Does sarcopenia predict perioperative mortality in patients with advanced ovarian cancer?

OBJECTIVE: The aim of this study was to assess prognostic value of frailty for the prediction of surgical complications and mortality in women with end-stage ovarian cancer subjected to curative oncological surgery and its value for long-term follow-up. PATIENTS AND METHODS: A total of 75 advanced-stage consecutive ovarian cancer patients who underwent elective surgery were investigated. The demographic data and clinical information related to the oncologic treatment were collected in the electronic and physical case records and included the following: age, ethnic group, comorbidities, staging of cancer, surgical procedure details, lymphadenectomy, American Society of Anesthesiology (ASA) grade, anesthetic technique, operative blood loss, operative time, and residual disease. A radiologist, who was blinded to patient outcomes, performed quantitative assessment of psoas muscle areas using the available computed tomography scan images at the caudal end of the third lumbar vertebra. RESULTS: The mean age was 61.2 ± 18.2 years, and the percentage of patients over 65 years was 78%. Comorbidities (hypertension, diabetes, chronic obstructive pulmonary disease, renal insufficiency) were seen in 37 patients (49%). Histological types were adenocarcinoma in all patients (0) mostly serous adenocarcinoma (62%) and stage 3 (58%). According to psoas muscle measurement, 55 patients (73%) were nonsarcopenic and 20 patients (26%) were sarcopenic. Debulking procedures were performed on all patients. Also, bowel resection was applied in 40% of patients. Preoperative anesthetic examinations had shown that they were mostly ASA score 2 (44 patients). Moreover, 26 patients were ASA score 3. Generally, total operative time was between 121-240 minutes, and total blood loss was generally under 500 ml. Postoperative complications were seen in 26% of the patients. Non-surgical complications were observed in 14% of the patients, while non-surgical complications were observed in 12%. Length of the hospital stay >10 days was seen in 10 patients. Mortality was seen in 1 patient 30 days after operation. Nonsurgical complications (pneumonia, urinary tract infections, cardiac complications) were significantly higher in comparison to nonsarcopenic patients. However surgical complications were comparable between each group. Mortality after hospitalization and length of hospital stay were significantly higher in sarcopenic patients in comparison with the nonsarcopenic group. CONCLUSIONS: The use of the value of the psoas muscle region is considered to be a method to predict the in-hospital mortality when there is an available abdominal CT scan that has already been performed for ovarian cancer patients with a significant comparable clinical and laboratory background. According to the findings, patients had worse surgical outcomes and higher postoperative nonsurgical complication rate when sarcopenic patients were compared to nonsarcopenic patients. Moreover, postoperative mortality and length of hospital stay were significantly higher in sarcopenic patients in comparison to non-sarcopenic group.

Work organization, sleep and metabolic syndrome among long-haul truck drivers.

BACKGROUND: The work organization of long-haul truck drivers in the USA contains factors that have been shown to degrade sleep. In combination, these factors generate elevated cardiometabolic risk by inducing components of the metabolic syndrome (MetS). However, the prevalence and severity of MetS and the degree to which such factors differentially influence MetS among these drivers are unknown. AIMS: To determine the prevalence and severity of MetS among US long-haul truck drivers and to determine the predictive value of demographic, work organization and sleep variables in MetS diagnosis and severity. METHODS: A non-experimental, descriptive, cross-sectional study, designed to collect survey, anthropometric and biometric data from US long-haul truck drivers. Descriptive analyses were performed for demographic, work organization, sleep and MetS measures. Logistic and linear regression analyses examined potential predictive relationships between demographic, work organization and sleep variables and MetS diagnosis and severity. RESULTS: The study population was 262. Nearly 60% of drivers met MetS diagnosis criteria. Over 80% had a waist circumference >102 cm, 50% had triglyceride levels of ≥150 mg/dl, 66% had an high-density lipoprotein of <40 mg/dl, 28% had a blood pressure of ≥135/80 mm Hg and 17% had a fasting glucose of ≥110 mg/dl. Driving experience and work day sleep quality were associated with MetS prevalence and severity. CONCLUSIONS: The prevalence and severity of MetS among this sample of US long-haul truck drivers were high. Preventive efforts should focus on experienced drivers and work day sleep quality.

Work patterns, sleeping hours and excess weight in commercial drivers.

BACKGROUND: Work and sleep patterns for commercial motor vehicle (CMV) drivers often include long working hours, shift work and diminished sleep duration and quality, which have been linked to overweight, obesity and other problems. AIMS: To explore possible connections between work, sleep and obesity among CMV drivers. METHODS: Survey and anthropometric data were collected from male long-haul CMV drivers in central North Carolina, USA, over a period of 6 months. Drivers' body mass index (BMI) was used as a measure of total body obesity and sagittal abdominal diameter (SAD) as a measure of central adiposity. RESULTS: Among the 260 study subjects, mean BMI was 33.1 (64% were obese or morbidly obese) and mean SAD was 32.3cm, classifying 89% of drivers as being at high or very high cardiometabolic risk. About 83% of drivers worked an irregular daily schedule, 64% worked irregular total daily hours, 32% worked irregular days of the week and 46% reported getting <7h of sleep during work nights. Significant predictors of BMI included the number of hours worked daily (P < 0.05) and the age (P < 0.01) of the driver, while age was also a significant predictor for SAD (P < 0.05). Significant predictors of sleep quality included the extent of shift work (P < 0.05) and sleep duration (P < 0.001). CONCLUSIONS: Work and sleep configurations appear to affect the weight status of CMV drivers. Shift work and sleep duration are both associated with the weight status of CMV drivers, and both appear to function as indicators of their sleep quality.

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy.

OBJECTIVE: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels. METHODS: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy. RESULTS: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V30-V50) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V60-V80) were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6, 10, and 15 MV energy levels both in plans with and those without SIB. CONCLUSION: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT. ADVANCES IN KNOWLEDGE: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed.

Do MMP-1 levels of gingival fibroblasts have a role in the gingival overgrowth of cyclosporine-treated patients?

The aim of this study was to compare the matrix metalloproteinase-1 (MMP-1) levels in gingival fibroblast cultures derived from two groups of renal transplant patients receiving cyclosporine (CsA) who exhibit gingival overgrowth and who have healthy periodontium. Gingival fibroblasts obtained from four patients with CsA-induced gingival overgrowth (CsA-GO) and four patients who receive CsA but have healthy periodontium were incubated with increasing concentrations of CsA and cultured for 72 hours. Expression levels of MMP-1 in all the groups were measured four times at 0, 24, 48, and 72 hours by the Rapid Collagenase Assay Kit. No significant difference was seen at baseline. As the CsA concentration and the duration in the cell media increased, the CsA-GO showed that fibroblasts displayed significantly suppressed MMP-1 levels with respect to the baseline, at which fibroblasts from CsA patients with healthy periodontium exhibited the same result as at the highest CsA concentration. Results of this study indicated that CsA therapy did not have a significant effect on MMP-1 levels. Since the overall pathogenesis of drug-induced gingival hyperplasia has been accepted as multifactorial, down-regulation of MMP-1 expression may play a minor role.

Evaluation of telomerase activity in gingival fibroblasts of cyclosporine-treated patients.

Gingival overgrowth (GO) is a common side effect following administration of cyclosporin A (CsA). Various case reports have shown that squamous cell carcinomas could arise in GO induced by CsA and phenytoin. It is also known that human telomerase activated in about 90% of cancers is mainly composed of hTR, hTERT, and TPI. The aim of this study was to investigate the potential role of telomerase activity in the pathogenesis of CsA-induced GO. Included in the study were 9 patients on CsA: 4 with and 5 without GO. Gingival tissues were obtained during gingivectomy or flap procedures; gingival fibroblasts were cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10,000 U/mL penicillin, 10 mg/mL streptomycin, 2 mmol/L l-glutamine, and 10% heat-inactivated fetal bovine serum at 37 degrees C under a humidified 95% air virgule 5% CO(2) atmosphere. Quantitative detection of hTERT mRNA was performed with the commercially available LightCycler Telo TAGGG hTERT Quantification Kit using real-time online PCR. The hTERT mRNA expression was positive in one patient, while hTERT mRNA expression was negative in the others. Because results indicated that there may be a relationship between CsA-induced GO and positive telomerase activity, detailed studies should be performed to confirm the present findings.

The effect of topical doxycycline usage on gingival crevicular fluid MMP-8 levels of chronic and aggressive periodontitis patients: a pilot study.

The aim of this study was to evaluate the efficacy of topical subgingival application of doxycycline hyclate (DH) gel adjunctive to non-surgical periodontal therapy on gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 levels in chronic and aggressive periodontitis patients. Forty teeth of 10 chronic periodontitis patients and 32 teeth of eight aggressive periodontitis patients were screened for 6 months. Scaling and root planing (SRP) was applied to the control sites and DH gel adjunctive to SRP was applied to the test sites of each patient simultaneously. GCF MMP-8 levels were analysed at baseline, 7 days; and at 1, 3 and 6 months by Sandwich Elisa Method. At 1, 3 and 6 months, probing depth (P < 0.0051) and plaque scores and bleeding on probing values (P = 0.000) significantly decreased in each group when compared with the baseline, but there was no statistically significant difference between the test and control sites. GCF MMP-8 levels reduced presenting statistically significant differences on 7 days, 1, 3 and 6 months in four of the groups (P < 0.05); however, intergroup differences were not statistically significant. Developing functional and immunological-based chair-side MMP tests might serve as useful adjunctive diagnostic tools when monitoring the effects of DH gel application.

The use of complementary and alternative medicine (CAM) therapies by Turkish women with gynecological cancer.

PURPOSE: To evaluate the prevalence and patterns of complementary and alternative medicine (CAM) utilization among Turkish women with gynecological cancer METHODS: In this cross-sectional study, a total of 156 patients treated between December 2002 and March 2005 at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of Gynecologic Oncology were evaluated. Data regarding CAM use were obtained from patients by means of face-to-face interviews. RESULTS: Sixty women (38.5%) had used CAM having been diagnosed with cancer; herbal medicine was the most common. The age, income, educational level, cancer site, FIGO stage, previous CAM usage, and time since patients were diagnosed with cancer were associated with CAM usage. The most (40%) commonly cited reason for CAM use was to boost the immune system. Although only 8.3% of CAM users received CAM information from health care professionals or CAM practitioners, this group of patients was more likely to discuss their CAM use with physicians. CONCLUSION: Our data suggest that physicians should increase their knowledge of CAM therapies and ask cancer patients about previous CAM history.

Can increased nuchal translucency in the first trimester of pregnancy predict gestational diabetes mellitus.

The current study was designed to evaluate whether increased nuchal translucency can predict gestational diabetes mellitus. This was a prospective observational study. Among the pregnant women at 11-14 weeks of pregnancy who came to our prenatal unit for a first trimester screening test, 389 pregnant women whose nuchal translucency above 95th centile were selected as the study group and 386 age-matched pregnant women whose nuchal translucency were within the normal range were enrolled as a control group. First, subjects underwent a 50 g glucose screening test; if it was positive then a 100 g oral glucose tolerance test was performed. The main outcome measures were the prevalence of gestational diabetes mellitus and impaired glucose tolerance and the number of macrosomic infants. Impaired glucose tolerance was more common in pregnant women whose nuchal translucency was above the 95th centile (p = 0.048). In addition, macrosomic infants were also more common in pregnant women with a fetal nuchal translucency above the 95th centile (p = 0.045). Macrosomia was more common in the study group with gestational diabetes mellitus (p = 0.046). In conclusion, increased nuchal translucency seems to be predictive for impaired glucose tolerance and macrosomia, which are associated with gestational diabetes mellitus.

HIV-risk behaviours of American spring break vacationers: a case of situational disinhibition?

Young adults are at high risk for acquiring STDs/HIV due primarily to multiple sex partners, unprotected sex, and substance use combined with sexual activity. Contranormative settings--such as the annual spring break vacation--provide ideal conditions for the potentially lethal interaction between alcohol, drugs, and sexual risk-taking. As a steadily growing form of youth travel and characterized by binge drinking, illicit drug use, and unsafe sexual practices, spring break has become a North American institution involving large numbers of travellers. In this study, the theory of interpersonal behaviour was used to explain college students' health-risk behaviours in the context of spring break and pre- and post-spring break surveys were used to examine casual sex and condom use behaviours. Multivariate analyses revealed peer influences, prior experiences with casual sex, alcohol consumption prior to sex, and impulsivity to be significant predictors of casual sex, while impulsivity and condom availability were significant predictors of students' use of condoms during casual sex.

Effects of norepinephrine on NMDA-induced neurotoxicity in cerebellar granular cell culture of rat pups.

In this study, norepinephrine was tested in 0.1, 1, 10, 25 and 50 microM doses in 100 microM NMDA toxicity on cerebellar granular cell culture of rats. NMDA in 100 microM concentration induced cell death significantly with respect to controls. Death cell population was 1.08 +/- 0.44% in control and 22.15 +/- 2.46% in 100 microM NMDA (P < 0.0001). None of the norepinephrine concentrations administrated 15 min prior to NMDA was able to reduce death cell scores to control levels. Results were 8.75 +/- 0.83% in 0.1 microM, 7.0 +/- 1.01% in 1 microM, 17.25 +/- 1.31% in 10 microM, 35.5 +/- 1.38% in 25 microM and 17.9 +/- 1.72% in 50 microM norepinephrine plus 100 microM NMDA administrated groups (P < 0.0001 for all with respect to control). Labetalol, as an alpha and beta blocker in 0.5 microM concentration which was given 15 min prior to norepinephrine was able to block the effects of it. In comparison with 100 microM NMDA administered group, only low doses of norepinephrine reduced the death cell scores significantly (for 0.1 and 1 microM norepinephrine plus NMDA groups; P < 0.0001). For 10 and 50 microM norepinephrine plus NMDA groups, death cell scores were found statistically insignificant from the NMDA-administered group (P > 0.05 for both) while for the 25 microM norepinephrine plus NMDA group, the death cell score was found to be statistically increased (P < 0.0001).

Response to nimodipine in caffeine-induced neurotoxicity in cerebellar granular cell culture of rat pups.

Methylxanthines (theophylline, theobromine and caffeine) are widely used as central nervous system stimulants and caffeine is used in the treatment of apnea in newborns. Plasma therapeutic concentration of caffeine is around 110 microM. Caffeine diffuses the blood brain barrier easily, increasing oxygen consumption in neurones and leading to cell death. In the present study, 4-7-day-old rats were used to obtain cerebellar granular cell cultures. Caffeine was used 50, 150, 250 and 350 microM concentrations and the most toxic dose for it was found to be 350 microM. Death cell scores were 0.9+/-0.63 for control, 1.1+/-0.63 for 50 microM, 0.89+/-0.47 for 150 microM (P>0.05 for both), 3.84+/-0.8 for 250 microM (P=0.024) and 6.2+/-0. 86 for 350 microM (P=0.001) caffeine concentrations. The role of voltage-dependent calcium channels in caffeine-induced neurotoxicity was tested with the doses of 100 and 200 microM nimodipine 45 min before or after the 350 microM caffeine. Both doses of nimodipine after caffeine administration were found to be ineffective in blocking neurotoxicity. Doses administered 45 min prior to caffeine, reduced death cell score to 0.89+/-0.23 (P=0.000) for 100 microM nimodipine and 2.35+/-0.96 (P=0.000) for 200 microM nimodipine administration into the cultures. A dose-dependent manner of nimodipine in ischemic states is well-known. In the light of these results, nimodipine may be used in the treatment of newborn apneas together with caffeine to prevent neurotoxic side effects of high or repeated doses of it.

High frequency of sister chromatid exchanges in lymphocytes of the patients with Behçet's disease.

Behçet's disease (BD) (OMIM 109650) is an immunogenetically based multisystem disease, characterized by iridocyclitis, arthritis, orogenital ulcerations and pustular skin lesions. Viral and autoimmune etiologies have been suggested and HLA-B5 has been found to predominate in BD. The disease is most seen in Turkey and Japan. Although familial cases have been reported, the mode of inheritance is not clear. To determine the genetic instability in BD, sister chromatid exchange (SCE) analysis has been performed on peripheral lymphocytes in 23 patients and 20 healthy controls. We found significantly higher SCE rates in the patient group (p < 0.0001). Our results may indicate that genetic impairment and genetic instability may play an important part in the etiology of BD.

Sister chromatid exchange analysis in patients exposed to low dose of iodine-131 for thyroid scintigraphy.

To determine the genotoxic risk associated with diagnostic exposure to low doses of iodine 131 (131I), sister chromatid exchange (SCE) analysis was performed in lymphocytes of 18 non-smoking women who received 370 kBq (10 microCi) intravenous 131I sodium iodide as an adjuvant for scintigraphy for diagnosing thyroid nodularity. SCE frequencies were measured before and after 131I administration. SCE results in the pre-treated phase were regarded as control. Although SCE values 24 h after 131I administration did not show a significant increment (p > 0.05), there was a significant increase 72 h after treatment (p < 0.05). These results indicate that genetic damage might be induced by low dose of 131I.

Sister chromatid exchange analysis in the lymphocytes of patients with ankylosing spondylitis.

OBJECTIVE: This study investigated whether any genomic change occurs in DNA level in ankylosing spondylitis (AS) by measuring sister chromatid exchange (SCE) frequency. METHODS: SCE frequency was detected on metaphase chromosomes obtained from peripheral blood lymphocyte cultures in 15 patients diagnosed as having AS. SCE values were also obtained from 15 healthy subjects as a control group. SCE frequencies were detected from metaphases obtained from standard blood cultures by using bromodeoxyuridine and staining by Giemsa. RESULTS: SCE frequencies of AS were statistically higher than those of the control group (p < 0.005). CONCLUSION: These results suggest that genetic factors may play a more important part than realised in the aetiology of AS.

Nimodipine improves kainic acid induced neurotoxicity in cerebellar granular cell culture: a double-blind dose-response study.

The neuroprotective role of nimodipine was tested in kainic acid (50 and 100 microM) induced neurotoxicity in cerebellar granular cell cultures of 4 to 7 day-old rat pups. Nimodipine was applied in 50, 100 and 200 microM concentrations. Kainate, in either dose, induced cerebellar granular cell death in respect to controls and the results were statistically significant (P = 0.000 for both doses). However, kainic acid in 100 microM concentration led to higher rates of cell death than 50 microM (P = 0.017). The neuroprotective role of nimodipine in kainate induced neurotoxicity was dose dependent. Kainate toxicity in 50 microM concentration was blocked by 50 and 100 microM nimodipine concentrations (P = 0.006 and P = 0.002, respectively) while 200 microM nimodipine was found ineffective. The most effective nimodipine dose for 100 microM kainic acid neurotoxicity was 200 microM (P = 0.000) while 50 and 100 microM concentrations of nimodipine were found ineffective. In this study, we have proven the dose-dependent neuroprotective role of nimodipine in kainate induced neurotoxicity in cerebellar granular cell cultures of rat pups.

Ultrasound guided aspiration of benign ovarian cysts: an alternative to surgery?

Treatment of ovarian cysts remains a problem for gynecologists despite the different treatment modalities that are available. This prospective study included 19 patients (aged 16-34 years) who were treated with ultrasound guided aspiration; cyst diameter ranged from 6 to 16 cm (mean 8 cm). There were recurrent cysts in five of the 19 patients. The results indicate that in cases of benign ovarian cysts, ultrasound guided aspiration may be an alternative to other treatment modalities.