A population-based study on incidence trends of kidney and renal pelvis cancers in the United States over 2000-2020.

Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55-69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000-2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70-84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics.

New Ultherapy method: Utilizing novel surgical and anatomical concepts yields outstanding results.

BACKGROUND: Micro-focused ultrasound (MFU) is a technique for skin rejuvenation and lifting, targeting the facial SMAS-a fibrous network encompassing the platysma muscle and parotid fascia. OBJECTIVE: This study aims to propose a novel and cost-effective method (suggested by Fatemi) for Ultherapy, comparing its effectiveness with the conventional approach. MATERIALS AND METHODS: A prospective double-blind clinical trial was conducted with 30 female volunteers randomly assigned to two groups: The control group (conventional method) and the experimental group (new method). Ultherapy procedures utilized MFU technology with low energy and a higher frequency. RESULTS: Statistically significant differences in lifting effects and improvement in skin laxity were observed between the two groups. The new method, with a focus on the parotideal area of the SMAS, demonstrated superior outcomes and higher patient satisfaction. CONCLUSION: The parotideal region's accessibility, increased thickness, and safety profile make it an ideal target for Ultherapy. This not only reduces the risk of nerve injury but also yields effective collagen remodeling and skin-lifting results.

The Association of Thyroid-Stimulating Hormone (TSH) Levels and Lipid Profile in Euthyroid Patients with Familial Hypercholesterolemia.

Previous studies reported a relationship between thyroid-stimulating hormone (TSH) and low-density lipoprotein cholesterol (LDL-C) levels. In this study, we aim to evaluate the impact of TSH levels on lipid profile in patients with familial hypercholesterolemia (FH) and euthyroid state. Patients were selected from the Isfahan FH registry. The Dutch Lipid Clinic Network (DLCN) criteria are used to detect FH. Patients were classified into no FH, possible FH, probable FH, and definite FH groups based on the DLCN scores. Patients with any cause of secondary hyperlipidemia, including hypothyroidism, were excluded from this study. The study group consisted of 103 patients with possible FH, 25 patients with definite FH, and 63 individuals with no FH. The mean TSH and LDL-C levels among participants were 2.10 ± 1.22 mU/l and 142.17 ± 62.56 mg/dl, respectively. No positive or negative correlation was found between serum TSH and total cholesterol (P value = 0.438), high-density lipoprotein cholesterol (P = 0.225), triglycerides (P value = 0.863), and LDL-C (P value = 0.203). We found no correlation between serum TSH levels and lipid profiles in euthyroid patients with FH.

Comparison of Equations for the Calculation of LDL-Cholesterol in Familial Hypercholesterolemia: Data from Iranian Registry.

OBJECTIVE: Low-density lipoprotein cholesterol is the mainstay of diagnosis, treatment, and follow-up of patients with familial hypercholesterolemia, the most prevalent autosomal domi- nant disorder among humans. Since the reference measurement method (ultracentrifugation) is time-consuming and expensive, many formulas emerged to calculate low-density lipopro- tein cholesterol levels and are commonly used in laboratories. METHODS: To compare the performance of 3 low-density lipoprotein cholesterol calcula- tion equations with a direct method (enzymatic photometric assay), the lipid profiles of 1148 patients of the registry of familial hypercholesterolemia in Iran were analyzed retrospec- tively, 270 of which had a possible or definite familial hypercholesterolemia diagnosis according to Dutch criteria. While measured using the direct method, we calculated the low-density lipoprotein cholesterol levels using the Friedewald, Chen, and Anandaraja formulas. RESULTS: Our results showed that all 3 formulas are highly correlated with the direct method, and the Chen formula showed the highest intra-class correlation coefficient among all (0.954 among all patients with hypercholesterolemia and 0.947 among the familial hyper- cholesterolemia population). In addition, the Chen formula was the most sensitive, and the Friedewald formula was the most specific formula using a low-density lipoprotein cholesterol cut-off of 100 in familial hypercholesterolemia patients. CONCLUSION: Our findings encourage applying the Chen formula in addition to the Friedewald formula to make better clinical decisions for familial hypercholesterolemia patients.

Effects of ketamine versus dexmedetomidine maintenance infusion in posterior spinal fusion surgery on acute postoperative pain.

BACKGROUND: One of the most challenging issues after posterior spinal fusion (PSF) surgery is providing appropriate pain control measures to enhance recovery of the patients. We aimed to compare effects of ketamine versus dexmedetomidine infusion during maintenance of anesthesia on acute postoperative pain in PSF surgery. METHODS: In a double-blinded randomized clinical trial, 87 patients candidates for PSF surgery were randomly assigned into three groups. Anesthesia protocol for all groups was the same except: the first group received 0.2 mcg/kg/h dexmedetomidine infusion, the second received 0.1 mg/kg/h ketamine infusion, and control group received normal saline infusion as a placebo. Pain intensity by VAS scale and level of sedation by Ramsey scale were assessed, and amount of opioid prescribed after surgery was measured and compared for patients during the recovery and at 2, 4, 6, 12, and 24 h after surgery in three groups, and hypotension and bradycardia during operation were reported. RESULTS: There was a significant difference among the groups regarding pain intensity and amount of opioids during recovery and at 2, 4, 6, 12, and 24 h after surgery. Pain intensity and amount of opioids for ketamine and dexmedetomidine groups were significantly lower than those in the controls during recovery and at the hours after surgery. There was no significant difference regarding bradycardia and hypotension and level of sedation during recovery and at the hours after surgery. CONCLUSION: Both ketamine and dexmedetomidine infusions during maintenance of anesthesia are effective in reducing acute postoperative pain effectively after PSF surgery.

Small Cell Carcinoma of Bladder; Still A Diagnostic and Therapeutic Challenge: Seven Years of Experience and Follow-up in A Referral Center.

PURPOSE: To report clinical, histopathological, and treatment features of small cell carcinoma of (SmccB) bladder during 7 years in a referral center. METHODS: The clinical, histopathological features, treatment modalities, and outcome of all patients with bladder SmccB treated between 2009 and 2016 who were managed in Hasheminejad Kidney Center (HKC) were retrospectively collected. RESULTS: Thirteen patients were diagnosed and managed with SmccB. The average age of patients was 64.92 years. For each patient, 8 markers were used for IHC staining on average. Neuroendocrine markers such as CD 56, Neuron Specific Enolase, Synaptophysin, and Chromogranin were found in a significant percentage of patients (69%, 38%, 54%, and 31% respectively). Patients were managed with TURBT alone (N=3), chemotherapy after TURBT (N=4), chemotherapy plus radical surgery (N=4) and radical surgery alone (N=2). The best clinical result was seen in chemotherapy received patients with or without radical surgery. The mean(SE) of survival rate in patients who received only chemotherapy alone was 42.4 (10.0) months, while in those who were managed with chemotherapy plus radical surgery it was 47.7 (10.1) months. CONCLUSION: In our center immunohistochemistry was needed for definitive diagnosis in 17/19 samples. Misdiagnosis happened in two samples without IHC request. We think that use of immunohistochemistry should be mandatory for diagnosis of SmccB to exclude misdiagnosis. Chemotherapy is the most important part of treatment and the addition of radical surgery can slightly improve patients' survival.