Background Population Research Articles

WS01.04 Longtime follow-up on exercise capacity and quality of life in people with cystic fibrosis receiving elexacaftor/tezacaftor/iIvacaftor – a Copenhagen cohort

Background: People with Cystic Fibrosis (CF) have decreased exercise capacity and quality of life (HRQoL) compared to the background population. Since 2020 third generation CF transmembrane conductance regulator modulator, elexacaftor, tezacaftor, ivacaftor (ETI) was approved for people with CF from the age of 12 in Denmark. The results of the treatment over short time, show among other increased lungfunction, HRQoL and BMI. The longterm effect regarding the new treatment is to date not fully evaluated especially not regarding exercise capacity.

The risk of myocardial infarction and heart failure in colon cancer in the United States: A population-based national study.

e15517 Background: Colon cancer ranks third in cancer mortality and estimated new cases in the United States. Along with the improved treatment and increased participation in screening, there are more than 1.5 million survivors. Venous thromboembolism (VTE) is associated with cancers due to various mechanisms that are common with arterial thromboembolism. Still, there are limited population-based studies on the risk of myocardial infarction (MI) and heart failure (HF) in colon cancer. Methods: Retrospectively we analyzed data from a nationwide commercial database (Explorys, IBM) from 1999 to October 2022. It gathers records from 26 healthcare systems in 50 states with nearly 80 million patients. We identified adults over 18 years old with colon cancer, MI, and HF. In addition, we obtained data on risk factors, including sex, age over 65 years, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), atrial fibrillation, obesity, and tobacco use. Multivariable logistic regression (MLR) was used to adjust for the variables collected. All tests were two-sided, and a p-value ≤ 0.05 was considered statistically significant—data presented as odds ratio (OR) with a 95% confidence interval (CI). Results: A population of 69,339,860 was included. Colon cancer was diagnosed in 304,650 (0.4%), MI in 1,691,900 (2.4%), and HF in 2,415,450 (3.5%). Males made 45%. The colon cancer group, compared to the background population, had a higher prevalence of patients aged over 65 years (66.8% vs. 30.7%), HTN (61% vs. 21.1%), HLD (50.7% vs. 16.9%), DM (31.4% vs. 8.8%), obesity (20.7% vs. 8.0%), and tobacco use (12.5% vs. 6.6%). MLR of variable studies (Table). Colon cancer was significantly associated with MI and HF. Conclusions: This is the largest population-based study of the risk of MI and HF in colon cancer in the United States. After adjustment for established risk factors that may confound the result, colon cancer was independently associated with a significant increase in the risk of MI and HF. Raising awareness among oncologists and cardio-oncologists' involvement at the time of diagnosis is essential to optimally and aggressively manage modifiable risk factors. Prospective studies are needed. [Table: see text]

The risk of cerebrovascular accidents in colon cancer in the United States: A population-based national study.

e15516 Background: Colon cancer is the 3rd most common cause of cancer death in the United States. However, death rates have been decreasing due to increased uptake of screening and advances in treatment; as a result, there are more than 1.5 million survivors. In addition, cancer as a risk for venous thromboembolism (VTE) is established, and the underlying mechanisms of VTE are shared with arterial thromboembolism. Yet, there is a lack of population-based data to define the risk of cerebrovascular accidents (CVA) in colon cancer. Methods: Retrospectively we analyzed data from a nationwide commercial database (Explorys, IBM) from 1999 to October 2022. It aggregates records from 26 healthcare systems across 50 states with almost 80 million patients. We identified adults over 18 years old with colon cancer and obtained data on risk factors, including sex, age over 65 years, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), atrial fibrillation, obesity, and tobacco use. Multivariable logistic regression was used to adjust for the variables collected. All tests were two-sided, and a p-value ≤ 0.05 was considered statistically significant. Results: A population of 69,339,860 was included. Colon cancer was diagnosed in 304,650 (0.4%) and CVA in 237,290 (0.3%). Males made 45%. The colon cancer group, compared to the background population, had a higher prevalence of patients aged over 65 years (66.8% vs. 30.7%), HTN (61% vs. 21.1%), HLD (50.7% vs. 16.9%), DM (31.4% vs. 8.8%), obesity (20.7% vs. 8.0%), tobacco use (12.5% vs. 6.6%) and CVA (5% vs. 0.3%). Multivariable logistic regression of variable studies (Table). Colon cancer was significantly associated with CVA. Conclusions: Our study included over 69 million adults, making it the most extensive population-based study of the risk of CVA in colon cancer in the United States. After adjustment for most established risk factors that may confound the result, colon cancer was associated with a significantly increased risk of CVA, and it was preceded only by HTN. Colon cancer portrayed more risk than atrial fibrillation. Limitations of population-based studies are several, including inaccuracies and miscoding. Our findings suggest that colon cancer survivors and patients with stable disease on treatment may have their prognosis and quality of life jeopardized by CVA. Prospective studies are needed, and management of modifiable risk factors in collaboration with primary care is paramount. [Table: see text]

Mortality in patients with incident rheumatoid arthritis and depression: a Danish cohort study of 11 071 patients and 55 355 comparators.

In patients with RA, the association between mortality and depression has been investigated only in patients with prevalent RA. In this study, we estimated the mortality risk associated with depression, defined as the first filling of a prescription for antidepressants, in patients with incident RA and background population comparators. From 2008 to 2018, we identified patients with incident RA in the nationwide Danish rheumatologic database, DANBIO. For each patient, we randomly selected five comparators. Participants were not treated with antidepressants or diagnosed with depression 3 years prior to the index date. From other registers we collected data on socioeconomic status, mortality and cause of death using unique personal identifiers. Using Cox models, we calculated hazard rate ratios (HRR) with 95% CI. In depressed patients with RA vs patients without depression, adjusted HRR for all-cause mortality was 5.34 (95% CI 3.02, 9.45) during 0-2 years and 3.15 (95% CI 2.62, 3.79) during the total follow-up period, and highest in patients <55 years with HRR 8.13 (95% CI 3.89, 17.02). In comparators with depression vs comparators without depression, the association with mortality was similar to that in patients with RA. There were no unnatural causes of death among depressed patients with RA. The most frequent natural causes of death were cancer, cardiovascular disease, stroke and pneumonia. In patients with RA, depression was a predictor of death but with a strength similar to that in matched comparators.

25-year trends in first-time hospitalizations for Parkinson's disease and subsequent mortality: A Danish nationwide cohort study

BackgroundIn most countries, incidence and mortality for Parkinson's disease (PD) have not been monitored by surveillance registries, although it could demonstrate the need for primary and tertiary prevention. ObjectiveTo examine 25-year trends in first-time hospitalizations for PD in Denmark and subsequent short and long-term mortality. MethodsIn a nationwide population-based cohort we identified all 34,947 individuals with a first-time hospitalization for PD from 1995 through 2019. We calculated standardized incidence rates of PD and 1-year and 5-year mortality by sex. Mortality rates were compared with a reference cohort randomly selected from the background population matched on sex, age, and index date. ResultsThe annual standardized incidence rate of PD was relatively stable during the study period in both men and women. The incidence of PD was higher in men than in women and with the highest incidence in those aged 70–79 years. One and 5-year mortality risk after first-time hospitalization for PD was similar for men and women, and decreased by around 30% and 20%, respectively, between 1995 and 2019. The matched reference cohort had a similar decline in mortality over time. ConclusionThe rate of first-time hospitalization for PD was relatively stable between 1995 and 2019, whereas subsequent short and long-term mortality declined during the period as in the reference cohort.

Familial predisposition to cardiovascular disease and death in patients with an out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Rigshospitalet Introduction Familial predisposition to cardiovascular disease (CVD) and death among patients with out-of-hospital cardiac arrest (OHCA), is sparsely described in current literature. A higher rate of events in first-degree relatives might imply an increased risk of future cardiac arrest and could provide vital improvements in prevention of sudden cardiac death. Therefore, investigation of CVD and death in family of OHCA-victims is needed. Purpose Determine familial predisposition to CVD and death in patients with OHCA. Methods This study used the nationwide Danish Cardiac Arrest Registry to identify all patients with OHCA (probands) of presumed cardiac origin from 2001-2014 and &amp;lt;70 years of age at time of OHCA. First-degree relatives were identified using the Danish Family Relations Database. We included probands with at least one identifiable first-degree relative. Date of OHCA was defined as index for first-degree relatives. The probands were stratified in age groups (0-18, 19-29, 30-49, and 50-69 years at OHCA) and CVD and death among first-degree relatives was assessed in each group. CVD was defined as diagnosis with any ICD-10 I00-I51 code (hypertension (I10-I14) excluded) and CVD-death defined as death with CVD being the main cause. Probands were matched with a background population (1:4) on age and sex. First-degree relatives of the background population were identified and stratified similarly to those of probands. Rates of familial predisposition to CVD and death in probands was compared to the background population. Results We identified 5,443 probands (75% male, median age 51 years) with 16,260 first-degree relatives; 10,207 parents (48.2% fathers, median age 71 years) and 6,053 full siblings (52.7% brothers, median age 47.2 years). Parents to probands had a higher rate of CVD (27.5% vs. 21.9%), a higher mortality rate (51.4% vs. 38.4%) and death more often caused by CVD (39.9% vs. 34.1%) compared to parents of the background population (p&amp;lt;0.001 for all). Stratified by age groups, probands in groups 19-29, 30-49 and 50-69 all had a higher rate of mortality among their parents compared to corresponding groups in the background population (bar diagram in fig.1). Siblings to probands also had a higher rate of CVD (4.9% vs. 2.9%, p&amp;lt;0.001), a higher rate of mortality (3.5% vs. 2.0%, p&amp;lt;0.001), and death more often caused by CVD (16.9% vs. 12.4%, p=0.19) compared to siblings of the background population. Stratified by age group, probands in groups 30-49 and 50-69 both had a higher mortality rate among their siblings compared to corresponding groups in the background population (bar diagram in fig.2). Conclusion Familial predisposition to both cardiovascular disease and death is more prevalent in patients with an out-of-hospital cardiac arrest compared to the background population. These results indicate that, cardiovascular disease and death of first-degree relatives is important risk factors for sudden cardiac arrest in the family.

Left atrial dyssynchrony in veteran athletes with paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): A Ph.D. grant from the DAM Foundation and a grant from the Raagholt foundation. Background Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Increased left atrial (LA) size is associated with AF in the general population. LA dilation in athletes is viewed mainly as a physiological response to exercise, and functional atrial parameters may help distinguish pathological from physiological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony. It is yet to be evaluated whether LA MD could be a marker of pathological remodeling in veteran athletes. Purpose To describe LA MD measured by speckle tracking echocardiography in male veteran athletes who had regularly participated in the 54 kilometer cross-country (XC) ski race Birkebeinerrennet in Norway with and without AF, and men with and without AF from a background population. Methods In total, 295 men, veteran XC skiers with (n=57) and without (n=88) paroxysmal AF, and men from a non-athletic population with paroxysmal AF (n=62) and without AF (n=88) were examined with echocardiography while in sinus rhythm. LA MD was defined as the standard deviation of time to peak strain (SD-TPS) including all accepted atrial segments, and stated both in milliseconds, and corrected by the cycle length ((SD-TPS(ms)/Cycle length(ms))x100)). The average of three consecutive loops was computed. A two-way between-groups analysis of variance was performed to explore the main effects of AF status, athletic status, and the interaction between AF status and athletic status in LA echocardiographic parameters. Results XC skiers (mean age 70.9±5.7 years) reported an average of 40-50 years of regular endurance exercise and had completed an average of 17 annual Birkebeiner races. LA volumes were associated with both AF and athletic status. LA MD in milliseconds was associated with AF, but not associated with athletic status. Conclusion LA MD was associated with paroxysmal AF both in veteran endurance athletes and non-athletes, and less affected by athletic status than atrial volumes. This implies that LA MD could be a useful marker when trying to distinguish physiological from pathological atrial remodeling in endurance athletes.

The experience of living with malignant meningioma.

Meningiomas are the most common, primary intracranial tumor and most are benign. Little is known of the rare patient group living with a malignant meningioma, comprising 1-3% of all meningiomas. Our aim was to explore how patients perceived quality of daily life after a malignant meningioma diagnosis. This qualitative explorative study was composed of individual semi-structured interviews. Eligible patients (n=12) were selected based on ability to participate in an interview, from a background population of 23 patients diagnosed with malignant meningioma at Rigshospitalet from 2000 to 2021. We performed an inductive thematic analysis following Braun and Clarke's guidelines. Eight patients were interviewed. The analysis revealed 4 overarching themes: (1) perceived illness and cause of symptoms, (2) identity, roles, and interaction, (3) threat and uncertainty of the future, and (4) belief in authority. The perceived quality of daily life is negatively impacted by the disease. Patients experience a shift in self-concept and close interactions, and some struggle with accepting a new everyday life. Patients have a high risk of discordant prognostic awareness in relation to health-care professionals. We provide a much-needed patient-centered perspective of living with malignant meningioma: quality of life was affected by perception of threat and an uncertainty of the future. Perception of illness and the interpretation of the cause of symptoms varied between subjects, but a common trait was that patients' identity, roles, and interactions were affected. Shared decision-making and a strengthened continuity during follow-up could aid this rare patient group.

Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study

BackgroundStillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium.MethodsStillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment.ResultsOur cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and 13.8‰). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were “certainly” attributable to SARS-CoV-2 infection, 13.0% (3/23) “probably” and 30.4% (7/23) “possibly”. Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise.ConclusionsSARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses.

Cancer in Patients With Familial Adenomatous Polyposis: A Nationwide Danish Cohort Study With Matched Controls

Familial adenomatous polyposis (FAP) is a hereditary disorder that predisposes patients to colorectal cancer (CRC). Prophylactic colectomy has greatly reduced the risk of CRC. However, new associations between FAP and the risk of other cancers have subsequently emerged. In this study, we assessed the risk of specific primary and secondary cancers among patients with FAP compared with matched controls. All known patients with FAP up until April 2021 were identified in the nationwide Danish Polyposis Register and paired with 4 unique controls matched by birth year, sex, and postal code. The risk of overall cancers, specific cancer types, and risk of a second primary cancer was assessed and compared with controls. The analysis included 565 patients with FAP and 1890 controls. The overall risk of cancer was significantly higher for patients with FAP than for controls (hazard ratio [HR], 4.12; 95% confidence interval [CI], 3.28-5.17; P < .001). The increased risk was mainly due to CRC (HR, 4.61; 95% CI, 2.58-8.22; P < .001), pancreatic cancer (HR, 6.45; 95% CI, 2.02-20.64; P= .002), and duodenal/small-bowel cancer (HR, 14.49; 95% CI, 1.76-119.47; P= .013), whereas no significant difference was observed for gastric cancer (HR, 3.29; 95% CI, 0.53-20.23; P= .20). Furthermore, the risk of a second primary cancer was significantly higher for patients with FAP (HR, 1.89; 95% CI, 1.02-3.50; P= .042). Between 1980 and 2020, the risk of cancer among patients with FAP decreased by ∼50%. Despite an absolute reduction in the risk of developing cancer among patients with FAP, the risk remained significantly higher than for the background population due to colorectal, pancreatic, and duodenal/small-bowel cancers.

Genetic and morphological characterization of United States tea (Camellia sinensis): insights into crop history, breeding strategies, and regional adaptability.

Multiple introductions of tea (Camellia sinensis) to the United States since the 1850s have resulted in US tea germplasm that are currently poorly characterized. To resolve questions concerning the relatedness and regional adaptability of US tea germplasm, 32 domestic individuals were evaluated using 10 InDel markers, and compared with a background population of 30 named and registered Chinese varieties of tea. The marker data were analyzed via a neighbor-joining cladistic tree derived from Nei's genetic distance, STRUCTURE, and Discriminant Analysis of Principal Components, which revealed four genetic groups. Nineteen individuals selected from the four groups were assessed for seven leaf traits, two floral descriptors, and leaf yield, to identify plants best adapted to Florida field conditions. Our analyses compared with available historical records led us to estimate the most likely provenance of some of the US individuals, to precisely identify tea plant material and to choose most diverse accessions for breeding tea improved for adaptability, yield and quality.

Repeated poisonings in Denmark – a nationwide study

Objective Poisonings contribute significantly to morbidity and mortality of patients. Some patients have numerous contacts to a poison information center, indicating repeated poisoning exposures. Information on the involved substances is necessary to explore methods to prevent self-harm and reduce mortality. The objective of this study was to characterize the patient population with repeated poison exposures in Denmark and identify the substances involved. Methods This study was a retrospective cohort study of enquiries to the nationwide Danish Poison Information Centre and the Danish National Patient Registry. The databases were used to identify patients with more than five individual poisoning episodes within a 12-month-period between 1 January 2013, and 31 December 2017. Results One hundred and thirty-seven patients and 995 patients met the inclusion criteria in the Danish Poison Information Centre and the Danish National Patient Registry, respectively. The majority were women (82.5% and 66.3% for the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively). The mean age was 24.7 and 29.5 years. Psychiatric comorbidities were frequent with 74.5% and 67.0% suffering from personality disorders and 70.1% and 54.5% from affective disorders in the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively. One thousand seven hundred and fifty-two poisoning episodes were identified in the Danish Poison Information Centre database, and the most common types of substance were ‘pharmaceuticals’ (1,420 episodes). The most common medications ingested were quetiapine, paracetamol and cyclizine. Median number of contacts to the Danish Poison Information Centre was 10. Patients with one or more poisoning episodes involving cyclizine had on average 11.4 poisoning episodes involving cyclizine. In the Danish National Patient Registry cohort 80.9% were alive after 10 years compared to 97.7% in the background population. Conclusion and Implications Most poisonings were intentional and occurred among younger women. Psychiatric comorbidity was frequent. Most often, pharmaceuticals were the toxic substance, mainly quetiapine, paracetamol and cyclizine. Changing the status of cyclizine from over the counter to prescription only medication, and implementing stricter rules for prescribing quetiapine, could limit future poisoning incidences.

Risk of Adverse Perinatal Outcomes in Hispanic Women With Pregestational Type 1 Diabetes Mellitus [ID: 1379155

INTRODUCTION: Type 1 diabetes mellitus (T1DM) during pregnancy is associated with increased risk of maternal and fetal complications. We aimed to compare the risk of adverse perinatal outcomes in women with pregestational T1DM to those of background population. METHODS: In this historical cohort study, we included Mexican pregnant women who attended from 2016 to 2021 a tertiary-level hospital in Mexico City. Group 1: Pregnant women with T1DM; group 2: pregnant women without diabetes, matched 1:2 by maternal age, pregestational body mass index (BMI), gestational age at admission and parity with women of group 1. Relative risk (RR) with a 95% CI was calculated using logistic regression. We had IRB approval. RESULTS: Group 1, n=203; group 2, n=406; there were no differences in maternal age, pregestational BMI, gestational age, and parity. The mean glycated hemoglobin A1C and gestational age at admission to prenatal care in T1DM women were 8.0±2.0 and 19.1±6.6, respectively. The risk of adverse perinatal outcomes was increased in women with T1DM and were expressed as RR (95% IC); preterm birth, 4.03 (3.0–5.3); preeclampsia, 5.2 (3.3–8.3); cesarean birth, 1.5 (1.3–1.7); miscarriage, 34 (4.5–253); congenital malformations, 8.5 (3.8–19.1); neonatal hypoglycemia, 15 (3.4–64); hyperbilirubinemia, 2.8 (1.6–4.9); respiratory distress syndrome, 8.6 (3.6–20); and large for gestational age, 6.8 (3.7–12.4). CONCLUSION: The risk of adverse perinatal outcomes was increased in Hispanic women with T1DM compared with general population. These adverse outcomes show the critical importance to prioritize education to patients and resources for glucose control to improve outcomes before and during pregnancy.

The incidence and outcomes of high-risk acute coronary syndromes in Western Cape Province, South Africa: A prospective cohort study.

Tygerberg Hospital (TBH) is a tertiary-level hospital in Western Cape Province, South Africa, that provides healthcare to a large low- to middle-income population with services including centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region despite a high burden of communicable diseases, including HIV. To describe the incidence of ST-elevation myocardial infarction (STEMI) and high-risk non-ST-elevation ACS (HR-NSTEACS) in the TBH referral network, describe the in-hospital and 30-day mortality of these patients, and identify important high-risk population characteristics. The Tygerberg Acute Coronary Syndrome Registry database is an ongoing prospective study that enrols all STEMI and HR-NSTEACS patients in the TBH referral network. All patients aged >18 years presenting with STEMI or HR-NSTEACS were treated in accordance with current European Society of Cardiology guidelines and were included prospectively over a 9-month surveillance period. A waiver of consent was granted to include patients who died before giving informed consent. Data collected included a demographic profile, risk factors for cardiovascular disease, in-hospital therapy and 30-day mortality. A total of 586 patients were enrolled, with a male predominance (64.5%) and incidence rates of STEMI and HR-NSTEACS of 14.7 per 100 000 and 15.6 per 100 000, respectively. The mean patient age was 58 years, and STEMI patients tended to be younger than HR-NSTEACS patients (56 v. 58 years; p=0.01). Cardiovascular risk factors were prevalent overall, but hypertension (79.8% v. 68.3%; p<0.01) and pre-existing IHD (29.1% v. 7.0%; p=0.03) were more prevalent in the HR-NSTEACS group. HIV was present in 12.6% of patients tested, similar to the background population rate. The overall 30-day all-cause mortality rate was 6.1%, with an in-hospital mortality rate of 3.9%. The 30-day mortality rates were similar for STEMI (1.8%) and HR-NSTEACS (2.6%) (p=0.75). HIV did not affect mortality rates. Use of a guideline-based approach to treating ACS in a low- to middle-income country setting yields mortality rates comparable to those in high-income countries. However, the lower-than-expected incidence rates of both STEMI and HR-NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and a relatively high proportion of STEMI, suggest potential under-recording of ischaemic heart disease in the region. The rate and outcomes of coronary artery disease (CAD) in people living with HIV were similar to those in people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.

MP44-15 THE VALUE OF PROSTATE-SPECIFIC ANTIGEN DENSITY IN LONG-TERM PROSTATE CANCER-MORTALITY RISK PREDICTION

You have accessJournal of UrologyCME1 Apr 2023MP44-15 THE VALUE OF PROSTATE-SPECIFIC ANTIGEN DENSITY IN LONG-TERM PROSTATE CANCER-MORTALITY RISK PREDICTION Sara Yousef Yacoub, Per-Olof Lundgren, Anders Kjellman, and Ove Gustafsson Sara Yousef YacoubSara Yousef Yacoub More articles by this author , Per-Olof LundgrenPer-Olof Lundgren More articles by this author , Anders KjellmanAnders Kjellman More articles by this author , and Ove GustafssonOve Gustafsson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSA density (PSAD) is used to distinguish elevated serum levels of PSA due to benign prostatic hyperplasia (BPH) from high serum levels caused by malignant disease. Several studies have demonstrated an association between high PSAD and risk for both biochemical recurrences after treatment with curative intent, as well as the risk for upstaging after prostatectomy after an initial strategy of active monitoring. In this study, our objective was to examine whether a baseline metric of PSAD is associated with prostate cancer-specific mortality after thirty years of follow-up. METHODS: In the late nineteen eighties, 2400 men between the ages of 55 and 70 were randomly sampled from a background population of about 27 000 men in the same age group living in a defined part of Stockholm, Sweden. 1779 men accepted the invitation for the study. The sampled cohort was invited to undergo screening for prostate cancer with a PSA test, digital rectal exam, and ultrasound of the prostate. PSAD was calculated for each patient. Outcomes, ie prostate cancer-specific mortality were extracted from the Swedish national cause of death registry. Hazard ratios for cancer-specific deaths were estimated using a Cox proportional hazard regression model. The area under the receiver operating curve (AUC) was determined using conditional logistic regression for men with a baseline PSA of 3.0 or more. RESULTS: PSAD was available for 1748 men. Median PSAD was 0.095 ng/mL/cm3 (IQR 0.073-0.14). The age-adjusted hazard ratio for lethal prostate cancer in the cohort of men with PSA>3.0 ng/mL was 3.5 (95% CI 2.5-4.9) per unit increase in PSAD. 463 men had a PSA of 3.0 ng/mL or more; in this cohort, there were 50 deaths attributed to prostate cancer. All 50 men who died from prostate cancer had a PSAD above the median at baseline. A model including PSAD, palpation, and ultrasound findings could distinguish lethal prostate cancer from non-cases at 30 years of follow-up with an AUC of 0.78. CONCLUSIONS: Several risk stratification models or tools have been evaluated to predict high-grade prostate cancer. If the endpoint of high-grade cancer is substituted with cancer-specific mortality a simple measure of PSA density performs similarly. For men with PSA in the gray area, PSAD predicts the lifelong risk for lethal prostate cancer. Limitations to this study include the lack of clinical data during follow-up, e.g not all nonlethal cancers are indolent which should be acknowledged when interpreting the results. Source of Funding: Grafströms foundation for urological research © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e617 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Yousef Yacoub More articles by this author Per-Olof Lundgren More articles by this author Anders Kjellman More articles by this author Ove Gustafsson More articles by this author Expand All Advertisement PDF downloadLoading ...

Increased risk of depression after Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is a potentially life-threatening disorder, and some patients may develop subsequent depression related to traumatic stress or permanent loss of motor function. We determined the short-term (0 to 2 years) and long-term (>2 years) risk of depression after GBS. Individual-level data from nationwide registries were linked in this population-based cohort study of all first-time hospital-diagnosed GBS patients in Denmark between 2005 and 2016 and individuals from the general population. After exclusion of individuals with previous depression, we computed cumulative rates of depression, defined as either antidepressant drug prescription or depression hospital diagnosis. We used Cox regression analyses to calculate adjusted depression hazard ratios (HRs) after GBS. We identified 853 incident GBS patients and recruited 8639 individuals from the general population. Depression within 2 years was observed in 21.3% (95% confidence interval [CI], 18.2% to 25.0%) of GBS patients and in 3.3% (95% CI, 2.9% to 3.7%) of those in the general population, resulting in a HR of 7.6 (95% CI, 6.2 to 9.3). The highest depression HR was observed within the first 3 months after GBS (HR, 20.5; 95% CI, 13.6 to 30.9). After the first 2 years, GBS patients and the general population members had similar long-term depression risks with an HR of 0.8 (95% CI, 0.6 to 1.2). During the first 2 years after GBS hospital admission, patients with GBS had a 7.6-fold increased hazard of depression compared with individuals in the general population. Two years after GBS, the risk of depression was similar to that of the background population.

Long-Term Cause of Death in Patients Who Underwent Transcatheter Aortic Valve Implantation

As our knowledge on treatment with transcatheter aortic valve implantation (TAVI) increases and more implantations are conducted, we need knowledge on how TAVI affects the end of life. Long-term causes of death remain sparsely described. The aim of the study was to examine differences in the cause of death according to time from TAVI. All patients who underwent TAVI in Denmark from 2008 to 2017 were matched on gender, age, and calendar year with controls from the background population (1:4). Mortality and the proportion of cardiovascular and noncardiovascular death was assessed at 1-year time points during follow-up. A total of 3,434 patients receiving TAVI and 13,672 controls were identified. The median follow-up was 2.67years for patients receiving TAVI and 2.90years for controls. Among patients receiving TAVI, 1,254 deaths (36.5%) were recorded, with 46.7% being from cardiovascular causes. The corresponding numbers for controls were 3,338 deaths (24.4%) and 27.2% being from cardiovascular causes. The proportion of cardiovascular deaths decreased from 53.8% in the first year after TAVI to 32.7% among those who died >7years from TAVI (p=0.008 for trend). For controls, no difference was seen in the proportion of cardiovascular death regardless of follow-up time. In conclusion, with data from nationwide registries, we provide results reassuring that patients with long-term survival from TAVI resemble the general public regarding the cause of death.

Multiple emission components in the Cygnus cocoon detected fromFermi-LAT observations

Context. Star-forming regions may play an important role in the life cycle of Galactic cosmic rays (CRs), notably as home to specific acceleration mechanisms and transport conditions. Gamma-ray observations of Cygnus X have revealed the presence of an excess of hard-spectrum gamma-ray emission, possibly related to a cocoon of freshly accelerated particles.Aims. We seek an improved description of the gamma-ray emission from the cocoon using ~13 yr of observations with theFermi-Large Area Telescope (LAT) and use it to further constrain the processes and objects responsible for the young CR population.Methods. We developed an emission model for a large region of interest, including a description of interstellar emission from the background population of CRs and recent models for other gamma-ray sources in the field. Thus, we performed an improved spectro-morphological characterisation of the residual emission including the cocoon.Results. The best-fit model for the cocoon includes two main emission components: an extended component FCES G78.74+1.56, described by a 2D Gaussian of extensionr68= 4.4° ± 0.1°−0.1°+0.1°and a smooth broken power law spectrum with spectral indices 1.67 ± 0.05−0.01+0.02and 2.12 ± 0.02−0.01+0.00below and above 3.0 ± 0.6−0.2+0.0GeV, respectively; and a central component FCES G80.00+0.50, traced by the distribution of ionised gas within the borders of the photo-dissociation regions and with a power law spectrum of index 2.19 ± 0.03−0.01+0.00that is significantly different from the spectrum of FCES G78.74+1.56. An additional extended emission component FCES G78.83+3.57, located on the edge of the central cavities in Cygnus X and with a spectrum compatible with that of FCES G80.00+0.50, is likely related to the cocoon. For the two brightest components FCES G80.00+0.50 and FCES G78.74+1.56, spectra and radial-azimuthal profiles of the emission can be accounted for in a diffusion-loss framework involving one single population of non-thermal particles with a flat injection spectrum. Particles span the full extent of FCES G78.74+1.56 as a result of diffusion from a central source, and give rise to source FCES G80.00+0.50 by interacting with ionised gas in the innermost region.Conclusions. For this simple diffusion-loss model, viable setups can be very different in terms of energetics, transport conditions, and timescales involved, and both hadronic and leptonic scenarios are possible. The solutions range from long-lasting particle acceleration, possibly in prominent star clusters such as Cyg OB2 and NGC 6910, to a more recent and short-lived release of particles within the last 10–100 kyr, likely from a supernova remnant. The observables extracted from our analysis can be used to perform detailed comparisons with advanced models of particle acceleration and transport in star-forming regions.

The Optical Signatures of Stochastic Processes in Many-Body Exciton Scattering.

We review our recent quantum stochastic model for spectroscopic lineshapes in the presence of a coevolving and nonstationary background population of excitations. Starting from a field theory description for interacting bosonic excitons, we derive a reduced model whereby optical excitons are coupled to an incoherent background via scattering as mediated by their screened Coulomb coupling. The Heisenberg equationsof motion for the optical excitons are then driven by an auxiliary stochastic population variable, which we take to be the solution of an Ornstein-Uhlenbeck process. Here, we present an overview of the theoretical techniques we have developed as applied to predicting coherent nonlinear spectroscopic signals. We show how direct (Coulomb) and exchange coupling to the bath give rise to distinct spectral signatures and discuss mathematical limits on inverting spectral signatures to extract the background density of states. Expected final online publication date for the Annual Review of Physical Chemistry, Volume 74 is April 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Quality of life in patients with hemorrhoidal disease

BackgroundOperation for hemorrhoidal disease is one of the most common operations performed globally. However, we know little about the impact of the disease on health-related quality of life (HRQoL), or the importance of the observed clinical and anatomical changes. MethodThis was a single-center cross-sectional and cohort study. HRQoL was assessed using the Short Form 12 and 36 (SF12 and SF36), EuroQoL 5-dimensions 5-levels (EQ-5D), and a disease specific questionnaire; Short Health Scale for Hemorrhoidal Disease (SHSHD). SF12 and EQ-5D scores in 257 patients with symptomatic hemorrhoids referred to our proctologic outpatient clinic were compared to a Danish background population adjusting for age, gender, body mass index and educational status.Symptoms were assessed using the Hemorrhoidal Disease Symptom Score. The anatomical pathology was graded using Goligher's classification. The associations between clinical characteristics and HRQoL were tested. The impact of surgical treatment was assessed in 111 patients followed one year postoperatively. ResultsPatients reporting a high symptom load had lower SF12 physical health scores compared with the background population. The EQ-5D indexes indicated impaired HRQoL in men, women <50 years and patients with higher education. Improvements in all three HRQoL measures were seen after surgery.Symptom burden had a negative association with HRQoL measures, whereas the surgeon's grading of anatomical pathology had no association. ConclusionHemorrhoidal disease has a negative impact on HRQoL related to the degree of symptoms. Surgical treatment improve the QoL. The surgeon's grading of anal pathology had no association with QoL.