ABSTRACT
OBJECTIVE: To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1year after RP. MATERIALS AND METHODS: Prostate cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB, and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures. RESULTS: 664/2989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve-sparing surgery (all P < .01). Cumulative incidence of SUI procedures was 1.4% at 10years after RP. Age (HR 2.68 per 10years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures. UF declined at 1year after RP, while UB and PF remained stable. UF, UB, and PF were inversely associated with number of ppd (all P < .01). Change in work status was not associated with incontinence or QoL scores. CONCLUSION: Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on QoL.
Subject(s)
Gene Expression Regulation/genetics , Pyoderma Gangrenosum/genetics , Adaptive Immunity/genetics , Adaptive Immunity/immunology , Area Under Curve , Gene Expression Regulation/immunology , Humans , Immunity, Innate/genetics , Pyoderma Gangrenosum/immunology , Signal Transduction/genetics , Signal Transduction/immunology , Skin/immunology , Up-Regulation/geneticsABSTRACT
DNA polymerase beta (pol beta) is a 39-kDa protein that functions in DNA repair processes in mammalian cells. As a first step toward understanding mechanisms of polymerase fidelity, we developed a genetic method to identify mammalian pol beta mutator mutants. This screen takes advantage of a microbial genetics assay and the ability of rat pol beta to substitute for Escherichia coli DNA polymerase I in DNA replication in vivo. Using this screen, we identified 13 candidate pol beta mutator mutants. Three of the candidate mutator mutants were further characterized in vivo and shown to confer an increased spontaneous mutation frequency over that of wild-type pol beta to our bacterial strain. Purification and subsequent analysis of one of our putative mutator proteins, the pol beta-14 protein, showed that it possesses intrinsic mutator activity in four different assays that measure the fidelity of DNA synthesis. Therefore, residue 265, which is altered in pol beta-14 and another of our mutant proteins, pol beta-166, is probably critical for accurate DNA synthesis by pol beta. Thus, our genetic method of screening for pol beta mutator mutants is useful in identifying active mammalian DNA polymerase mutants that encode enzymes that catalyze DNA synthesis with altered fidelity compared with the wild-type pol beta enzyme.
Subject(s)
DNA Polymerase I/genetics , DNA Replication/genetics , Genetic Complementation Test , Mutagenesis/genetics , Selection, Genetic , Animals , Escherichia coli/genetics , Phenotype , Rats , Recombinant Proteins , Tyrosine/geneticsABSTRACT
Military medical treatment facilities (MTFs) throughout the nation have felt the impact of the dramatic transition from traditional fee-for-service health insurance coverage to managed care programs. Some facilities have had to struggle to survive. Yet one facility, the Naval Medical Center-San Diego, San Diego, California, nearly doubled its revenue collections in spite of a reduction in billable claims, reduced staff, and a substantial increase in non-billable policies.
Subject(s)
Employee Incentive Plans , Hospitals, Military/economics , Patient Credit and Collection/methods , California , Communication , Income , Inservice TrainingABSTRACT
In attempting to isolate the various components involved in the stimulus induced by partial hepatectomy, the effect of sudden increased portal flow to the whole liver has been studied. The technique involved the construction of a portacaval anastomosis and after a week, reconstitution of the original portal vein, allowing resumption of portal blood flow. The effects of increased portal flow in this experiment were to induce hypertrophy of hepatocytes and a minor degree of DNA synthesis.
