate specific antigen, complete removal of the adenoma can be achieved by this procedure.