Nikolajsenanderson9421

Bezoar like a source of jejunal afferent cycle bulk right after pylorus conserving pancreaticoduodedectomy: An incident document.

INTRODUCTION In this article we advance a potential explanation for the incidence of cardiovascular (CV) and cardiometabolic risk in patients undergoing androgen deprivation therapy (ADT) for prostate cancer. Our conceptual model involves the differential impact of gonadotropin-releasing hormone (GnRH) agonists and antagonists on the follicle-stimulating hormone (FSH) system. MATERIALS AND METHODS Authors searched online repositories and meeting abstract databases for relevant materials. RESULTS Mounting evidence links FSH with development and progression of prostate cancer. What is also becoming clear is that the differential effects of GnRH agonists and antagonists on FSH may at least partially explain the differing effects these agents have on CV risk during ADT. While GnRH antagonists immediately suppress FSH, GnRH agonists provoke a transient surge in FSH that may contribute to the higher CV risk observed with these agents. Additionally, recent studies suggest that GnRH antagonists may significantly reduce CV risk compared to GnRH agonists, particularly in men with pre-existing CV disease. CONCLUSIONS Patients with cardiovascular risk factors who require ADT may benefit from the better control of FSH provided by GnRH antagonists. ADT itself appears to heighten CV risk, and data suggest that FSH may at least partly drive this risk by promoting inflammation, atherosclerosis, insulin resistance, adipocyte rearrangement and plaque instability.INTRODUCTION Phyllanthus niruri (P. niruri) is the most commonly listed active ingredient in commercially available herbal therapies for kidney stones, despite limited supporting clinical evidence. We performed a meta-analysis to evaluate its efficacy in reducing stone burden. We used Google Trends to analyze its relative popularity in internet searches relative to conventional stone therapies. MATERIALS AND METHODS A comprehensive literature search for controlled human studies containing data on the effect of P. niruri treatment on stone size and number was performed. Pooled analysis of change in mean stone size and number with P. niruri was performed using a fixed-effects model. Standardized mean difference (SMD) and 95% CI were reported. Google searches in the United States within the 'Health' category, for topics 'Gale of the wind (P. niruri)', 'Extracorporeal shockwave lithotripsy' (ESWL), 'Ureteroscopy' (URS), 'Laser lithotripsy' (URSL) and 'Percutaneous nephrolithotomy' (PCNL), conducted between January 2014 and December 2018, were quantified. Annual median relative search volumes (RSV; 0-100 scale) were compared using the Kruskal-Wallis test. Post-hoc pairwise comparisons were performed using the Dunn test with Holm-Sidak adjustment. RESULTS Two studies met inclusion criteria. P. niruri treatment resulted in significant decreases in mean stone size (SMD -0.39 cm, 95% CI = -0.68 to -0.09, p = 0.01) and number (SMD -0.38, 95% CI = -0.68 to -0.09, p = 0.01). Selleckchem Cyclopamine Median RSV for P. niruri was similar to that for ESWL, PCNL and URS through 2015, but was significantly higher than for ESWL and PCNL after 2015, and higher than for URS after 2016 (each p value p ≤ 0.0012). CONCLUSIONS Limited clinical evidence supports modest efficacy of P. niruri in reducing stone burden, pending further study. Public interest in P. niruri is growing within the United States, possibly reflecting a rising demand.INTRODUCTION In addition to survival endpoints, we explored the impact of Charlson Comorbidity-Index (CCI) on the acute and late toxicities in men with localized prostate cancer who received dose-escalated definitive radiotherapy (RT). MATERIALS AND METHODS CCI scores at diagnosis and survival outcomes were identified for men with intermediate/high-risk prostate cancer treated with RT (1/2007-12/2012). Study-cohort was accordingly grouped into no, mild and severe comorbidity (CCI-0, 1 or 2+). CCI-groups were compared for demographics, prognostic-factors; and RT-related toxicities based on RTOG/CTCAE criteria. Kaplan-Meier curves and Uni/multivariate (MVA) analyses were used to examine the influence of CCI-group on overall (OS), disease-specific (DSS) and biochemical-relapse free (BRFS) survival. RESULTS We included 257 patients with median age 73 years (48-85), 53% African-American and 67% had intermediate-risk. Median prostate RT-dose was 76 Gy; and 47% received androgen-deprivation therapy. Selleckchem Cyclopamine CCI-0,1,2+ groups encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively and were well-balanced. Ten and 15-years OS were significantly different (76% versus 46% versus 55% for 10-years OS and 53% versus 31% versus 14% for 15-years OS for CCI-0 versus CCI-1[HR2.25; CI[1.31-3.87]] versus CCI-2+[HR2.73; CI[1.73-4.31]]; p 0.05). CONCLUSIONS Higher CCI is a significant predictor for late RT-related side-effects and shorter OS in men with localized prostate cancer. Baseline comorbidities should be considered during initial counseling and follow up visits.INTRODUCTION To report 2-year safety and effectiveness of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume 80-150 cc prostates. MATERIALS AND METHODS Between September-December 2017, 101 men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent an ultrasound-guided robotically executed Aquablation procedure in a prospective multicenter international clinical trial (WATER II). Baseline, procedural and follow up parameters were recorded at baseline and scheduled postoperative visits. Herein we report 2-year safety and efficacy for this cohort. RESULTS Mean prostate volume was 107 cc (range 80-150 cc). Mean IPSS improved from 23.2 at baseline to 5.8 at 2 years (17-point improvement, p less then .0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 2 years (p less then .0001). Maximum urinary flow increased from 8.7 to 18.2 cc/sec. Two subjects underwent a repeat procedure for BPH symptoms over the 2-year follow up period. By 2 years or study exit, all but 2 of 74 subjects stopped taking alpha blockers. Similarly, all but 4 of 32 subjects stopped taking 5α-reductase inhibitors. CONCLUSIONS Two-year prospective multicenter follow up demonstrated that the Aquablation procedure is safe and effective in the treatment of men with LUTS due to BPH and prostates 80-150 cc with durable treatment efficacy, acceptable safety profile and a low retreatment rate. ClinicalTrials.gov number, NCT03123250.