Palmar keratoses in family members of individuals with bladder cancer

A total of 270 bladder cancer cases, 178 first-degree relatives and 127 spouses of the bladder cancer cases and 329 hospital controls were studied to evaluate the association between palmar keratoses, bladder cancer and environmental and genetic factors. Crude prevalences of keratoses in the 4 groups were 67, 54, 42 and 23%, respectively.

Logistic regression models showed that bladder cancer patients had a raised risk of having palmar keratoses relative to hospital controls (odds RATIO = 6.95; 95% CI: 4.77–10.12) whereas blood-relatives and spouses had significantly increased odds ratios only if the case in their family (or some other blood-relative) possessed keratoses.

Among several environmental and behaviour factors, only cigarette smoking was significantly associated with increased risk (odds RATIO = 2.32; 95% CI: 1.63–3.29). The data suggest a genetic component may influence the occurrence of palmar keratoses, but some unknown environmental agent appears to be causing the association between spouses.     

Case-referent study on occupational risk factors for bladder cancer in southern Israel

Objective: To evaluate the possible association between occupational exposures (risk factors) and male bladder cancer in the Negev region (southern Israel) to enable preventive strategies to be applied. Methods: A total of 92 male bladder cancer patients, diagnosed at a regional medical center between 1989 and 1993, were studied by interview and compared with 92 males without oncological disease after matching by age and country of origin. A special questionnaire was developed to gather information on demography, life-time occupational history, smoking habits, coffee consumption, and health status. Statistical analysis of the case-referent data was done using the SPSS-5 package for performance of the chi-square test, conditional logistic regression, and multiple classification analysis. Results: Significant associations were found between bladder cancer occurrence and (1) three different groups of occupational exposures [a – solvents (P = 0.002, OR not computed due to the lack of exposed persons among referents), b – dusts (P = 0.02; OR = 4.67), and c – exposure to multiple chemicals (P < 0.001, OR = 6.25); (2) nephrolithiasis (P = 0.02, OR = 11.00); and (3) cigarette smoking (P = 0.01, OR = 1.87). Conclusions: Certain types of occupational exposure, different from that to aromatic amines and dyes, may be considered as contributing factors in the epidemiology of bladder cancer. Better identification of these chemicals and the work processes where they are used may help in abating such exposures, thus leading to a reduction in the risk for this relatively common cancer. Received: 6 April 1998 / Accepted: 16 January 1999     

基层医院导尿相关尿路感染的危险因素分析

目的分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天(OR值5.59;95%CI 1.94～16.16)、卧床时间≥15天(OR值4.23;95%CI 1.85～9.67)、膀胱冲洗(OR值3.63;95%CI 1.83～7.23)与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

基层医院导尿相关尿路感染的危险因素分析

目的 分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天（OR值5．59;95％CI1．94～16．16）、卧床时间≥15天（OR值4．23;95％CI1．85～9．67）、膀胱冲洗（OR值3．63;95％CI1．83～7．23）与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

Phenobarbital use and bladder cancer risk

Background: Two epidemiologic studies have reported an inverse association between use of phenobarbital (PB) and bladder cancer development. It was proposed that PB use protects against bladder cancer by inducing enzymes that participate in the detoxification of human bladder carcinogens, such as the aminobiphenyls and naphthylamines, which are found in cigarette smoke. Methods: A population-based case–control study was conducted in Los Angeles, California, involving 815 incident bladder cancer cases and an equal number of controls who were matched to the index cases by neighborhood, sex, date of birth (within 5years), and race. Detailed information on lifetime use of PB was collected through in-person interviews. Results: Ever use (20 or more times over lifetime) of PB was not associated with risk of bladder cancer (OR: 0.86; 95% CI: 0.54, 1.39). Regular use of PB also was not associated with risk of bladder cancer in either men or women, in either smokers or non-smokers, although the number of regular users in cases and controls were relatively small (21 cases vs. 15 controls, OR: 1.20; 95%CI: 0.59, 2.45). In fact, compared with non-users, subjects in the highest category of lifetime PB consumption were at a non-significant 2.46-fold increased risk of bladder cancer (95% CI: 0.90, 6.78). Conclusions: The present study did not observe a protective role of PB use in bladder cancer development in the general population.     

Quality-of-life following thoracotomy for lung cancer

Contrary to the issues of perioperative morbidity and survival following surgery for lung cancer, little attention has been given to quality-of-life. To address this, quality-of-life was assessed preoperatively and 1, 3, 6 and 9 months postoperatively in a cohort of 117 consecutive subjects who underwent thoracotomy with a certain or presumptive diagnosis of lung cancer. Those with cancer (n = 91) confirmed at thoracotomy were contrasted to those without (n = 26). Moderate to severe dyspnea, reported in 14% preoperatively, increased to 34% at 1 and 3 months (p < 0.005) but returned to approximately 10% at 6 and 9 months. Similarly, activities of daily living were impaired in 11% preoperatively; this disability increased to 21% at 1 month (p < 0.005), and returned to baseline at 6 and 9 months. Those with cancer compared to those without a postoperative diagnosis of cancer had similar quality-of-life preoperatively but deteriorated more in the postoperative period. This study demonstrates that important deterioration in quality-of-life occurs during the first 3 months postoperatively in those with a final diagnosis of cancer but improvement back to baseline can be expected thereafter.     

Trends in cigarette smoking among children in a southern community, 1976–1994: The Bogalusa Heart Study

Cigarette smoking among adolescents continues to be a major public health problem in the United States. Smoking trends from 1976–1977 to 1992–1994 were examined in the Bogalusa Heart Study, an investigation of cardiovascular disease risk factors among black and white, male and female adolescents in a semirural town in the southern United States. Age-race-sex specific χ² tests for trends over five survey periods were conducted. In almost every age group, black boys and girls were less likely to be current smokers or to have ever smoked or tried cigarettes, as compared with white boys and girls, respectively (P < 0.01). Within age groups, few significant trends in smoking status from 1976–1977 through 1992–1994 were observed among white boys and girls. Among black males and females, however, sharp decreases were observed among all age groups in the prevalence of having ever smoked or tried cigarettes (P = 0.0001) and among the older age groups in the prevalence of being a current smoker (P = 0.0001). Thus, substantial declines in the prevalence of smoking were observed among black children but not among white children. Further research is required to understand why these ethnic differences in smoking occurred so that public health programs may target further the smoking behaviors in children.     

儿童复杂性尿路感染致病菌及耐药分析

摘要:目的　通过对儿童复杂性尿路感染（complicated Urinary Tract Infection,cUTI）常见致病菌分布及耐药情况的研究,为临床治疗提供依据。方法　回顾性对2012年1月到2013年12月儿科住院治疗的141例尿培养阳性的cUTI致病菌的分布及常见致病菌药敏进行分析。结果　革兰阴性杆菌是导致儿童cUTI的主要致病菌,占58.6%,以大肠埃希菌（43.4%）最常见;其次革兰阳性球菌占35.2%（屎肠球菌和粪肠球菌分别占18.6%和10.3%）;真菌6.2%。大肠杆菌对氨苄西林的耐药率高达100%,添加舒巴坦后耐药率下降为52.9%;在头孢菌素类中,对头孢唑啉、头孢曲松和头孢吡肟耐药率较高（＞40%）,而对头孢替坦耐药率低于其他头孢菌素类（P＜0.05）,对阿米卡星、呋喃妥因和厄他培南敏感（＞95%）;屎肠球菌对青霉素,四环素等耐药率较高（＞85%）,对万古霉素、替加环素和利奈唑胺敏感。结论　大肠埃希菌、屎肠球菌和粪肠球菌是尿路感染常见致病菌,这些致病菌对多种抗生素耐药率很高,应根据药敏结果调整经验用药。     

Bladder cancer, tobacco smoking, coffee and alcohol drinking in Brescia, northern Italy

The association between tobacco smoking, the consumption of coffee and alcohol and bladder cancer was investigated in a hospital-based case-control study in Brescia, northern Italy. A total of 172 incident cases (135 men and 37 women) and 578 controls (398 men and 180 women) were enrolled. As expected, cigarette smoking was strongly associated with bladder cancer. The odds ratios (OR) for coffee drinking adjusted for age, education, residence and cigarette smoking in current drinkers were 2.6 (95% confidence interval, CI: 1.1–6.1) in men and 5.2 (95% CI: 1.0–30.4) in women. A dose-response relationship was found in men, with the highest risk in the highest category of exposure: drinkers of more than 5 cups per day had an OR of 4.5 (95% CI: 1.2–16.8). The ORs for current alcohol drinkers were 2.1 (95% CI: 1.0–4.8) in men and 3.4 (95% CI: 1.2–9.7) in women; according to grams of ethanol drunk per day (grams/day, g/d) the ORs were: 1.7 (1–20 g/d), 1.6 (21–40 g/d), 4.3 (41–60 g/d) and 4.6 (61+ g/d) in men and 3.1 (1–20 g/d) and 3.9 (21+ g/d) in women. These results suggest that regular consumption of both coffee and alcohol can be independently associated with an increased bladder cancer risk.     

Tobacco smoking,coffee, cocoa and tea consumption in relation to mortality from urinary bladder cancer in Italy

This paper examines changes in mortality from urinary bladder cancer in Italy during the years 1950-81 in relation to changes in smoking habits and in coffee, cocoa and tea consumption. The authors found that, in both sexes and for all ages, mortality has been increasing throughout this period, although the rates and relative increase have consistently been much lower and more gradual for women than for men.From the analysis of age-cohort-period variation it seems that bladder cancer mortality can also be influenced by changes in smoking habit patterns and by variation in the quality of diagnoses. The increase in death risk for both sexes in Italy up to cohorts born around 1905-10 can be related to occupational exposures and to high-tar-content tobacco smoking, whereas the tendency for mortality rates to stabilize and decline in cohorts born after 1910 were influenced by changes from high-tar-content and no-filter cigarettes to low-tar-content and filter cigarettes and by prevention measures taken in at-risk working environments.The consumption of coffee, cocoa and tea does not seem to be related to the increase in bladder cancer risk in Italy.Corresponding author.     

Diesel exhaust exposure and bladder cancer risk

A total of 136 cases of men with urinary bladder cancer and 272 matched hospital controls were examined for potential exposure to diesel exhaust. A lifetime occupational history was obtained for all subjects in the study and assessment of exposure to diesel exhaust was based on the job titles of the subject and self-reported exposure. The risk was assessed by odds ratios, with adjustment for confounding variables, in particular cigarette smoking. There was no evidence of elevated risk in occupations with possible or probable exposure (the ORs adjusted for smoking were 1.1. and 0.9 respectively). Truck driving alone was also not associated with elevated risk (adjusted OR=0.5). There was a weak positive crude association with any exposure, including self-reports (OR=1.4); however after adjustment for smoking, the estimate did not retain statistical significance (OR=1.2, 95% CI=0.8-2.0). This study provides little to support the hypothesis of an excess of bladder cancer risk from occupational exposure to diesel exhaust.Corresponding author.     

上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的高危因素分析

目的 探讨肿瘤部位与上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的关系.方法 对行根治手术并获随访的168例上尿路移行上皮细胞癌患者的临床资料进行回顾性总结,比较不同部位上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的风险,采用Cox回归分析术后复发膀胱肿瘤风险的独立影响因素.结果 168例患者术后1、3、5年的无复发膀胱肿瘤的生存率分别为88%、76%和63%.观察期内,共有49例术后发生膀胱肿瘤复发,中位首次复发时间为20个月.肾盂癌术后复发率为30.8%(28/91);输尿管中段癌术后复发率为8.3%(2/24),输尿管下段癌术后复发率为48.7%(19/39).肾盂癌与输尿管癌患者术后无复发膀胱肿瘤生存率比较差异无统计学意义(P>0.05).多因素分析结果显示输尿管下段癌为影响上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的独立变量(P<0.01).结论 输尿管下段癌患者术后复发膀胱肿瘤的风险高于其他部位上尿路移行上皮细胞癌.

Abstract：

Objective To investigate the relationship between tumor location and the risk of developing bladder cancer in pafients treated by nephroureterectomy(NU)for upper urinary tract transitional cell carcinoma(UUT-TCC).Methods The clinical data of 168 UUT-TCC patients who underwent NU were reviewed.Univariate and multivariate analysis were carried out to determine the risk factors for intravesical recurrence after NU.Results The recurrence-free survival rate at 1,3 and 5 years after NU were 88%, 76%and 63%.All patients were followed up for a median period of 45(12-107)months During this period, a total of 49 patients developed bladder tamors after surgery,of which 28 cases were renal pelvic carcinoma, 2 cases were rniddle ureter carcinoma and 19 cases were distal ureter carcinoma.The recurrence-free survival of renal pelvic carcinoma and ureter carcinoma had no significant difference by Log-Rank test(P>0.05).On multivariate analysis,only locating in distal ureter carcinoma was the independent risk predictor for intravesical recurrence after NU (P<0.01).Conclusion Pafients with UUT-TCC at distal ureter carry a higher risk for intraeesieal recunerrce after NU than those with TCC at other location of upper urinary tract.     

Relationship of cigarette smoking, alcohol use, and dietary habits with sigmoid colon adenomas

The relationship between cigarette smoking, alcohol use, and dietary factors and the risk of adenomas of the sigmoid colon was examined in male self-defense officials who received a preretirement health examination at three Self-Defense Forces hospitals in Japan. In the comparison between 228 patients with sigmoid adenomas and 1484 control subjects with normal colonoscopy findings ( 60 cm from the anus), a clear dose-response relationship was observed between cigarette smoking and risk of adenoma. After adjustment for rank, body mass index, alcohol use, and physical activity as well as for hospital and survey season, the odds ratios (and 95% confidence intervals (CIs)) for the categories of 0, 1 to 399, 400 to 799, and 800 or more cigarette-years were 1.0, 2.1 (1.2 to 3.5), 2.8 (1.8 to 4.3), and 3.5 (2.1 to 5.8), respectively. Current alcohol drinkers tended to have an increased risk, but without a dose-response relation. Among four types of alcoholic beverages (shochu, sake, beer, and whiskey), only whiskey showed a weak association with risk of adenoma. None of the 13 dietary items studied (including meat and rice consumption) was measurably associated with adenoma risk. The present findings provide additional evidence that cigarette smoking is a risk factor for colon adenomas. It is inconclusive regarding alcohol intake's association with adenoma risk.     

放松疗法在膀胱癌术后膀胱灌注化疗中的应用

目的探讨放松疗法在膀胱灌注化疗中的护理效果。方法将85例膀胱癌患者随机分为观察（43例）和对照组（42例）,对照组行常规护理,观察组在此基础上进行身心放松训练。比较两组化疗后不适发生率及持续时间。结果观察组化疗后膀胱刺激征、发热、胃肠道反应发生率及持续时间与对照组比较,差异有统计学意义（P〈0．05,P〈0．01）。结论对膀胱癌患者在健康教育的基础上进行身心放松训练能有效地降低膀胱灌注化疗的应激反应,降低化疗后不适的发生率,缩短其持续时间。     

宫颈癌根治术后留置导尿管相关泌尿系感染分析

目的 探讨宫颈癌根治术患者留置导尿管相关泌尿系感染。方法 对86例宫颈癌根治术患者留置导尿管后泌尿系感染与其留置时间、膀胱冲洗次数、抗菌药物使用情况等关系进行分析。结果 留置导尿管<10 d,泌尿系感染率为0,膀胱功能恢复良好;留置导尿管>10 d,泌尿系感染率为10.26％,膀胱功能恢复不良占5.12％。膀胱冲洗1～3次,泌尿系感染率为12.50％;膀胱冲洗4～8次,泌尿系感染率为10.34％,无统计学差异。使用抗菌药物在7 d以内者,感染率为0,而使用抗菌药物在8～15 d者,感染率为11.11％。结论 留置导尿管时间越长,感染率越高。感染率不会因抗菌药物使用时间长而下降。     

Cardiovascular risk factors and hyperinsulinemia in elderly men: The Honolulu Heart Program

Associations of cardiovascular risk factors, including several measures of adiposity, with hyperinsulinemia were assessed in 3562 elderly (71 to 93 years of age) Japanese American men from the Honolulu Heart Program who were examined between 1991 and 1993. In addition, cardiovascular risk factors measured 25 years earlier were also examined in relation to hyperinsulinemia. Hyperinsulinemia was defined as fasting insulin 95th percentile (20 μU/mL) among the subset of subjects (n = 504) who were nonobese and free of clinical diabetes and glucose intolerance. When this definition was applied to the entire population, the prevalence of hyperinsulinemia declined cross-sectionally with age (P < 0.001) from 24.2% in men aged 71 to 74 years to 16.4% in men aged 85 to 93 years. Factors having a positive and independent association with hyperinsulinemia included body mass index (BMI), triglycerides, glucose, hematocrit, use of diabetic medication, heart rate, and hypertension. The association with physical activity was negative. Triglycerides, BMI, diabetic medication, hypertension, and smoking levels measured 25 years earlier were also associated independently with hyperinsulinemia. Associations were similar in nondiabetic subjects. Three measures of adiposity (BMI, waist circumference, and subscapular skinfold thickness) were independently related to hyperinsulinemia cross-sectionally. However, associations involving a difference between the 80th and 20th percentiles in each adiposity measure appeared strongest for BMI (odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.7 to 5.6) and waist circumference (OR = 4.1, 95% CI = 3.3–5.1) and slightly weaker for subscapular skinfold thickness (OR = 2.1, 95% CI = 1.8–2.5). These findings suggest that features of an insulin resistance syndrome including dyslipidemia, glucose intolerance, hypertension, and obesity, assessed both cross-sectionally and 25 years previously, are associated independently with hyperinsulinemia in elderly Japanese American men.     

Personal hair dye use and bladder cancer: a meta-analysis

Despite considerable research, the issue of hair dyes and bladder cancer is still open to discussion. In January 2013, we searched in PubMed/EMBASE to identify observational studies investigating the association between personal use of hair dyes and bladder cancer incidence/mortality. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Fifteen case-control and two cohort studies were available for meta-analysis (8504 cases/deaths, 14,102 controls, and 617,937 persons at risk). Compared with no use, the pooled RR of bladder cancer for personal use of any type of hair dyes was 0.93 (95% CI, 0.82–1.05), with moderate heterogeneity among studies (I² = 34.1%, P = .07). Similar RRs were found for females (RR = 0.95) and males (RR = 0.81). Based on seven studies, the pooled RR for personal use of permanent hair dyes was 0.92 (95% CI, 0.77–1.09). Compared with no use, no association was observed for the highest categories of duration of use and lifetime frequency of use of both any type of dyes and permanent dyes. The pooled RR from four studies reporting results for use of dark-colored dyes was 1.29 (95% CI, 0.98–1.71). This meta-analysis allows to definitively exclude any appreciable excess risk of bladder cancer among personal hair dye users.     

Citrus fruit intake and bladder cancer risk: a meta-analysis of observational studies

Epidemiological studies have investigated the association between citrus fruit and bladder cancer risk; however, the results are inconsistent. To assess these issues, we conducted a meta-analysis of currently available studies. We identified relevant articles by searching the MEDLINE and EMBASE databases. We calculated the summary relative risk (RR) with 95% confidence interval (95% CI) using a random effect model. We included eight case–control studies and six cohort studies in the meta-analysis. There was a significant inverse association between citrus fruit intake and bladder cancer risk in all pooled studies (RR: 0.85; 95% CI, 0.76–0.94) and case–control studies (RR: 0.77; 95% CI, 0.64–0.92), but not in the cohort studies (RR: 0.96; 95% CI, 0.87–1.07). Our results suggest that citrus fruit intake is related to decreased bladder cancer risk. Subsequent well-designed, large prospective studies are needed to obtain better understanding of this relationship.     

The unproven utility of the preoperative urinalysis: Economic evaluation

The clinical effectiveness of the preoperative urinalysis is unproven, yet it is routinely obtained before surgery. To determine if the routine urinalysis might be economically beneficial, we evaluated its cost-effectiveness and cost-benefit.

In the setting of elective clean-wound, non-prosthetic knee procedures, we estimated that: (1) nearly U.S. $7,000,000 is spent annually on preoperative urinalyses and associated costs; (2) given the best estimate of the increase in risk of wound infection attributable to urinary tract infection, 4.58 wound infections may be prevented annually, at a cost of $1,500,000 per wound infection prevented; (3) the cost of treating additional cases of wound infection, given no preoperative urinalysis, is approximately five hundred-fold less than the cost of screening with routine urinalyses.

We conclude that the routine preoperative urinalysis is clinically and economically unsound before clean-wound, non-prosthetic knee surgery and probably before other types of clean-wound surgery. For this relatively inexpensive test, aggregate costs are disproportionately high and appear to outweigh clinical benefits.     

外来化合物诱发膀胱癌机制的研究进展

在研究表明外来化合物可诱发膀胱癌,但其机制尚不清楚,本文概述了与膀胱癌相关的一些外来化合物及其癌机理,并从外来化合物诱发膀胱癌的癌基因、肿瘤抑制基因及机体状态等细胞分子生物学方面进行综述。