Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 343
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Palliat Med ; 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31580790

RESUMO

Background: The number of hospital-based palliative care consultation teams (PCCTs) has increased in Japan, and quality improvement (QI) of PCCTs is an issue. The Japanese Society for Palliative Medicine is building a framework for continuous QI of PCCT activities. Objective: The objective of this study was to develop a program to support QI for PCCTs, and to describe the initial experience with the program. Design: The report details the development of a self-check program, followed by a one-year follow-up observational survey. Methods: We developed a self-check program using the concept of the Plan-Do-Check-Act (PDCA) cycle and a multidisciplinary expert panel. A total of 114 PCCTs entered the program in the first year. Results: We developed three forms for the CHECK, ACT-PLAN, and DO phases aligned with the PDCA cycle. The forms consisted of 34 items across 8 domains. A total of 83 PCCTs (729 members) returned the CHECK, ACT-PLAN forms, and 41 PCCTs returned the DO forms after one year. Overall, 213 high priority issues were identified in the ACT phase. The issues of many PCCTs were "Sharing goals of care is inadequate within the PCCT (33%)" and "Sharing goals of care is inadequate between patient/family or primary team and the PCCT (28%)." Improvements in identified issues were: "achieved" 23% and "almost achieved" 48% after one year. Conclusions: We developed a self-check program to support QI efforts for hospital-based PCCTs. The priority issues among PCCTs and improvement goals with examples were identified. These results will support ongoing efforts to develop a continuous improvement model for QI of PCCTs.

2.
Arch Toxicol ; 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31576414

RESUMO

A previous study showed that people living in urban areas are generally exposed to low-frequency noise (LFN) with frequencies below 100 Hz and sound levels of 60-110 dB in daily and occupational environments. Exposure to LFN has been shown to affect balance in humans and mice. However, there is no information about prevention of LFN-mediated imbalance because of a lack of information about the target region based on health risk assessment of LFN exposure. Here, we show that acute exposure to LFN at 100 Hz, 95 dB, but not at 85 dB or 90 dB, for only 1 h caused imbalance in mice. The exposed mice also had decreased cervical vestibular-evoked myogenic potential (cVEMP) with impaired activity of vestibular hair cells. Since imbalance in the exposed mice was irreversible, morphological damage in the vestibules of the exposed mice was further examined. The exposed mice had breakage of the otoconial membrane in the vestibule. LFN-mediated imbalance and breakage of the otoconial membrane in mice were rescued by overexpression of a stress-reactive molecular chaperone, heat shock protein 70 (Hsp70), which has been shown to be induced by exposure of mice to 12 h per day of LFN at 95 dB for 5 days. Taken together, the results of this study demonstrate that acute exposure to LFN at 100 Hz, 95 dB for only 1 h caused irreversible imbalance in mice with structural damage of the otoconial membrane as the target region for LFN-mediated imbalance, which can be rescued by Hsp70.

3.
PLoS One ; 14(9): e0222979, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31557200

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is criticized by some as an expensive treatment in super-elder patients with limited life expectancy. However, there is a knowledge gap regarding the magnitude of clinical benefit provided by TAVI in comparison with conservative management in patients with severe aortic stenosis (AS) in real clinical practice, which would be important in the decision making for TAVI. METHODS: We combined two independent registries, namely CURRENT AS and K-TAVI registries. CURRENT AS was a multicenter registry enrolling 3815 consecutive patients with severe AS irrespective to treatment modalities between January 2003 and December 2011. K-TAVI was a multicenter, prospective registry including 449 consecutive patients with severe AS, who underwent TAVI with SAPIEN XT balloon-expandable valves between October 2013 and June 2016. In these 2 registries, 449 patients received TAVI and 894 patients were managed with conservative strategy. We conducted propensity score matching and finally obtained a cohort of 556 patients (278 patients for each group) for the analysis. The primary outcome measures were all-cause death and heart failure (HF) hospitalization at 2-year. RESULTS: The cumulative 2-year incidences of all-cause death and HF hospitalization were significantly lower in the TAVI group than in the conservative group (16.8% versus 36.6%, P<0.001, and 10.7% versus 37.2%, P<0.001). After adjusting the residual confounders, TAVI reduced the risks of all-cause death (HR, 0.46; 95%CI, 0.32-0.69; P = 0.0001) and HF hospitalizations (HR, 0.25; 95%CI, 0.16-0.40; P<0.0001) compared with conservative strategy. There was no difference in the cumulative incidence of non-cardiovascular death between the 2 groups. CONCLUSIONS: TAVI in the early Japanese experience was associated with striking risk reduction for all-cause death as well as HF hospitalization as compared with the historical cohort of patients with severe AS who were managed conservatively just before introduction of TAVI in Japan.

4.
Sci Rep ; 9(1): 13908, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31558734

RESUMO

Recently, wild strains of Saccharomyces cerevisiae isolated from a variety of natural resources have been used to make bread, beer, wine, and sake. In the current study, we isolated wild S. cerevisiae MC strain from the carnation (Dianthus caryophyllus L) flower and produced sake using its cerulenin-resistant mutant strain MC87-46. Then, we characterized the components, including ethanol, amino acids, organic acids, and sugars, in the fermented sake. Sake brewed with MC87-46 is sweet owing to the high content of isomaltose, which was at a concentration of 44.3 mM. The low sake meter value of -19.6 is most likely due to this high isomaltose concentration. The genomic DNA of MC87-46 encodes for isomaltases IMA1, IMA2, IMA3, IMA4 and IMA5, as well as the isomaltose transporter gene, AGT1. However, these genes were not induced in MC87-46 by isomaltose, and the strain did not possess isomaltase activity. These results show that MC87-46 cannot utilize isomaltose, resulting in its accumulation in the fermented sake. Isomaltose concentrations in sake brewed with MC87-46 were 24.6-fold more than in commercial sake. These findings suggest that MC87-46 may be useful for commercial application in Japanese sake production because of its unique flavour and nutrient profile.

5.
Urol Int ; : 1-5, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554005

RESUMO

INTRODUCTION: To determine the pre-treatment factors related to the improvement of overactive bladder (OAB) symptom after alpha-1 blocker monotherapy in patients with benign prostatic hyperplasia complicated by OAB (BPH/OAB). METHODS: Post-hoc analysis of a prospective study in patients with BPH/OAB, randomized to receive silodosin 8 mg (n = 157) or naftopidil 75 mg (n = 157) treatment for 12 weeks, was performed. At 12 weeks post-administration, patients were divided into 2 groups (good responder [GR] group and poor responder [PR] group), according to the improvement in the OAB symptom score (OABSS). We compared the pre-administration parameters between both groups and evaluated the factors related to OAB improvement. RESULTS: Of 314 patients, 159 patients (50.6%) were classified into the GR and 155 (49.4%) into the PR. International Prostate Symptom score, total OABSS, OABSS urgency-score, OABSS urgency urinary incontinence (UUI)-score, post-void residual urine volume (PVR), and selection rate of naftopidil were significantly higher in the PR than in the GR. On multivariate logistic regression analysis, larger PVR, higher OABSS-UUI-score, and the choice of naftopidil were significant risk factors for insufficient improvement of OAB symptoms. CONCLUSIONS: Pre-treatment PVR, UUI severity, and the choice of treatment agent are predicting factors related to OAB improvement after alpha-1 blocker monotherapy in patients with BPH/OAB.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31386103

RESUMO

OBJECTIVE: Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1-year after diagnosis in asymptomatic severe AS patients. METHODS: We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1-year using a multivariable logistic regression model. RESULTS: The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, hemoglobin ≤11.0g/dl, chronic lung disease (2 points), diabetes mellitus, hemodialysis, and any concomitant valve disease (1 point). The predictive accuracy of the model was good with the area under the curve of 0.79 and 0.77 in the derivation and validation sets (N = 425). In the validation set, the 1-year incidence of AS-related events was much higher in patients with score ≥2 than in patients with score ≤1 (Score 0: 2.2%, Score 1: 1.9%, Score 2: 13.4%, Score 3: 14.3%, and Score ≥4: 22.7%, P<0.001). CONCLUSIONS: The CURRENT-AS risk score integrating clinical and echocardiographic factors well predicted the risk of AS-related events at 1-year in asymptomatic patients with severe AS, and was validated internally.

8.
Circ J ; 83(9): 1944-1953, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31316039

RESUMO

BACKGROUND: There has not been a previous report on the long-term outcomes of those patients who refuse aortic valve replacement (AVR) despite physicians' recommendations.Methods and Results:Among 3,815 consecutive patients with severe aortic stenosis (AS) enrolled in the CURRENT AS registry, the study population comprised 2,005 symptomatic patients, who were subdivided into 3 groups by their treatment strategy and the reasons for conservative strategy (Initial AVR group: n=905; Patient rejection group: n=256; Physician judgment group, n=844). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalization. Patients in the patient rejection group as compared with those in the physician judgment group were younger, and had less comorbidities, and lower surgical risk scores. The cumulative 5-year incidence of the primary outcome measure in the patient rejection group was markedly higher than that in the initial AVR group, and was similar to that in the physician judgment group (60.7%, 19.0%, and 66.4%, respectively). CONCLUSIONS: Patient rejection was the reason for non-referral to AVR in nearly one-quarter of the symptomatic patients with severe AS who were managed conservatively. The dismal outcome in patients who refused AVR was similar to that in patients who were not referred to AVR based on physician judgment despite less comorbidities and lower surgical risk scores in the former than in the latter.

9.
Chemosphere ; 235: 713-718, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31279121

RESUMO

Chemical leukoderma is a patchy hypopigmentation in the skin. Phenol derivatives such as raspberry ketone have been reported to cause the development of occupationally induced leukoderma. Recently, 2% (w/w) rhododenol, a reduced form of raspberry ketone used in a skin-lightning agent, also caused the development of leukoderma in >16,000 users, about 2% of all users, in Asian countries including Japan. However, a method for assessing the risk of leukoderma caused by 2% rhododenol has not been established despite the fact that the development of leukoderma caused by 30% rhododenol was previously shown in animal experiments. Establishment of a novel technique for risk assessment of leukoderma in humans caused by external treatment with chemicals is needed to prevent a possible future chemical disaster. This study demonstrated that external treatment with 2% rhododenol and the same concentration of raspberry ketone caused the development of leukoderma in murine tail skin without exception with significant decreases in the amount of melanin and number of melanocytes in the epidermis. Thus, a novel in vivo technique that can assess the risk of leukoderma caused by 2% rhododenol was developed. The unique technique using tail skin has the potential to prevent chemical leukoderma in the future.

10.
JAMA Netw Open ; 2(6): e195892, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31225889

RESUMO

Importance: Scarce data are available on the association of mineralocorticoid receptor antagonist (MRA) use with outcomes in acute decompensated heart failure (ADHF). Objective: To investigate the association of MRA use with all-cause mortality and hospital readmission in patients with ADHF. Design, Setting, and Participants: This cohort study examines participants enrolled in the Kyoto Congestive Heart Failure (KCHF) registry, a physician-initiated, prospective, multicenter cohort study of consecutive patients admitted for ADHF, between October 1, 2014, and March 31, 2016, into 1 of 19 secondary and tertiary hospitals throughout Japan. To balance the baseline characteristics associated with the selection of MRA use, a propensity score-matched cohort design was used, yielding 2068 patients. Data analysis was conducted from April to August 2018. Exposures: Prescription of MRA at discharge from the index hospitalization. Main Outcomes and Measures: Composite of all-cause death or heart failure hospitalization after discharge. Results: Among 3717 patients hospitalized for ADHF, 1678 patients (45.1%) had received MRA at discharge and 2039 (54.9%) did not. After propensity score matching, 2068 patients (with a median [interquartile range] age of 80 [72-86] years, and of whom 937 [45.3%] were women) were included. In the matched cohort (n = 1034 in each group), the cumulative 1-year incidence of the primary outcome was statistically significantly lower in the MRA use group than in the no MRA use group (28.4% vs 33.9%; hazard ratio [HR], 0.81; 95% CI, 0.70-0.93; P = .003). Of the components of the primary outcome, the cumulative 1-year incidence of heart failure hospitalization was significantly lower in the MRA use group than in the no MRA use group (18.7% vs 24.8%; HR, 0.70; 95% CI, 0.60-0.86; P < .001), whereas no difference in mortality was found between the 2 groups (15.6% vs 15.8%; HR, 0.98; 95% CI, 0.82-1.18; P = .85). No difference in all-cause hospitalization was observed between the 2 groups (35.3% vs 38.2%; HR, 0.88; 95% CI, 0.77-1.01; P = .07). In additional analyses that stratified by left ventricular ejection fraction, the association of MRA use with the primary outcome was statistically significant in patients with left ventricular ejection fraction of 40% or greater. Conclusions and Relevance: Use of MRA at discharge from ADHF hospitalization did not appear to be associated with lower mortality but was associated with a lower risk of heart failure readmission. This finding suggests that MRA treatment at discharge may have minimal, if any, clinical advantages.

11.
Environ Health Prev Med ; 24(1): 39, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153359

RESUMO

BACKGROUND: Cervical vestibular evoked myogenic potential (cVEMP) testing is a strong tool that enables objective determination of balance functions in humans. However, it remains unknown whether cVEMP correctly expresses vestibular disorder in mice. OBJECTIVE: In this study, correlations of cVEMP with scores for balance-related behavior tests including rotarod, beam, and air-righting reflex tests were determined in ICR mice with vestibular disorder induced by 3,3'-iminodipropiontrile (IDPN) as a mouse model of vestibular disorder. METHODS: Male ICR mice at 4 weeks of age were orally administered IDPN in saline (28 mmol/kg body weight) once. Rotarod, beam crossing, and air-righting reflex tests were performed before and 3-4 days after oral exposure one time to IDPN to determine balance functions. The saccule and utricles were labeled with fluorescein phalloidin. cVEMP measurements were performed for mice in the control and IDPN groups. Finally, the correlations between the scores of behavior tests and the amplitude or latency of cVEMP were determined with Spearman's rank correlation coefficient. Two-tailed Student's t test and Welch's t test were used to determine a significant difference between the two groups. A difference with p < 0.05 was considered to indicate statistical significance. RESULTS: After oral administration of IDPN at 28 mmol/kg, scores of the rotarod, beam, and air-righting reflex tests in the IDPN group were significantly lower than those in the control group. The numbers of hair cells in the saccule, utricle, and cupula were decreased in the IDPN group. cVEMP in the IDPN group was significantly decreased in amplitude and increased in latency compared to those in the control group. cVEMP amplitude had significant correlations with the numbers of hair cells as well as scores for all of the behavior tests in mice. CONCLUSIONS: This study demonstrated impaired cVEMP and correlations of cVEMP with imbalance determined by behavior tests in a mouse model of vestibular disorder.


Assuntos
Equilíbrio Postural/fisiologia , Transtornos das Sensações/fisiopatologia , Doenças Vestibulares/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Animais , Comportamento Animal/efeitos dos fármacos , Comportamento Animal/fisiologia , Modelos Animais de Doenças , Células Ciliadas Vestibulares/patologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Nitrilos/efeitos adversos , Equilíbrio Postural/efeitos dos fármacos , Sáculo e Utrículo/patologia , Transtornos das Sensações/induzido quimicamente , Doenças Vestibulares/induzido quimicamente , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/patologia , Potenciais Evocados Miogênicos Vestibulares/efeitos dos fármacos , Testes de Função Vestibular
12.
Sci Rep ; 9(1): 9028, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227759

RESUMO

Well water for drinking with increased levels of iron in arsenic-polluted areas has been reported worldwide. Oral exposure to arsenic has been shown to be associated with hearing loss, while there is no evidence for an association between excessive exposure to iron and hearing loss in humans. In this study, we determined iron and arsenic levels in biological samples and hearing levels by pure tone audiometry (PTA) in subjects in a control area and an arsenic-polluted area in Bangladesh. The iron level in well water in the arsenic-polluted area was significantly higher than that in piped supply water in the control area. Subjects in the polluted area (n = 109), who had higher iron and arsenic levels in hair and toenails than those in subjects in the control area (n = 36), had an increased risk of hearing loss at 8 kHz and 12 kHz after adjustments for age, gender, smoking and BMI. Significant associations of the exposure group with hearing loss at 8 kHz and 12 kHz remained after further adjustment for arsenic levels in toenails and hair. Thus, this pilot study showed that excessive exposure to iron via drinking water is a potential risk for hearing loss in humans.

13.
Nagoya J Med Sci ; 81(2): 337-340, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31239602

RESUMO

A 55-year-old man with a solitary kidney was diagnosed with an 8.5 cm renal cell carcinoma in the right kidney without metastasis. Twenty five months of sunitinib treatment reduced the tumor from 8.5 to 5.5 cm and enabled nephron-sparing surgery. He has no evidence of recurrence 58 months after the surgery.

14.
J Vis Exp ; (146)2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-31058909

RESUMO

This work presents a protocol employing the microwave photoconductivity decay (µ-PCD) for measurement of the carrier lifetime in semiconductor materials, especially SiC. In principle, excess carriers in the semiconductor generated via excitation recombine with time and, subsequently, return to the equilibrium state. The time constant of this recombination is known as the carrier lifetime, an important parameter in semiconductor materials and devices that requires a noncontact and nondestructive measurement ideally achieved by the µ-PCD. During irradiation of a sample, a part of the microwave is reflected by the semiconductor sample. Microwave reflectance depends on the sample conductivity, which is attributed to the carriers. Therefore, the time decay of excess carriers can be observed through detection of the reflected microwave intensity, whose decay curve can be analyzed for estimation of the carrier lifetime. Results confirm the suitability of the µ-PCD protocol in measuring the carrier lifetime in semiconductor materials and devices.

15.
Chemosphere ; 229: 611-617, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102916

RESUMO

Since tannery workers in developing countries are chronically exposed to high levels of chromium (Cr), there are serious concerns about health problems. However, there has been limited study in which Cr levels were measured in tannery workers, who are chronically exposed to Cr. Our preliminary inspection showed that there was hyperpigmented skin in tannery workers. We therefore investigated the correlation between skin pigmentation levels digitally evaluated as L* values by using a reflectance spectrophotometer and Cr levels in skin appendages in 100 male tannery workers and in 49 male non-tannery workers in Bangladesh. Digitalized skin pigmentation levels of the face and feet in addition to Cr levels in hair and toenails in tannery workers were significantly higher than those in non-tannery workers in our univariate analysis. Spearman's rank correlation coefficient analysis showed significant correlation between duration of tannery work (years) and Cr levels in hair (r = 0.62) and toenails (r = 0.61). Our multivariate analysis also showed that Cr levels in hair and toenails were significantly correlated with digitalized skin pigmentation levels of the face and feet in addition to duration of tannery work in all participants. Thus, our results showed the development of hyperpigmented skin in tannery workers. Our results also suggested that hyperpigmented skin could be a useful diagnostic marker for chronic exposure to Cr. Furthermore, cutaneous L* value might be a convenient marker for detection of chronic Cr poisoning, since the digitalized values enable objective evaluation of skin pigmented levels by general people as well as dermatologists.


Assuntos
Cromo/análise , Hiperpigmentação/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Bangladesh , Cromo/toxicidade , Face , , Cabelo/química , Humanos , Hiperpigmentação/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Unhas/química , Pele/química , Espectrofotometria/métodos , Curtume
16.
Environ Health Prev Med ; 24(1): 36, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101002

RESUMO

BACKGROUND: Melanin is detectable in various sense organs including the skin in animals. It has been reported that melanin adsorbs toxic elements such as mercury, cadmium, and lead. In this study, we investigated the adsorption of molybdenum, which is widely recognized as a toxic element, by melanin. METHODS: Molybdenum level of the mouse skin was measured by inductively coupled plasma mass spectrometry. The pigmentation level of murine skin was digitalized as the L* value by using a reflectance spectrophotometer. An in vitro adsorption assay was performed to confirm the interaction between molybdenum and melanin. RESULTS: Our analysis of hairless mice with different levels of skin pigmentation showed that the level of molybdenum increased with an increase in the level of skin pigmentation (L* value). Moreover, our analysis by Spearman's correlation coefficient test showed a strong correlation (r = - 0.9441, p < 0.0001) between L* value and molybdenum level. Our cell-free experiment using the Langmuir isotherm provided evidence for the adsorption of molybdenum by melanin. The maximum adsorption capacity of 1 mg of synthetic melanin for molybdenum was 131 µg in theory. CONCLUSION: Our in vivo and in vitro results showed a new aspect of melanin as an adsorbent of molybdenum.


Assuntos
Melaninas/química , Molibdênio/química , Poluentes Químicos da Água/química , Adsorção , Animais , Melaninas/metabolismo , Camundongos , Camundongos Pelados , Camundongos Transgênicos , Molibdênio/metabolismo , Molibdênio/farmacologia , Pele/química , Pele/efeitos dos fármacos , Pigmentação da Pele/efeitos dos fármacos , Poluentes Químicos da Água/metabolismo , Poluentes Químicos da Água/farmacologia
17.
Prostate ; 79(10): 1065-1070, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31025722

RESUMO

BACKGROUND: Although the presence of intraductal carcinoma of the prostate (IDC-P) influences biochemical failure in radical prostatectomy patients, no data are available regarding the impact of its integration into the classification grade group system. Thus, the aim of this study was to enhance the utility of the grade group system by integrating the presence of IDC-P. METHODS: This study was a retrospective evaluation of 1019 patients with prostate cancer who underwent radical prostatectomy between 2005 and 2013 without neoadjuvant or adjuvant therapy. The data on age, prostate-specific antigen (PSA) level at diagnosis, pathological T stage (pT), presence of Gleason pattern 5 (GP5), presence of IDC-P, and surgical margin status were analyzed to predict PSA recurrence after prostatectomy. RESULTS: The median patient age was 67 (range, 45-80) years and the median initial PSA level was 6.8 (range, 0.4-82) ng/mL. The median follow-up period was 82 (range, 0.7-148) months. IDC-P was detected in 157 patients (15.4%). Among these patients, the increase in the positive rate of IDC-P correlated with tumor upgrading. The grade groups (GGs) were as follows: GG1 without IDC-P, 16.0% (n = 163); GG2 without IDC-P, 46.1% (n = 470); GG3 without IDC-P, 15.7% (n = 160); GG4 without IDC-P, 2.6% (n = 27); GG5 without IDC-P, 4.1% (n = 42); any GG with IDC-P, 15.4% [n = 157; GG 2 (n = 29); GG3 (n = 60); GG4 (n = 13); GG5 (n = 55)]. Any grade Group with IDC-P showed significantly worse prognosis than any other group without IDC-P (P < 0.0001). In a multivariate analysis, integration of the IDC-P into the Grade Groups, the PSA level at diagnosis, and the surgical margin status were significant prognostic predictors (P < 0.0001, < 0.0001 and < 0.0001, respectively). CONCLUSIONS: Integrating the presence of IDC-P into the grade group system will result in more accurate predictions of patient outcome.

18.
Neurourol Urodyn ; 38(5): 1417-1422, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989706

RESUMO

AIMS: Although detrusor underactivity is often encountered in elderly patients, the etiology remains unclear. We have hypothesized that sarcopenia was associated with impaired bladder contractility. Therefore, we have evaluated the relationship between bladder contractility and clinical parameters including sarcopenia markers in elderly male patients. METHODS: This retrospective, single-centre study included male patients over 65 years of age who underwent a pressure flow study (PFS). We excluded patients with any previous medical histories that could affect bladder function, currently on urinary medication, and with no available data of abdominal CT scan. The psoas muscle area (PMA) (cm2 /m2 ) was measured as a surrogate for psoas muscle mass on computed tomography. PMA, serum CRP, and albumin are known as sarcopenia markers. Correlation and multiple regression analyses were performed to evaluate the association of bladder contractility index (BCI) with the following parameters: age, body mass index (BMI), prostate volume, bladder outlet obstruction index (BOOI), serum C-reactive protein (CRP), serum albumin, and PMA. RESULTS: Out of 558 male patients identified in our PFS database, 119 patients were enrolled. In the correlation analysis, age, prostate volume, serum albumin, BOOI, and PMA significantly correlated with BCI. However, no significant correlation of BCI with CRP or BMI was observed. Multiple linear regression analysis showed that serum albumin, BOOI, and PMA were significantly associated with BCI. CONCLUSIONS: We have demonstrated that serum albumin and PMA were significantly positively associated with detrusor contractility. It is possible that sarcopenia is associated with impaired detrusor contractility.

19.
Int J Cardiol ; 291: 69-76, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30948218

RESUMO

BACKGROUND: The impact of delays in the treatment with radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been well evaluated. The aim of this study was to investigate the impact of diagnosis-to-ablation time (DAT) on the long-term clinical outcomes after AF-RFCA. METHODS: We enrolled 1206 consecutive patients undergoing first-time RFCA for AF. The study population was divided into 2 groups based on DAT: short (<3 years) (N = 675) and long (>3 years) (N = 531) DAT groups. RESULTS: Mean follow-up duration was 5.0 ±â€¯2.5 years. The 5-year event-free rates from recurrent atrial tachyarrhythmias after the first and second RFCAs were significantly higher in short DAT group than in long DAT group (60.2% versus 48.3%, log-rank P < 0.001; 83.2% versus 75.2%, log-rank P = 0.02, respectively), leading to reduced cardiovascular hospitalization in short DAT group. After adjusting baseline differences, short DAT was independently associated with lower arrhythmia recurrence rates after the first and second RFCAs (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.60-0.86 and HR 0.72, 95%CI 0.55-0.95, respectively). There were no significant differences between the 2 groups in the event-free rates from all-cause and cardiovascular deaths, heart failure hospitalization, and ischemic stroke. However, among patients with a history of heart failure or reduced left ventricular function, the event-free rate from heart failure readmission was significantly higher in short DAT group (85.0% versus 61.0%, P = 0.004). CONCLUSIONS: In the management of AF, early RFCA was associated with significantly lower arrhythmia recurrence compared with delayed RFCA, leading to reduced cardiovascular hospitalization, especially in heart failure patients.

20.
Int J Urol ; 26(6): 618-622, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887604

RESUMO

OBJECTIVES: To analyze sequential changes of diabetic cystopathy based on urodynamic data in patients with diabetes mellitus. METHODS: Participants included male diabetes patients who underwent a pressure flow study at Nagoya University Graduate School of Medicine, Nagoya, Japan, from April 2005 to October 2016. Patients with a previous history of lower urinary tract dysfunction were excluded. Bladder dysfunction was categorized into four urodynamic patterns: (i) normal; (ii) detrusor overactivity with normal detrusor contractility; (iii) detrusor hyperreflexia/impaired contractility; and (iv) detrusor underactivity. The urodynamic patterns were evaluated according to the presence of diabetic retinopathy and nephropathy, which was correlated to diabetes mellitus duration. Furthermore, the association of clinical factors with voiding function, as well as sensory function, was investigated. RESULTS: A total of 57 patients were enrolled. Detrusor overactivity with normal detrusor contractility patterns was seen only in cases with neither diabetic retinopathy nor diabetic nephropathy, whereas the prevalence of detrusor hyperreflexia/impaired contractility pattern was highest in cases with diabetic retinopathy. Detrusor underactivity pattern was found with the highest frequency in cases with both diabetic retinopathy and diabetic nephropathy. On multivariate analysis, the existence of diabetic retinopathy was only significantly correlated with bladder contractility index. Furthermore, multivariate analysis showed that first desire volume and maximum cystometric capacity were significantly positively correlated with post-void residual urine volume, and also negatively correlated with voiding efficiency independent of bladder contractility index. CONCLUSIONS: Diabetes patients have diverse progressive bladder dysfunction according to the diabetes stage. An optimal screening program is necessary to detect and manage diabetic cystopathy at an early stage.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA