Association between duration of gonadotrophin-releasing hormone agonist use and cardiovascular risks: A population-based competing-risk analysis.

BACKGROUND: Although androgen deprivation therapy has known cardiovascular risks, it is unclear if its duration is related to cardiovascular risks. This study thus aimed to investigate the associations between gonadotrophin-releasing hormone (GnRH) agonist use duration and cardiovascular risks. METHODS: This retrospective cohort study included adult patients with prostate cancer receiving GnRH agonists in Hong Kong during 1999-2021. Patients who switched to GnRH antagonists, underwent bilateral orchidectomy, had <6 months of GnRH agonist, prior myocardial infarction (MI), or prior stroke was excluded. All patients were followed up until September 2021 for a composite endpoint of MI and stroke. Multivariable competing-risk regression using the Fine-Gray subdistribution model was used, with mortality from any cause as the competing event. RESULTS: In total, 4038 patients were analyzed (median age 74.9 years old, interquartile range (IQR) 68.7-80.8 years old). Over a median follow-up of 4.1 years (IQR 2.1-7.5 years), longer GnRH agonists use was associated with higher risk of the endpoint (sub-hazard ratio per year 1.04 [1.01-1.06], p = 0.001), with those using GnRH agonists for ≥2 years having an estimated 23% increase in the sub-hazard of the endpoint (sub-hazard ratio 1.23 [1.04-1.46], p = 0.017). CONCLUSION: Longer GnRH agonist use may be associated with greater cardiovascular risks.

Saliva flow rates and clinical characteristics of patients with burning mouth syndrome: A case-control study.

Burning mouth syndrome (BMS) is a chronic pain condition that most commonly affects postmenopausal women older than 50 years of age. Xerostomia is a common complaint among BMS patients. However, previous studies showed inconsistent findings regarding saliva flow rate reduction. This study examined saliva flow rates, degree of mucosal hydration, xerostomia, and clinical characteristics in BMS patients compared with healthy controls. Unstimulated whole saliva (USWS) was collected through passive drooling; residual mucosal saliva (RMS) was collected using filter paper strips. Stimulated whole saliva (SWS) was collected while chewing on gum base. Oral exam and self-report data were collected. A total of 50 women (22 BMS cases and 28 healthy controls) aged 50 years or older were included in the analysis of this study. Mean age was 62 years for cases and 56 years for controls (P=0.05). Compared with controls, cases had significantly lower USWS flow rates (P<0.001) and had a higher prevalence of xerostomia (P=0.001), gastrointestinal disease (P<0.001), and vaginal dryness (P=0.01). These data show that oral and vaginal dryness are common among BMS patients. Further studies are needed to investigate potential pathophysiological mechanisms related to the quality of saliva and mucosal barrier status among these patients.

Effect of the aromatic substituent on the para-position of pyridine-bis(oxazoline) sensitizers on the emission efficiency of their EuIII and TbIII complexes.

Two efficient lanthanide ion sensitizers 2,6-bis(oxazoline)-4-phenyl-pyridine (PyboxPh, 1) and 2,6-bis(oxazoline)-4-thiophen-2-yl-pyridine (Pybox2Th, 2) were synthesized. 1 crystallizes in the monoclinic space group P21/c with cell parameters a = 16.3794(4) Å, b = 7.2856(2) Å, c = 11.7073(3) Å, ß = 97.229(1)° and V = 1385.97(6) Å3. 2 crystallizes in the monoclinic space group P21/n with cell parameters a = 5.9472(2), b = 16.0747(6), c = 14.3716(5) Å, ß = 93.503(1)° and V = 1371.35(8) Å3. Photophysical characterization of 1 shows that its triplet state energy is located at 22 250 cm-1 and efficient energy transfer is observed for EuIII and TbIII. Solutions of [Ln(PyboxPh)3]3+ in dichloromethane display an emission efficiency of 37.2% for Ln[double bond, length as m-dash]Eu and 24.0% for Ln[double bond, length as m-dash]Tb. The excited state lifetimes for EuIII and TbIII are 2.227 ms and 723 µs, respectively. The triplet state energy of 2 is located at 19 280 cm-1 and is therefore too low to efficiently sensitize TbIII emission. However, the sensitization of EuIII is effective, with an emission quantum yield of 14.5% and an excited state lifetime of 714 µs. This shows that the derivatization of the chelator is strongly influenced by the aromatic substituents on the para-position of the pyridine ring. New isostructural 1 : 1 complexes of PyboxPh with EuIII (3) and TbIII (4) were also isolated and crystallize in the triclinic space group P1[combining macron] with cell parameters a = 9.1845(2) Å, b = 10.3327(2) Å, c = 11.9654(2) Å, α = 98.419(1)°, ß = 108.109(1)°, γ = 91.791(1)°, V = 1064.08(4) Å3 and a = 7.8052(1) Å, b = 11.8910(1) Å, c = 14.2668(2) Å, α = 72.557(1)°, ß = 86.355(1)°, γ = 77.223(1)°, V = 1231.95(3) Å3, respectively.

A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta.

OBJECTIVE: The purpose of this study was to compare clinical outcomes between open repair and thoracic endovascular aortic repair (TEVAR) in traumatic ruptured thoracic aorta. METHODS: A comprehensive search was undertaken of the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair. Databases were evaluated to July 2018. Odds ratios (ORs), weighted mean differences, or standardized mean differences and their 95% confidence intervals (CIs) were analyzed. The primary outcomes were stroke, paraplegia, and 30-day mortality rates; secondary outcomes were requirement for reintervention and 1-year and five-year mortality rates. RESULTS: A total of 1968 patients were analyzed in 21 articles. TEVAR was performed in 29% (n = 578) and open repair in 71% (n = 1390). TEVAR and open repair did not differ in the mean age of patients (42.1 ± 14 years vs 44.1 ± 14 years; P = .48). There was no difference in duration of intensive care and total hospital stay between TEVAR and open repair groups (12.7 ± 11.1 days vs 12.6 ± 8 days [P = .35] and 27.5 ± 14.6 days vs 25.9 ± 11 days [P = .80], respectively). Similarly, no statistically significant difference in postoperative paraplegia or stroke rate was noted between TEVAR and open repair (1.4% vs 2.3% [OR, 1.27; 95% CI, 0.59-2.70; P = .54] and 1% vs 0.5% [OR, 0.63; 95% CI, 0.18-2.18; P = .46]). Lower 30-day and 1-year mortality was noted in TEVAR (7.9% vs 20% [OR, 2.94; 95% CI, 1.92-4.49; P < .00001] and 8.7% vs 17% [OR, 2.11; 95% CI, 0.99-4.52; P = .05]). There was no difference in 5-year mortality (23% vs 17%; OR, 0.07; 95% CI, -0.07 to 0.20; P = .33). However, there was a higher rate of reintervention at 1 year in the endovascular group (0% vs 6%; OR, 0.17; 95% CI, 0.03-0.96; P = .04). CONCLUSIONS: TEVAR carries lower in-hospital mortality and provides satisfactory perioperative outcomes compared with open repair in traumatic ruptured thoracic aorta. It also provides a favorable 1-year survival at the expense of higher reintervention rates.

Minimally Invasive Versus Conventional Aortic Root Replacement - A Systematic Review and Meta-Analysis.

BACKGROUND: Mini-sternotomy has been proven superior to full sternotomy in aortic valve replacement by providing better perioperative outcomes. We investigated whether such technique provides better outcomes in patients undergoing aortic root surgery. METHODS: A comprehensive electronic literature search was undertaken among the four major databases (PubMed, Ovid, Scopus and EMBASE) to identify all published studies up to June 2018. The search terms used related to mini-sternotomy versus full sternotomy, aortic root, valve sparing, Bentall procedure. Only articles that compared mini against full sternotomy were considered in this analysis. After excluding articles based on title or abstract, the full text articles selected had reference lists searched for any potential further articles to be included in this review. RESULTS: A total of 2,765 patients were analysed from across eight comparative studies that were included in the quantitative analysis of the parameters of interest that fulfilled the criteria for meta-analysis. Mini-sternotomy aortic root replacement was associated with significantly shorter cardiopulmonary bypass time (p=0.009), lower rate of blood transfusion (p=0.01). additionally, they had lower operative mortality (p=0.02), and shorter stay at intensive care and at hospital (p=0.0009, p=0.03 respectively). However, there was no difference between mini-sternotomy and conventional aortic root replacement in terms of aortic cross-clamp time (p=0.28), total operation time (p=0.31), re-exploration rate for bleeding (p=0.28), stroke rate (p=0.90), wound infection rate (p=0.96), and length of mechanical ventilation (p=0.10). CONCLUSION: Mini-sternotomy is a safe, feasible alternative option to full sternotomy in aortic root repair. However, the significant heterogeneity in data points to the need for a larger, well-designed trial to support the currently limited literature evidences.

Ligand Design for Luminescent Lanthanide-Containing Metallopolymers.

The isolation of emissive materials with lanthanide ions is a topic of interest for imaging, display, and sensing applications, and it requires tuning of the electronics of the systems, such that, during the process of sensitization of the metal-centered luminescence, energy transfer from the sensitizer to the lanthanide ion is efficient and the resulting materials have the characteristics required for a given application. We discuss here our group's work in controlling the singlet- and triplet-state energies of sensitizing ligands through the choice of functional groups on the pyridine rings chelating to the lanthanide ions and show how we achieved progressively higher emission efficiencies. We describe targeted functionalization that led to highly emissive systems in solution and in the solid state and to new metallopolymers with norbornene or dicyclopentadiene-based backbones and pyridinebis(oxazoline) pendants, which display red EuIII-based, green TbIII-based, and, for the first time, blue TmIII-based emission.

Targeting health visitor care: lessons from Starting Well.

BACKGROUND: UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. DESIGN: A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. SETTING: Starting Well project, Glasgow, UK. PREDICTORS: Health visitor rating of family needs. MAIN OUTCOME MEASURES: Families receiving high visiting rates or referred to social work services. RESULTS: Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. CONCLUSIONS: Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.

Growth rate of hepatocellular carcinoma: evaluation with serial computed tomography or magnetic resonance imaging.

OBJECTIVE: To evaluate the growth rate of untreated hepatocellular carcinoma (HCC) by calculating tumor volume doubling time (TVDT) on serial computed tomography (CT) or magnetic resonance imaging (MRI) and to predict TVDT based on initial tumor size. METHODS: Sixteen untreated HCCs in 11 patients with cirrhosis who underwent serial CT or MRI at our institution were retrospectively identified. Two independent readers recorded bidimensional measurements for all tumors, which were used to determine tumor volume (TV). Growth rate was expressed as TVDT. A mathematic model was used to predict TVDT based on baseline tumor size. RESULTS: Mean baseline and follow-up TVs were 10.5 cm3 (range: 0.7-243.6 cm3) and 22.0 cm3 (range: 2.5-870.8 cm3), respectively. Mean duration of follow-up was 176 days (range: 76-472 days). Mean TVDT was 127 days (95% confidence interval: 80, 203; range: 17.5-541.4 days). Expected TVDT could be expressed as TVDT = 114 x (baseline volume)0.14 (P < 0.002). CONCLUSION: The results of this study suggest a preferred interval follow-up of approximately 4.5 months (127 days) for HCC screening. Small HCCs show a tendency toward faster growth and may require shorter follow-up to demonstrate progression.

Severe acute respiratory syndrome: management and reconfiguration of a radiology department in an infectious disease situation.

Severe acute respiratory syndrome, or SARS, is a new infectious disease pandemic with important public health concerns. The high infectivity rate by means of droplet transmission places health care workers at substantial risk of contracting the disease. Radiology departments are particularly affected, since imaging plays a vital role in both diagnosis and follow-up of this disease. The authors outline their experience in infection control and isolation procedures during this outbreak. Barrier precautions, reconfiguration of the department, separation of imaging equipment, cleaning procedures, personal protective equipment, and staff safety are discussed.