Polyomavirus Replication and Smoking Are Independent Risk Factors for Bladder Cancer After Renal Transplantation.

BACKGROUND: Solid organ transplant recipients are at increased risk for developing malignancies. Polyomaviruses (PV) have been historically associated with experimental tumor development and recently described in association with renourinary malignancies in transplant patients. The aim of this study was to investigate the relationship between PV replication and smoking, and the development of malignant neoplasms in kidney transplant recipients. METHODS: A retrospective case-control study was conducted for PV replication in all kidney biopsies and urine cytologies performed between 1998 and 2014 from kidney transplant recipients at the University of Maryland Medical Center. Polyomavirus-positive patients (n = 943) were defined as having any of the following: a kidney biopsy with PV associated nephropathy, any urine cytology demonstrating "decoy" cells, and/or significant polyomavirus BK viremia. Polyomavirus-negative matched patients (n = 943) were defined as lacking any evidence of PV replication. The incidence of malignancy (excluding nonmelanoma skin tumors) was determined in these 1886 patients and correlated with demographic data and history of smoking. RESULTS: There was a 7.9% incidence of malignant tumors after a mean posttransplant follow-up of 7.9 ± 5.4 years. Among all cancer subtypes, only bladder carcinoma was significantly associated with PV replication. By multivariate analysis, only PV replication and smoking independently increased the risk of bladder cancer, relative risk, 11.7 (P = 0.0013) and 5.6 (P = 0.0053), respectively. CONCLUSIONS: The findings in the current study indicate that kidney transplant recipients with PV replication and smoking are at particular risk to develop bladder carcinomas and support the need for long-term cancer surveillance in these patients.

A comprehensive examination of topographic thickness of skin in the human face.

BACKGROUND: Knowledge of topographic skin thickness is important to plastic surgery of the face as it may guide resection and restoration in oncologic, aesthetic, and reconstructive procedures. OBJECTIVE: The purpose of this study is to report the relative thickness of the face throughout 39 distinct subunits. METHODS: Full-thickness punch biopsy samples were obtained at 39 predetermined anatomic locations of the face from 10 human cadaveric heads. Tissue was fixed in paraffin-embedded slides and analyzed using triplicate measurement of dermis and epidermis using computerized measurements. Data were analyzed using univariate statistical analysis and expressed as mean thickness values and relative thickness (RT) values based on the thinnest portion of the face. RESULTS: The area of the face with the thickest dermis was the lower nasal sidewall (1969.2 µm, dRT: 2.59), and the thinnest was the upper medial eyelid (758.9 µm, dRT: 1.00). The area with the thickest epidermis was the upper lip (62.6 µm, eRT: 2.12), and the thinnest was the posterior auricular skin (29.6 µm, eRT: 1.00). Our results confirm that eyelid skin is the thinnest in the face. The thickest portions of the skin appeared to be in the lower nasal sidewall, but the measurements are comparable to those in the ala and posterior auricular skin, which are novel findings. CONCLUSIONS: The greatest epidermal, dermal and total skin thickness are found in the upper lip, right lower nasal sidewall, and left lower nasal sidewall respectively. The least epidermal skin thickness is in the posterior auricular skin. The least dermal skin thickness, and the least total skin thickness, are both in the upper medial eyelid.

Impact of invasive management versus noninvasive management on functional status and quality of life following non-Q-wave myocardial infarction: a randomized clinical trial.

BACKGROUND: Multiple studies have examined whether clinical outcomes are improved by invasive management following non-Q-wave myocardial infarction (NQWMI). However, it remains unclear whether functional status and quality of life are affected by an invasive strategy. METHODS: Following NQWMI, we randomized 88 patients to invasive management vs noninvasive management. The primary end point was functional status assessed at 12 months using maximal endurance exercise treadmill testing measured in metabolic equivalents. Secondary end points included changes in scores between baseline and 12 months on the Duke Activity Status Index, the Seattle Angina Questionnaire, and the Medical Outcomes Study 36-Item Short-Form Survey. RESULTS: Of the 42 patients in the invasive arm, 83% underwent initial angiography. Of the 46 patients in the noninvasive arm, 91% underwent initial stress testing. Inhospital and 12-month revascularization rates were similar in the 2 arms (24% vs 22%, P > or = .99; 31% vs 30%, P > or = .99). Maximal endurance exercise treadmill testing was also similar at 12 months (7.8 vs 6.7 metabolic equivalents, P = .24). Patients in the invasive arm showed improved functional status by mean difference in their Duke Activity Status Index scores (4.3 vs -3.5, P = .04). Improvements in angina-specific quality of life for patients in the invasive arm were demonstrated by the Seattle Angina Questionnaire measures of anginal stability (21.6 vs -5.3, P = .02), anginal frequency (22.9 vs 2.3, P = .02), treatment satisfaction (11.2 vs -10.3, P = .02), and disease perception (24.7% vs 10.9%, P = .07). CONCLUSIONS: Compared with patients undergoing noninvasive management of NQWMI, patients undergoing invasive management have some measures indicative of improved functional status.