Effects of L-arginine on Vascular Smooth Muscle Cell Proliferation and Apoptosis after Balloon Injury

Objective—Vital exhaustion (VE) and a hypercoagulable state both have been associated with coronary artery disease (CAD). Candidate mechanisms by which VE predicts CAD events are impaired fibrinolysis and inflammatory changes, the latter also affecting hemostasis. We investigated whether VE and inflammation would independently relate to hemostasis.

Design—Study participants were 217 (mean age?±?SD, 40?±?9 years) apparently healthy men and women working at an airplane manufacturing plant in Germany who completed the Shortened 9‐item VE Maastricht Questionnaire. All subjects had a set of classic cardiovascular risk factors assessed, and plasma levels of fibrin D‐dimer, type I plasminogen activator inhibitor (PAI‐1) antigen, C‐reactive protein (CRP), and tumor necrosis factor (TNF)‐α were measured.

Results—PAI‐1 correlated with VE (r?=?0.18, p?=?0.009), CRP (r?=?0.20, p?=?0.004), and TNF‐α (r?=?0.18, p?=?0.009); D‐dimer correlated with CRP (r?=?0.16, p?=?0.018). In linear regression analyses, VE and TNF‐α independently explained 2 and 1%, respectively, of the variance in PAI‐1.

Conclusion—Our study corroborates previous findings on impaired fibrinolysis in VE. The findings suggest that VE and inflammation may impair fibrinolysis by different pathways, and independently of traditional cardiovascular risk factors.     

Independent relation of vital exhaustion and inflammation to fibrinolysis in apparently healthy subjects

OBJECTIVE--Vital exhaustion (VE) and a hypercoagulable state both have been associated with coronary artery disease (CAD). Candidate mechanisms by which VE predicts CAD events are impaired fibrinolysis and inflammatory changes, the latter also affecting hemostasis. We investigated whether VE and inflammation would independently relate to hemostasis. DESIGN--Study participants were 217 (mean age+/-SD, 40+/-9 years) apparently healthy men and women working at an airplane manufacturing plant in Germany who completed the Shortened 9-item VE Maastricht Questionnaire. All subjects had a set of classic cardiovascular risk factors assessed, and plasma levels of fibrin D-dimer, type I plasminogen activator inhibitor (PAI-1) antigen, C-reactive protein (CRP), and tumor necrosis factor (TNF)-alpha were measured. RESULTS--PAI-1 correlated with VE (r=0.18, p=0.009), CRP (r=0.20, p=0.004), and TNF-alpha (r=0.18, p=0.009); D-dimer correlated with CRP (r=0.16, p=0.018). In linear regression analyses, VE and TNF-alpha independently explained 2 and 1%, respectively, of the variance in PAI-1. CONCLUSION--Our study corroborates previous findings on impaired fibrinolysis in VE. The findings suggest that VE and inflammation may impair fibrinolysis by different pathways, and independently of traditional cardiovascular risk factors.     

Inflammatory biomarkers,vascular procedures of lower limbs,and wound healing

Abnormal, persistent inflammation after bypass surgery could prevent healing of an ischaemic foot lesion. In 37 patients with peripheral arterial disease (PAD) (Rutherford Grade III Category 5) who underwent infrapopliteal vein graft and midfoot amputation, plasma levels of fibrinogen, C‐reactive protein (CRP), interleukin‐1 (IL‐1), interleukin‐6 (IL‐6), tumour necrosis factor‐α (TNF‐α), and matrix metalloproteinase‐2 and ‐9 (MMP‐2 and MMP‐9) were determined preoperatively and during the follow up. Nine patients without clinical and Doppler evidence of arterial disease, who underwent post‐traumatic midfoot primary amputation, were included in the experiment group, and 15 age‐matched healthy volunteers served as control. In patients who had midfoot amputation for trauma, all wounds healed. Seven (19%) wounds in patients with an occluded graft healed, and five (13%) required major amputation because of a non‐healing wound. Time required for complete healing of the lesion was similar between trauma and PAD patients (8 ± 2 months vs 11 ± 6, respectively, P = NS). Univariate analysis demonstrated that, in PAD patients, the postoperative high levels of TNF‐α, IL‐6, and MMP‐2 and ‐9 were predictive for wound healing failure at 3, 6, and 9 months (P < 0.05), respectively. Furthermore, the subgroup of patients who experienced occlusion of the vein graft during follow up had a significant increase of MMP‐2, ‐9, IL‐6, and TNF‐α at 3, 6, and 9 months (P < 0.05), respectively. Monitoring inflammatory markers allows the determination of patients at risk of healing failure of midfoot amputation after distal revascularisation and might predict the fate of the vein graft.     

Pouchitis may increase the risk of dysplasia after restorative proctocolectomy in patients with ulcerative colitis.

Aim Dysplasia of the pouch mucosa after restorative proctocolectomy is rare. The aim of this study was to establish whether there is a correlation between pouchitis and dysplasia. Method A group of 276 patients treated for ulcerative colitis by restorative proctocolectomy between 1984 and 2009 was analysed. The presence or absence of pouchitis and dysplasia within the pouch was evaluated. Results Inflammation was diagnosed in 66 (23.9%) patients, low‐grade dysplasia in five (1.8%), high‐grade dysplasia in three (1.1%), and cancer in one patient (0.4%). The prevalence of low‐grade dysplasia was significantly higher in patients with inflammation than in those without (P < 0.04). High‐grade dysplasia was significantly more frequent in pouchitis than in non‐inflamed pouches (P < 0.01). Logistic regression analysis suggested that the occurrence of mucosal inflammation increased the risk of low grade dysplasia. Conclusion Patients with chronic pouchitis are at risk of dysplasia and require surveillance of the pouch.     

Predictors for clinically relevant Gleason score upgrade in patients undergoing radical prostatectomy

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Clinically relevant GSU in the prostatectomy specimen is a common phenomenon. Clinically relevant GSU occurs in one of three patients with clinically ‘very’ low‐risk PCa, and a low number of biopsy cores is the key negative predictor.

OBJECTIVE

? To evaluate clinical predictors for Gleason score upgrade (GSU) in radical prostatectomy (RP) specimen, especially in patients with ‘very’ low risk PCA (T1c and biopsy Gleason score ≤6 and PSA <10 ng/ml and ≤2 positive biopsy cores and PSA density <0.15).

Patients and Methods

? 402 consecutive patients undergoing RP between 2004 and 2006, including a subgroup of 62 patients with ‘very’ low risk PCA, were examined. ? Patients were categorized for clinically relevant GSU (defined as upgrade into a higher PCA risk category). ? Parameters including number of biopsy cores obtained, positive biopsy cores, prostate weight, PSA, DRE and pathology department were evaluated for their role as predictors. ? Furthermore, GSU in RP specimen was analyzed for its impact on pT‐stage.

RESULTS

? Clinically relevant GSU occurred in 38.1% in the whole cohort and in 32.3% in the ‘very’ low risk PCA subgroup. Gleason score downgrade (GSD) occurred in 4.7%. ? Number of biopsy cores obtained and prostate weight were independent negative predictors of GSU in all 402 patients (P = 0.02 and P = 0.03, respectively). ? In the ‘very’ low risk group, only number of biopsy cores obtained revealed as an independent negative predictor of GSU (P = 0.02). ? PSA, DRE, number of positive cores or pathology department were not associated to GSU. ? In the ‘very’ low risk group, GSU was related with extracapsular tumor extension (P = 0.05).

Conclusions

? Clinically relevant GSU in RP specimen is still a challenging problem. ? Increasing the number of biopsy cores lower this risk significantly. GSD is rare and thus of minor importance for treatment decisions.     

Acute cellular rejection the first year after heart transplantation and its impact on survival: a single‐centre retrospective study at Skåne University Hospital in Lund 1988–2010

Acute cellular rejection (ACR) the first year after heart transplantation (HT) and its impact on survival was investigated. All 215 HT patients at our centre 1988–2010, including 219 HTs and 2990 first‐year endomyocardial biopsies (EMBs), were studied. ‘Routine’ EMBs obtained 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40 and 52 weeks after HT, and ‘additional clinically indicated’ (ACI) EMBs, were graded according to the 1990‐ISHLT‐WF. The frequency and severity of first‐year ACRs was low, with 6.5% of routine EMBs and 14.1% of ACI EMBs showing ACR ≥ grade 2. Proportionally more (P < 0.05) first‐year ACRs ≥ grade 2 were found among EMBs in HTs performed during 1988–1999 (9.6%) than 2000–2010 (5.5%), EMBs performed during 16–52 weeks (8.8%) than 1–12 weeks (6.3%) after HT, EMBs in HTs with paediatric (11.3%) than adult (7.1%) donors, and EMBs in sex‐mismatched (10.4%) than sex‐matched (6.3%) HTs. Five‐ and ten‐year survival was furthermore lower (P < 0.05) among HTs with ≥1 compared with 0 first‐year ACRs ≥ grade 3A/3B (82% vs. 92% and 69% vs. 82%, respectively). Ten‐year survival was 74% compared with 53% in the ISHLT registry. In conclusion, our results indicate that first‐year ACRs ≥ grade 3A/3B affect long‐term survival. We believe frequent first‐year EMBs may allow early ACR detection and continuous immunosuppressive adjustments, preventing low‐grade ACRs from progressing to ACRs ≥ grade 3A/3B, thereby improving survival.     

Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta‐analysis

The Pentax Airway Scope^® is a single‐use optical videolaryngoscope designed to assist with difficult tracheal intubation. We systematically reviewed the efficacy of the Pentax Airway Scope with that of a conventional laryngoscope for tracheal intubation in adults with ‘normal’ and ‘difficult’ airways. We included 17 randomised controlled trials with a total of 1801 participants. We used the DerSimonian and Laird random‐effects model to calculate pooled relative risk or weighted mean differences. The relative risk (95% CI) of a Cormack–Lehane grade‐1 laryngeal view was 2.40 (1.76–2.49) with the Pentax Airway Scope compared with the Macintosh laryngoscope, p < 0.00001. We found no other differences between the two laryngoscopes. Despite a superior laryngeal view, the Pentax Airway Scope provides little clinical benefit over the conventional laryngoscope.     

Stress recovery during an ocean boat race

The aim was to study the effects of intense and sustained stress associated with a several months long endurance test with special emphasis on the biology of recovery. Biological stress markers of ‘catabolism’ (cortisol in saliva and HbA_1c in blood) and ‘anabolism’ (testosterone in saliva) were followed in crewmembers during a 9‐month around the world sailing race. During sustained mental stress the diurnal cortisol curve was flattened, HbA_1c was at the upper part of the normal range and testosterone levels were low. In the latter part of the race the crew mastered the situation and the stress markers were normalized. Our longitudinal approach disclosed a striking shift in the profile of stress markers from a ‘catabolic’ to an ‘anabolic’ state, corresponding to a decline of mental stress. Copyright © 2004 John Wiley & Sons, Ltd.     

High‐calcium dialysate: A factor associated with inflammation,malnutrition and mortality in non‐diabetic maintenance haemodialysis patients

Aim: Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein‐energy wasting. However, the association of high‐calcium dialysate with malnutrition and/or inflammation in non‐diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high‐calcium dialysate and mortality in this population. Methods: A total of 717 non‐diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis‐related data were obtained for cross‐sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. Results: Patients with high‐calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard‐ and low‐calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high‐calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high‐calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429–5.352) for 2 year all‐cause mortality in these patients. Conclusion: The analytical results indicate that high‐calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non‐diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high‐calcium dialysate.     

Visfatin and endothelial function in dialyzed patients

Aim: Visfatin is an adipocytokine that has recently generated much interest. The aim of the study was to assess visfatin in correlation with markers of endothelial damage and inflammation in haemodialyzed and peritoneally dialyzed patients. Methods: Visfatin, leptin, apelin and adiponectin, markers of coagulation (thrombin–antithrombin complexes (TAT), prothrombin fragments 1+2 (F1+2)), fibrinolysis (tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI‐1)), endothelial function/injury (Von Willebrand factor (vWF), thrombomodulin, intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), CD146) and inflammation (high‐sensitivity C‐reactive protein (hsCRP), tumour necrosis factor‐α (TNF‐α) and interleukin (IL)‐6) were assessed. Results: Triglycerides, hsCRP, creatinine, IL‐6, TNF‐α, vWF, F1+2, TAT, thrombomodulin, ICAM, VCAM, CD146, PAI‐1, leptin, adiponectin and visfatin were elevated in dialyzed patients over controls. Visfatin correlated significantly, in univariate analysis, in haemodialyzed patients with markers of endothelial damage/inflammation (CD146, ICAM, IL‐6), other adipocytokines, Kt/V and dialysis vintage, and tended to correlate with hsCRP. In peritoneally dialyzed patients, visfatin correlated significantly with haemoglobin, and markers of endothelial damage. In the healthy volunteers visfatin correlated significantly with ICAM, creatinine and IL‐6. In multiple regression analysis in HD patients visfatin was only independently related to Kt/V, dialysis vintage and IL‐6. Conclusion: Elevated visfatin related to markers of inflammation might represent a novel link between inflammation and adipocytokines in dialyzed patients. Time on dialyses and dialysis adequacy may influence visfatin in dialyzed patients due to the decreased clearance of visfatin.     

Prostate cancer family history and eligibility for active surveillance: a systematic review of the literature

Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for AS. To determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance, PubMed searches of ‘family history and prostate cancer’, ‘family history and prostate cancer progression’ and ‘factors of prostate cancer progression’ were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis. Review of the six publications suggests that family history does not increase the risk of prostate cancer progression, whilst a subgroup analysis in one study found that family history increases the risk of prostate cancer progression only in African‐Americans. A family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for AS. Further studies are needed to better understand the relationship between race, family history, and eligibility for AS.     

Circulating endothelial cells are associated with future vascular events in hemodialysis patients

BACKGROUND: Endothelial dysfunction and injury are thought to have a key role in the pathogenesis of cardiovascular disease. We hypothesized that the presence of circulating endothelial cells, as a reflection of ongoing endothelial injury, might provide a novel means for predicting cardiovascular events in hemodialysis subjects who are known to be at marked increased risk for cardiovascular disease. METHODS: Circulating endothelial cell number was determined in 29 hemodialysis patients who were then followed for vascular events for 470 +/- 172 days. In a second cohort of 44 hemodialysis patients, circulating endothelial cell number was correlated with markers of inflammation, namely high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10, and monocyte chemoattractant protein-1 (MCP-1), and endothelial dysfunction, soluble vascular cellular adhesion molecule-1 (VCAM-1). RESULTS: Seven of the 19 subjects with elevated circulating endothelial cells (defined as >19 cells per mL) had cardiovascular (N= 5) or vascular (N= 5) events during follow-up, whereas no events occurred in subjects with a low number of circulating endothelial cells (相似文献   

Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta‐analysis

Some, but not all studies have suggested intra‐operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta‐analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a ‘nitrous oxide group’ (total 2297 patients) vs a ‘no‐nitrous oxide group’ (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71–0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no‐nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the maximal risk reduction was obtained in female patients (pooled relative risk 0.76, 95% CI 0.60–0.96). When nitrous oxide was used in combination with propofol, the antiemetic effect of the latter appeared to compensate the emetogenic effect of nitrous oxide (pooled relative risk 0.94, 95% CI 0.77–1.15). We conclude that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.     

Distinct patterns and behaviour of urothelial carcinoma with respect to anatomical location: how molecular biomarkers can augment clinico-pathological predictors in upper urinary tract tumours

Purpose

Upper urinary tract urothelial carcinoma (UTUC) shares many similarities with bladder-UC, but there is strong evidence on a clinical, aetiological, epidemiological and genetic level that key differences exist. In this review, we aim to highlight how UTUC differs from bladder-UC and report on the utility of molecular markers in the diagnosis and management of UTUC.

Materials and methods

A systematic literature search was conducted using the Medline and Embase databases and specific keyword combinations: ‘urothelial carcinoma’, ‘bladder cancer’, ‘transitional cell carcinoma’, ‘upper tract’, ‘upper urinary tract’, ‘genetics’, ‘prognosis’ and ‘biomarkers’.

Results

UTUC has specific acquired (e.g. Balkans nephropathy, phenacetin abuse) and genetic hereditary non-polyposis colorectal cancer risk factors compared with bladder-UC. In general, the molecular biology of UC is broadly similar, irrespective of location in the urinary tract. However, there are distinct genetic (microsatellite instability) and epigenetic (hypermethylation) differences between some UTUC and bladder-UC. Clinical-pathological variables (e.g. hydronephrosis, tumour architecture, tumour location, stage and grade) have independent predictive power in UTUC, but tissue and urinary biomarkers can improve the clinical prediction of recurrence, invasion and survival in UTUC, though the evidence level is weak.

Conclusions

UTUC shares many similarities with bladder-UC, but there is strong evidence that they should be considered as distinct urothelial entities. Prospective multi-institutional studies investigating molecular markers are urgently needed to augment clinic-pathological predictors in UTUC.     

Incidence and risk factors for preincision hypotension in a noncardiac pediatric surgical population

Background: Routine monitoring of blood pressure is an essential part of perioperative care in adults and children. It is however not known whether intraoperative hypotension (IOH) is clinically important in the ‘healthy’ pediatric patient. This may be partly due to the lack of data on the incidence and consequences of IOH in this group of patients. We utilized the Brain Trauma Foundation definition of hypotension to describe the incidence of preincision hypotension (PIH) in a large pediatric noncardiac surgical population and identified risk factors for the occurrence PIH. Methods: We examined the electronic perioperative records of all children aged 1–17 years undergoing general anesthesia for noncardiac surgeries between January 2005 and June 2007 in our institution. Frequency and factors associated with PIH were computed. Binary logistic regression with forward step‐wise algorithm was used to examine factors associated with PIH. Results: There were 22 263 children of whom 57.6% were males. Most (94.9%) cases were elective, American Society of Anesthesiologists (ASA) I–II (79.5%) procedures. Inhalational induction was predominantly used in this cohort (67%) although 33% of patients had propofol either as a sole induction agent or as part of a ‘co‐induction’ regime. Single or multiple episodes of PIH occurred in 35.8% of patients. PIH was more common in patients with ASA ≥ III (P < 0.001); those with preoperative hypotension (P < 0.001); and following intravenous induction (P < 0.001) as well as propofol co‐induction (P < 0.001). On multivariate analysis the following were significant predictors of PIH: baseline hypotension, propofol co‐induction, age, ASA ≥ III, and long preincision period. Conclusion: Preincision hypotension is common in the pediatric surgical population undergoing general anesthesia. Factors independently predictive of PIH included high ASA status, pre‐existing hypotension, propofol co‐induction prolonged preincision period and adolescent age group. The importance of blood pressure monitoring, prompt recognition of hypotension and use of appropriate intervention is emphasized.     

After radical retropubic prostatectomy 'insignificant' prostate cancer has a risk of progression similar to low-risk 'significant' cancer

OBJECTIVE

To assess progression and survival among patients with small‐volume, well‐differentiated, organ‐confined prostate cancer found at radical retropubic prostatectomy (RRP), often defined as being ‘insignificant’, thus testing whether they are indeed ‘insignificant’.

PATIENTS AND METHODS

We identified 6496 men treated for prostate cancer by RRP between 1990 and 1999, and defined ‘insignificant’ tumours as those in men having a prostate‐specific antigen (PSA) level of <10 ng/mL before RRP, a cancer volume of ≤0.5 mL, a specimen Gleason of score ≤6 and stage ≤pT2. Survival was assessed using the Kaplan‐Meier method and compared using the two‐sided log‐rank test.

RESULTS

‘Insignificant’ tumours were found in 354 (5.5%) men, of whom only one had metastatic progression and none died from prostate cancer, with a median (range) follow‐up of 9.2 (0.8–15.6) years. Biochemical progression‐free survival (87% vs 85%, respectively, at 10 years, P = 0.5), systemic progression‐free survival (100% vs 99%, P = 0.3), overall survival (91% vs 88%, P = 0.16) and cancer‐specific survival (100% in each group, P = 0.32) were each similar among men with ‘insignificant’ prostate cancer and men with low‐risk (defined by Gleason score, preoperative PSA level, seminal vesicle and surgical margin status) ‘significant’ cancer. Clinical stage, biopsy Gleason score and preoperative PSA doubling time were multivariably predictive of ‘insignificant’ tumours at RRP.

CONCLUSIONS

‘Insignificant’ prostate cancer at RRP is associated with a comparable risk of biochemical progression as low‐risk ‘significant’ cancer. Although clinical predictors for ‘insignificant’ pathology can be identified, it remains to be established whether such patients can be safely managed conservatively.     

Initial management of prostate cancer: first year experience with the Norwegian National Prostate Cancer Registry

Study Type – Therapy (individual cohort)
Level of Evidence 2b

OBJECTIVE

Improving a country’s management of cancer patients requires continuous evaluation, and requires the availability of population‐based prognostic and therapeutic variables. We aimed to document the national diagnostic and therapeutic tasks in Norwegian patients with prostate cancer diagnosed in 2004, with the 2003 European Association of Urology (EAU) guidelines representing the background.

PATIENTS AND METHODS

The Norwegian Prostate Cancer Registry (NoPCR) was established in 2004, and data collected during this first year were reviewed. The Tumour‐Node‐Metastasis group, prostate‐specific antigen (PSA) level and Gleason score were recorded as basic diagnostic variables, with the initial treatment. Patients with nonmetastatic T1‐T3 tumours were separated from those with advanced disease (T4 and/or N+ and/or M+). Patients with T1‐T3 tumours, aged ≤75 years, and in good health were candidates for curative local treatment (‘CurCands’) and were allocated to risk groups.

RESULTS

The compliance rate to the NoPCR was 96%; 2693 (72%) of 3744 eligible patients had T1‐T3 tumours and 833 (22%) had advanced disease (not classifiable in 218, 6%). Of 1650 CurCands (low‐risk 500; intermediate‐risk 453; high‐risk 697), 62% had radical prostatectomy or radiotherapy with or without hormone therapy, with the remaining 23% and 10% managed by, respectively, hormone therapy only or observation (other/unknown treatment, 6%).Only 64% of CurCands in the combined intermediate/high‐risk group had local treatment. In the low‐risk group local treatment was used in 57% of the patients, mainly in men with T2 tumours. In intermediate‐ and high‐risk CurCands, PSA was the strongest factor determining the performance of curative treatment. Adjuvant radiotherapy after radical prostatectomy was used in four of 142 patients with tumour‐involved margins.

CONCLUSION

In 2004 the initial management of prostate cancer in Norway was largely in accordance with the 2003 EAU guidelines, though there was some evidence of ‘over‐treatment’ of low‐risk patients and ‘under‐treatment’ of intermediate‐ and high‐risk patients. Some improvement of data collection by the NoPCR is warranted. National prostate cancer registries can contribute to improving the medical care of these patients.     

Identifying relationships between symptom clusters and quality of life in adults with chronic mixed venous and arterial leg ulcers

The objective of this study was to identify symptom clusters and their effect on quality of life (QOL) of adults with chronic leg ulcers of mixed venous and arterial aetiology. A secondary analysis of data from four existing prospective longitudinal studies conducted by a wound healing research group in Australia was undertaken. A total of 110 patients who met the inclusion criteria were selected for this study. Exploratory factor analysis (EFA) was used to identify symptom clusters and correlational analyses to examine relationships between the identified symptom clusters and QOL. The EFA identified two distinct symptom clusters: a ‘systemic symptom cluster’ consisting of pain, fatigue and depressive symptoms; and a ‘localised‐leg symptom cluster’ including pain, fatigue, oedema, lower limb inflammation and exudate. Physical QOL correlated significantly with the systemic symptom cluster (r = ?0·055, P < 0·0001) and the localised‐leg symptom cluster (r = ?0·054, P < 0·0001), whereas mental QOL was associated only with the systemic symptom cluster (r = ?0·038, P = 0·01). The results suggest that appropriate intervention strategies targeting specific symptom clusters should be developed. Targeting patients with symptom clusters is particularly important because they are at high risk and the most vulnerable for reduced QOL.     

Expanding the Criteria of Organ Procurement from Donors with Prostate Cancer: The Application of the New Italian Guidelines

Prostate cancer (CaP) represents the most prevalent malignancy in men more than 60‐year‐old, posing a problem in organ procurement from elderly subjects. However, most of the currently diagnosed CaP are low‐grade and intraprostatic, with low metastatic risk, and there is recent evidence that most patients are overdiagnosed. The Italian National guidelines about organ acceptance from neoplastic donors changed in March 2005, extending the pool of potential candidates with CaP and introducing the function of a second opinion expert. Between 2001 and February 2005, 40 candidate donors with total PSA≥10 and/or positive digital rectal examination underwent histopathological analysis of the prostate: 15 (37.5%) donors harboured CaP, and 25 (62%) were judged at ‘standard risk’. After the introduction of the new guidelines in 2005, the second opinion expert judged at ‘standard risk’ 48 of 65 donors, while 17 of 65 needed histopathological analysis. Four (6.2%) donors harboured CaP, and 61 (94%) where judged at ‘standard risk’, with a significant increase of donated and actually transplanted organs. The application of the new guidelines and the introduction of a second opinion expert allowed a significant extension of the ‘standard risk’ category also to CaP patients, decreasing the histopathological examinations and expanding the donor pool.     

Effects of Caffeine and Stress on Biomarkers of Cardiovascular Disease in Healthy Men and Women with a Family History of Hypertension

The connection between caffeine and its potentially detrimental effects on blood markers of cardiovascular disease (CVD) are controversial. Most studies have focused on cholesterol as a putative mediator of the caffeine–CVD relationship. Other blood markers such as C‐reactive protein (CRP) and fibrinogen have been understudied. We examined the effects of caffeine and psychological stress on these CVD markers in healthy, young men and women with a confirmed family history of hypertension. A total of 52 normotensive, healthy adults (26 men and 26 women) aged 18–29 years (21.4 ± 0.3) participated in a laboratory session to examine stress reactivity following caffeine consumption. All participants had normal cholesterol levels. Blood pressure (BP), heart rate, serum cortisol and CRP and plasma fibrinogen were collected. Men and women administered caffeine displayed an additional increase in systolic BP and cortisol response to the stressor (p < 0.05). Stress interacted with caffeine and sex to alter cortisol, fibrinogen and systolic BP but not CRP levels. These results may shed light on sex‐specific pathways that associate caffeine with CVD. Copyright © 2013 John Wiley & Sons, Ltd.