Median Level Research Articles

High prevalence of low bone mineral density in young adults with phenylketonuria

ABSTRACT Background It has been reported that phenylalanine (Phe)-restricted diets may have negative effects on bone health in patients with classical phenylketonuria (cPKU). We aimed to evaluate bone mineral density (BMD) in adults with cPKU and determine the risk factors associated with low BMD. Methods Eighty adult patients with cPKU were examined, including 41 women and 39 men. The age range was 18.3-39.4 years (median 22.8). The femoral and lumbar BMD were measured by dual energy X-ray absorptiometry. The patients were evaluated in two groups with low (Z-score ≤−2) and normal BMD (Z-score > −2). Results Low BMD was detected in 20 patients (25%). The low BMD group had significantly more males (75% vs 40%, p < 0.01) and lower mean body mass index (BMI, 22.4 vs 24.5 kg/m2, p = 0.02). Paradoxically, mean blood calcium and 25-hydroxy vitamin D levels were higher in the low BMD group, but only marginally (10.0 vs 9.8 mg/dl and 25.1 vs 21.0 µg/L respectively, p < 0.05). The groups did not differ significantly with regards to age, mean Phe levels at diagnosis, median Phe levels above the age of 12 years, other nutritional parameters or vitamin-mineral supplementation. There was no history of clinical fractures. Discussion Although osteopenia, osteoporosis and low BMD have been reported in PKU, conflicting data also exist. Our study of a large adult cPKU cohort strongly supports previously published limited data that suggest male sex and low BMI confer a higher risk for low BMD in cPKU; and age, Phe levels and dietary adherence do not. In our study, although the patients were young, low BMD was quite common (25%). Bone health should be evaluated even in young adults with cPKU, especially in males and those with low BMI, regardless of treatment compliance and vitamin-mineral status. Prospective studies reporting on clinical outcomes such as bone pain or fractures will be valuable in the coming years.

Investigation of Liver Function Test Findings in COVID-19 Patients Considering the Disease Timeline

Background: Several lines of evidence suggest that SARS-CoV-2 infection impacts liver function; however, the evaluation of these changes over time according to the disease timeline remains unclear. Objectives: The objective of this study was to identify potential alterations in liver function parameters during the first to fifth waves of COVID-19 and compare these alterations with the demographic and clinical outcomes of patients across the waves. Methods: This cross-sectional study included 1501 hospitalized patients with a confirmed RT-PCR diagnosis of COVID-19, referred to Shahid Sadoughi Hospital, Yazd, Iran, between November 20, 2019, and November 20, 2021. Liver function parameters, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin, direct bilirubin, and albumin, were assessed using standard clinical laboratory methods. Statistical analyses were conducted to evaluate differences in liver function parameters across the five pandemic waves, with significance set at P &lt; 0.05. Results: The median age of the hospitalized patients (N = 1501) was 61 ± 21.8 years, with the majority being male (816, 54.3%). The Kruskal-Wallis test showed a significant increase in the median levels of ALP, total bilirubin, and direct bilirubin in the first wave; the AST and ALT in the third wave; and serum albumin in the second wave (P &lt; 0.001). The median serum levels of total bilirubin and direct bilirubin were significantly higher in older patients compared to younger patients (P &lt; 0.001), and the median ALT and serum albumin were significantly lower in older patients (P &lt; 0.0001). In males, the median values of AST, ALT, total bilirubin, and direct bilirubin were significantly higher than in females (P &lt; 0.0001). The median values of all parameters, except serum albumin, in deceased patients were significantly higher compared to discharged patients, and serum albumin was significantly lower. Conclusions: In this descriptive study, we observed that older and male patients were more frequently hospitalized than females. Our findings showed variations in liver parameters across different pandemic waves, suggesting distinct behaviors of various SARS-CoV-2 strains.

Radical prostatectomy without prostate biopsy based on a noninvasive diagnostic strategy: a prospective single-center study.

Prostate biopsy is the most common approach for diagnosing prostate cancer (PCa); however, it has inherent limitations, such as the invasive procedure, postoperative complications, and false negative results. We aimed to provide a noninvasive diagnostic strategy for patients with highly suspected PCa and to evaluate the feasibility of performing biopsy-spared radical prostatectomy. This prospective study included a total of 57 patients between November 10, 2022, and December 1, 2023. All 57 patients underwent radical prostatectomy without prior prostate biopsy based on a noninvasive diagnostic strategy consisting of a diagnostic prediction model [comprised of the prostate imaging-reporting and data system (PI-RADS) score and prostate-specific antigen density (PSAD)] and the 18F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/computed tomography (CT) examination. The primary endpoint was the positive predictive value (PPV) of clinically significant PCa [the International Society of Urological Pathology (ISUP) grade ≥2, Gleason score ≥3 + 4]. The secondary endpoints were a PPV of any-grade PCa (ISUP grade ≥ 1, Gleason score ≥3 + 3) and high-grade PCa (ISUP grade ≥3, Gleason score ≥4 + 3), and the false positive rate of the diagnostic strategy. Of the 371 screened patients with clinically suspected PCa, 57 patients fulfilled the criteria and consented to participate in this study. The median PSAD level was 0.56 (0.42-0.82) ng/mL2; 13 (22.8%) patients were identified as having a PI-RADS score of 4, and 44 (77.2%) patients with a PI-RADS score of 5. The median SUVmax of 18F-PSMA-1007 PET/CT was 21.6 (15.8-33.0). For the 57 enrolled patients who received radical prostatectomy directly, the PPV of clinically significant PCa was 98.2% [56/57, 95% confidence interval (CI): 90.6-100%]. Only 1.8% (1/57, 95% CI: 0.0-9.4%) of patients were diagnosed with clinically insignificant PCa (ISUP grade = 1, Gleason score = 3 + 3). The PPV of any-grade PCa and high-grade PCa were 100% and 73.7% (42/57, 95% CI: 60.3-84.5%), respectively. No one had a false positive result. We proposed a noninvasive diagnostic strategy consisting sequentially of a diagnostic prediction model and the 18F-PSMA-1007 PET/CT examination for diagnosing PCa. Despite some limitations, our initial findings suggest the potential feasibility of radical prostatectomy without prior prostate biopsy.

Early Prediction of Gestational Diabetes Mellitus and Insulin Therapy Requirement Using First-Trimester PAPP-A and Free β-hCG MoMs Levels: A Retrospective Case–Control Study

Objectives: To evaluate the association between gestational diabetes mellitus (GDM), including insulin-dependent GDM with pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) and free beta human chorionic gonadotropin (free β-hCG) MoM levels, and to assess their potential as predictive risk factors. Methods: This retrospective study included 2588 women with singleton pregnancies who underwent combined first-trimester screening, along with the 50 g glucose challenge test (GCT) and a 100 g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. Patients were initially divided into four groups based on the glucose screening results, and PAPP-A and free β-hCG MoMs were compared between these groups. GDM cases managed by diet were then compared with those requiring insulin therapy. Results: Of the study population, 132 women (5.10%) were diagnosed with GDM, 112 (84.8%) managed their glycemia with dietary changes, while 20 (15.2%) required insulin therapy. PAPP-A levels were significantly lower in the GDM group compared to the control group (p &lt; 0.001). In addition, the insulin-dependent GDM group had significantly lower PAPP-A levels than the diet-controlled group (p &lt; 0.001). No significant differences were observed in the free β-hCG MoM levels between the groups (p = 0.292). Receiver operating characteristic analysis identified 0.815 as the optimal PAPP-A cut-off value for predicting GDM, with a sensitivity of 61.4%, specificity of 61.6%, and an area under the curve (AUC) of 0.649 (95% CI: 0.595–0.703). For insulin-dependent GDM, the same threshold yielded an AUC of 0.621 (95% CI: 0.563–0.679), with a sensitivity of 58.6% and a specificity of 59.7%. Conclusions: Low serum PAPP-A MoM levels are significantly associated with the development of GDM, including insulin-dependent cases. Although PAPP-A alone may not be a definitive predictive marker for GDM, low levels could support the recommendation for early screening as part of a broader diagnostic approach.

Radical prostatectomy outcomes of prostate cancer cases: Insights from a leading surgeon's experience in Azerbaijan.

Prostate cancer is a significant health concern worldwide and ranks as the 4th most frequent cancer among men in Azerbaijan. While robot-assisted laparoscopic radical prostatectomy is the preferred surgical technique in many countries, open retropubic radical prostatectomy (ORP) remains the primary treatment option in Azerbaijan due to limited access to robotic surgical systems. This study aims to analyze the outcomes of ORP in patients with local and locally advanced prostate cancer. We retrospectively evaluated 95 men who underwent extraperitoneal retropubic ORP for prostate cancer at our center between May 2020 and December 2023. Comprehensive data on patient demographics, preoperative parameters, surgical details, and postoperative outcomes were collected. Statistical analyses were conducted using IBM SPSS 27.0 software. The mean age of the patients was 65.9 years. The median preoperative PSA level was 14.8 ng/mL, and lymph node enlargement was identified in 29.5% of patients. A rectal injury occurred in one patient (1.1%) as the only intraoperative complication. The mean intraoperative blood loss was 330 mL, and the median hospital stay was 6 days. A positive surgical margin was observed in 38.9% of cases. Diabetes mellitus and higher intraoperative blood loss were associated with prolonged hospital stays (≥ 7 days). Erectile dysfunction was reported in 52.6% of patients 6 months postoperatively, while urinary incontinence was observed in 2.2%. ORP outcomes in Azerbaijan are comparable to those reported for laparoscopic and robot-assisted techniques in terms of perioperative and oncological results. Despite the absence of advanced surgical technology, ORP remains an effective treatment option for prostate cancer when performed by experienced surgeons.

Characterization of PSA dynamics and oncological outcomes in patients with metastatic hormone-sensitive prostate cancer treated with androgen receptor signaling inhibitors.

This study investigated the characteristics of prostate-specific antigen (PSA) dynamics when androgen receptor signaling inhibitor (ARSI), or vintage agent (bicalutamide) was used for patients with metastatic hormone-sensitive prostate cancer (mHSPC). A total of 213 mHSPC patients from each of the ARSI and bicalutamide groups treated between 2015 and 2022 were selected from multiple institutions using propensity score-matched analysis to align backgrounds. PSA progression-free survival (PFS) and overall survival (OS) were assessed. PSA level at 3months, PSA nadir level, and time to PSA nadir were examined to analyze of PSA kinetics. ARSI treatment significantly improved PSA PFS compared to bicalutamide (P = 0.0063), although no significant difference in OS was seen (P = 0.3134). No significant differences were observed between treatment groups in median PSA levels at 3months (1.47 vs 0.52ng/ml, P = 0.3042) or PSA nadir levels (0.263 vs 0.1345ng/ml, P = 0.1228). Bicalutamide treatment demonstrated longer time to nadir than ARSI in progression-free cases (median: 243 vs 213.5days, P = 0.0003). Survival tree analysis found that PSA nadir ≤ 1.5ng/ml and time to nadir ≥ 145days were the optimal cut-offs for best stratifying OS with bicalutamide, while PSA nadir ≤ 0.45ng/ml and time to nadir ≥ 70days were optimal with ARSI. No significant differences in PSA response was seen between groups; however, distinct optimal cut-offs were demonstrated for PSA nadir and time to nadir. The present findings will be useful for optimal PSA monitoring for mHSPC patients and for early identification of poor-prognosis populations.

Performance evaluation of CXCL10 ELISA “cosmic” kit to measure CXCL10 in cerebrospinal fluid of patients with HTLV‐1‐associated myelopathy

AbstractObjectivesThis study aimed to validate the clinical utility of cerebrospinal fluid (CSF) CXCL10 measurements in HTLV‐1‐associated myelopathy (HAM) using a CXCL10 ELISA “Cosmic” kit, a more widely applicable method than cytometric bead array (CBA).MethodsCSF CXCL10 levels were measured in 165 samples from 111 patients with HAM and 18 controls using a CXCL10 ELISA “Cosmic” kit. We assessed the following: (1) CSF CXCL10 concentrations by HAM activity level (high, moderate, and low) versus controls; (2) correlation with CBA; (3) cutoff values, sensitivity, and specificity for differentiating among HAM activity levels; (4) changes in HAM activity after steroid therapy; and (5) relationship between HAM activity and prognosis in patients undergoing steroid therapy. A correlation coefficient of ≥0.9 with CBA was the primary endpoint.ResultsThe median CSF CXCL10 levels in the high, moderate, low, and control groups were 4016.0, 841.0, 112.8, and 102.5 pg/mL, respectively. The ELISA findings were highly correlated with the CBA findings (r = 0.99). Cutoff values were set at 2500 pg/mL (sensitivity, 93.3%; specificity, 100%) to distinguish between high and moderate activity and 180 pg/mL (sensitivity, 81.8%; specificity, 100%) for low to moderate activity comparable to CBA. The new cutoffs enabled the detection of HAM activity changes and prediction of motor disability progression under steroid therapy.ConclusionCXCL10 ELISA “Cosmic” kit findings were strongly correlated with CBA findings, meeting the primary endpoint and demonstrating comparable sensitivity and specificity for distinguishing HAM activity. This product shows a promising ability to determine the therapeutic strategy.

Compatibility of salivary lactate dehydrogenase level using a test kit with the community periodontal index in Japanese adults.

The purpose of this study was to investigate the association between salivary lactate dehydrogenase (LD) levels, assessed using a test kit, and the community periodontal index (CPI) and to determine the feasibility and reliability of the test kit for screening periodontal disease in adults. The study included 205 patients (58.5% female, median and 25-75 percentiles of age 55.0, 46.0-66.0years) who visited two university hospitals and one university clinic in Japan. Resting saliva sample was collected from each participant, and LD level was evaluated in real time using a kit featuring an integer scale ranging from 1 to 10. Individual pocket scores were categorized as follows: score = 0 (≤ 3mm), score = 1 (4-5mm), and score = 2 (≥ 6mm) and gingival bleeding scores were categorized as follows: score = 0 (absence of condition) and score = 1 (presence of condition). Notably, 120 participants (58.5%) exhibited a pocket score = 1 or 2, and 123 participants (60.0%) exhibited a gingival bleeding score = 1. The optimal cutoff values for salivary LD level to distinguish pocket scores = 1 or 2 from 0 and score = 2 from 0 or 1 were 4.0 and 5.0, respectively, with a sensitivity and specificity of ≥ 0.65. The median salivary LD level for a gingival score = 1 was significantly higher than that for gingival score = 0, and the optimal cutoff value for the salivary LD level was 4.0, with a sensitivity and specificity of ≥ 0.62. Our results suggested that a salivary LD level ≥ 4.0 in adults may suggest the presence of periodontal disease, thereby emphasizing the kit`s utility as a screening tool.

Rifaximin-Alpha Increases Lactase Activity in Patients with Irritable Bowel Syndrome Without Constipation and Small Intestinal Bacterial Overgrowth.

Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase. To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation. This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400mg rifaximin-alpha every 8h for 2weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated. After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34-13.7)mg/dL vs. 10.4 (IQR 7.1-17.3)mg/dL, p = 0.002. Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation.

Severe SARS-CoV-2 infection is associated with increased risk of De novo HLA antibody production in lung transplant recipients: Single-center study.

The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients (LTR). Respiratory viral infections may be associated with de-novo HLA donor-specific antibody (DSA) production and impact lung transplant outcomes. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in LTR include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo DSA production in LTR. We performed a retrospective chart review of 63 consecutive LTR diagnosed with COVID-19 to investigate this concern. COVID-19 disease severity was divided into 3 groups: mild, moderate, and severe. Mild disease was defined as patients with COVID-19 diagnosis who were stable enough to be treated as out-patients. Moderate disease was defined as patients who required admission to the hospital and were on less than 10 l of oxygen at rest. Severe disease was identified as patients who required hospitalization and were on more than 10 l of oxygen with or without mechanical ventilation or extra corporal membrane oxygenation (ECMO). Groups were compared using the Kruskal-Wallis test. A total of 11, 43, and 9 LTR were diagnosed with mild, moderate, and severe COVID-19 respectively. We observed no significant differences in the CPRA pre-COVID-19 compared to 1 and 6 months post-COVID-19 diagnosis in 6/11 (54.5 %), 18/43 (41.8 %), and 6/9 (66.9 %) LTR with mild (p = 0.66), moderate (p = 0.74), and severe (p = 0.22) COVID-19 respectively. HLA class I and II DSA were detected pre-COVID-19 diagnosis and persisted with no significant differences in the median MFI levels at 1 and 6 months post-COVID-19 diagnosis in 2/11 (p = 0.93), 7/43 (p = 0.71), and 0/9 LTR with mild, moderate, and severe COVID-19 respectively. De-novo HLA DSA were detected within 6 months post-COVID-19 diagnosis in 0/11 (0 %), 1/43 (2.3 %), and 3/9 (33.3 %%) LTR with mild, moderate, and severe COVID-19 respectively (p = 0.001). Severe COVID-19 may be associated with increased risk of de novo HLA DSA production resulting in allograft dysfunction.

Fasting mimicking diet during neo-adjuvant chemotherapy in breast cancer patients: a randomized controlled trial study

ObjectivePreclinical evidences suggests that while fasting can reduce the side effects and toxicity of chemotherapy, it can make cancer cells more susceptible to chemotherapy. This study aimed to examine the effects of fasting mimicking diet (FMD) during neo-adjuvant chemotherapy in breast cancer (BC) patients.MethodsForty-four newly diagnosed human epidermal growth factor receptor 2-negative (HER2-negative) patients with BC were randomized equally into two groups (22 each), to receive either a fasting mimicking diet (FMD) or their regular diet for 3 days prior to and during neoadjuvant chemotherapy. This FMD was repeated every 3 weeks for 8 cycles. Efficacy, toxicity, hematologic, metabolic, and inflammatory parameters were measured and compared.ResultsThe occurrence of grade III vomiting and neutropenia in the control group was significantly higher than the FMD group (P = &amp;lt;0.001 and p = 0.04 respectively). Erythrocytes (p = 0.01) and neutrophils (p = 0.002) counts were significantly higher in FMD group compared to control group after cycle 8. There was a significant increase in median glucose and median insulin levels (p = 0.01 and p = 0.005, respectively) in the control group between baseline and after cycle 8. While, the median Insulin-like growth factor-1 (IGF1) (p = 0.006) and hs-CRP (p = 0.02) levels were significantly decreased in the FMD group. At the end of study (after cycle 8), the median glucose level was significantly higher in control group (p = 0.008), while the median hs-CRP level was significantly lower in FMD group (p = 0.01). The Miller and Payne pathological response 4/5 (90–100% tumor cell loss) and the radiologically complete or partial response, as measured by MRI or ultrasound before surgery occurred more frequently in FMD group compared to the controls (p = 0.01).ConclusionFasting mimicking diet was well tolerated during chemotherapy and reduced toxicity of chemotherapy and also, had beneficial effects of some metabolic parameters.Clinical Trial Registrationhttps://irct.behdasht.gov.ir/user/trial/61386/view.

Evaluation of Pentraxin-3 levels in children with multisystem inflammatory syndrome.

Early recognition of cardiac involvement and prediction of disease prognosis are essential for the management of inflammatory diseases such as multisystem inflammatory syndrome. This study aimed to investigate the role of Pentraxin-3 levels in identifying cardiac involvement and evaluating disease severity in patients with multisystem inflammatory syndrome. The study included 56 multisystem inflammatory syndrome patients and 26 healthy children as a control group. The multisystem inflammatory syndrome group was divided into those with cardiac involvement (n = 34) and those without (n = 22), as well as those with clinically mild-moderate (n = 30) and severe (n = 26) multisystem inflammatory syndrome. Blood samples for measurement of Pentraxin-3 levels were obtained from all patients before treatment and from the healthy controls. In the patient group, the mean age was 8.2 ± 4 years (range: 2-17 years), and the male-to-female ratio was 1.8. In the control group, these values were 9.5 ± 3.7 years (range: 2-16 years) and 1.9, respectively (p > 0.05). Plasma Pentraxin-3 levels were significantly higher in multisystem inflammatory syndrome patients compared to controls (7.1 ± 5 ng/mL vs. 2.9 ± 2.1 ng/mL, p = 0.001). Patients with cardiac involvement had a significantly higher median Pentraxin-3 level than those without (5.8 ng/mL vs. 4.1 ng/mL, p = 0.004). Severe disease was also associated with a higher median Pentraxin-3 level compared to mild-moderate disease (6.1 ng/mL vs. 4.4 ng/mL, p = 0.001). Pentraxin-3 level was negatively correlated with left ventricular ejection fraction and positively correlated with B-type natriuretic peptide, troponin. Elevated Pentraxin-3 levels in multisystem inflammatory syndrome patients may help predict the clinical course of the disease and cardiac involvement. However, larger-scale prospective studies are needed to further elucidate this.

Evaluating the Impact of Dermal Absorption on Internal Doses of Dechlorane Plus in Chinese E-waste Recycling Employees

E-waste recycling employees represent a specific population with a high potential for exposure to dechlorane plus (DP). However, the impact of skin-adherent DP on human exposure within this group has not been well characterized. This study aimed to address this gap by collecting handwipe and matched serum samples (n=86 pairs) of Chinese e-waste recycling employees. In vivo human dermal bioavailability of DP was also examined to achieve effective exposure estimation. As a result, DP was detected in all handwipe and serum samples, indicating the occurrence of widespread exposure in the study population. For all the participants, the median level of ∑DP (the sum of syn-DP and anti-DP) in the serum was 45.1 ng g-1 lipid weight (lw), while handwipe samples showed the loading of 10.8 ng per wipe. Notably, significant associations were found between DP handwipe loadings and matched serum levels (p<0.05). Next, the in vivo human dermal bioavailability was estimated to be 9.54% for ∑DP. Based on this value, the estimated average daily dose was 0.231 ng kg-1 d-1 (median values), contributing 10.9% to serum levels of ∑DP. The significant associations and 10.9% percentage contribution together underscore the non-negligible influence of dermal absorption on DP internal doses in the e-waste recycling employees. Moreover, the extremely high levels of DP (up to 3.64E+04 ng g-1 lw) detected in serum highlight the extent of DP accumulation in humans. Continuous monitoring and assessment are warranted among e-waste workers due to the persistent organic pollutant properties of DP.

Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?

Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery. Retrospective multicenter cohort. Two quaternary academic medical centers. Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period. Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery. Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication. Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers. NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.

Exploring RF-EMF levels in Swiss microenvironments: An evaluation of environmental and auto-induced downlink and uplink exposure in the era of 5G

The advancement of cellular networks requires updating measurement protocols to better study radiofrequency electromagnetic field (RF-EMF) exposure emitted from devices and base stations. This paper aims to present a novel activity-based microenvironmental survey protocol to measure environmental, auto-induced downlink (DL), and uplink (UL) RF-EMF exposure in the era of 5G. We present results when applying the protocol in Switzerland.Five study areas with different degrees of urbanization were selected, in which microenvironments were defined to assess RF-EMF exposure in the population. Three scenarios of data transmission were performed using a user equipment in flight mode (non-user), inducing DL traffic (max DL), or UL traffic (max UL). The exposimeter ExpoM-RF 4, continuously measuring 35 frequency bands ranging from broadcasting to Wi-Fi sources, was carried in a backpack and placed 30cm apart from the user equipment.The highest median RF-EMF levels during the non-user scenario were measured in an urban business area (1.02 mW/m2). Here, DL and broadcasting bands contributed the most to total RF-EMF levels. Compared to the non-user scenario, exposure levels increased substantially during max DL due to the 5G band at 3.5 GHz with 50% of the median levels between 3.20-12.13 mW/m2, mostly in urban areas. Note that the time-division nature of this band prevents distinguishing between exposure contribution from DL beamforming or UL signals emitted at this frequency. The highest levels were measured during max UL, especially in rural microenvironments, with 50% of the median levels between 12.08-37.50 mW/m2. Mobile UL 2.1 GHz band was the primary contributor to exposure during this scenario.The protocol was successfully applied in Switzerland and used in nine additional countries. Inducing DL and UL traffic resulted in a substantial increase in exposure, whereas environmental exposure levels remained similar to previous studies. This data is important for epidemiological research and risk communication/management.

Comparison of IL-6, IL-10, and TNFα levels between PLWHIV with and without Kaposi Sarcoma and healthy controls.

Kaposi sarcoma (KS) is an angioproliferative disease caused by human herpesvirus 8 (HHV-8) and is mediated by cytokines in an immunodeficient environment. This study aimed to compare IL-6, IL-10, and TNFα levels among AIDS patients with disseminated KS (DKS), treatment naïve patients living with HIV (PLWHIV) without DKS, and healthy controls. Secondary outcomes were to compare cytokines levels in patients with DKS and unfavorable outcomes, as well as an analysis of the behavior of cytokines over time. This cohort study was performed at two centers in Mexico City. Three groups were included. Group 1: HIV+ treatment naïve with DKS, Group 2: HIV+ treatment naïve without KS, and Group 3: HIV negative, healthy controls. Plasmatic IL-6, IL-10, and TNFα levels were measured at baseline and over time in Groups 1 and 2. Seventy-six patients were included: 39 (52%) in Group 1, 17 (22%) in Group 2, and 20 (26%) in Group 3. The median baseline IL-6, IL-10, and TNFα levels were significantly higher in group 1. In group 1, baseline IL-6 was higher in patients who died than in survivors (14.4 vs 5.8 pg/mL p=0.048). Patients with severe immune reconstitution inflammatory syndrome due to KS (S-IRIS-KS) had higher IL-6 values than those without it (14.4 vs 5.8 pg/mL p=0.004). In the repeated-measures model in group 1, IL-10 levels were higher in patients who died (p<0.001) and developed IRIS-KS (p=0.01). IL-6, IL-10, and TNF α levels were markedly higher in patients with DKS. IL-6 and IL-10 levels were higher in patients with unfavorable outcomes.

Factors Predicting Renal Outcomes in Hypertensive Emergencies With Severe Renal Impairment: A Single-Center Retrospective Study.

Hypertensive emergencies, characterized by elevated blood pressure (BP) and multiple organ damage, have poor prognosis. Patients occasionally show gradual improvement in renal function with appropriate antihypertensive treatment despite renal impairment. However, reports analyzing factors predicting prognosis in patients with hypertensive emergencies and severe renal impairment are limited. This retrospective study aimed to investigate clinical features and predictors of renal outcomes in such patients. Patients admitted to our hospital diagnosed with hypertensive emergency with severe renal impairment (serum creatinine [Cr] level > 2.5 mg/dL) between 2007 and 2021, were enrolled and divided into two groups: those who received renal replacement therapy (RRT) after 3 years (RRT group) and those who did not (non-RRT group); clinical characteristics and laboratory data were compared. Fifteen patients were enrolled, with a median age and serum Cr level of 48 years and 5.97 mg/dL, respectively. No significant between-group difference was observed in serum Cr levels or kidney size. However, the non-RRT group exhibited significantly higher levels of serum lactate dehydrogenase (LDH) levels and significantly lower platelet counts (PLT), suggesting development of microangiopathic hemolysis due to severe endothelial damage. Furthermore, the non-RRT group exhibited lower serum potassium levels than the RRT group, accompanied by high plasma renin activity and serum aldosterone levels, suggesting activation of the renin-angiotensin system (RAS). In the non-RRT group, serum Cr, LDH, potassium levels, and PLT improved significantly after treatment. Serum LDH, potassium levels, and PLT are useful predictors of renal prognosis in hypertensive emergencies with extremely poor renal function. In some cases, severe renal damage can be ameliorated by appropriate antihypertensive therapy. A positive response to treatment often signifies a favorable prognosis. Furthermore, early initiation of RAS inhibitors may be beneficial for lowering BP and providing renal protection.

Incidence and risk factors of silent deep venous thromboembolism before interval debulking surgery in ovarian cancer patients, a tertiary centre experience

ObjectiveTo determine the prevalence and risk factors for the development of asymptomatic venous thromboembolism (VTE) in ovarian cancer patients who underwent interval cytoreductive surgery after finishing neoadjuvant chemotherapy. MethodsThis is a prospective observational trial. Female patients with pathologically proven ovarian cancer who received neoadjuvant chemotherapy without clinical evidence of VTE were included. ResultsA total of 107 patients were enrolled in this study. The mean age was 53.37 years, and the mean body mass index (BMI) was 34.11 kg/m2. Seven (6.5 %) patients suffered from silent VTE, as documented by bilateral Doppler ultrasound in the pre- and postoperative settings. The mean age of the patients in the VTE group was 56.17 years, and their mean body mass index was 31.71 Kg/m2. Their median serum CA125 concentration was elevated (325.6 units/ml). On the other hand, the median D-dimer level was elevated by 678 ng/ml fibrinogen equivalent units (FEUs) in the same group of patients. In the present study, comorbidities did not influence the incidence of VTE, as the 7 patients who were diagnosed with VTE did not have any comorbidities. Most of the patients who were diagnosed with serous adenocarcinoma (71.4 %) or stage IIIc disease (57.1 %) were most likely to develop VTE. ConclusionSilent VTE is more prevalent in patients with advanced-stage ovarian cancer and serous carcinomas

Clinically significant prostate cancer detection rate in biopsy-naïve patients with mpMRI and microultrasound topographically discordant lesions: A single-center retrospective analysis

Introduction and objectivesMultiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro–US-guided targeted biopsy (micro–US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx). Material and MethodsWe analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57–70), median prostate-specific antigen level was 7 ng/mL (IQR, 5–9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35–64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa. ResultsMicro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26–46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36–50), resulting in a -8% difference (95% CI: −10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a −3% difference (95% CI: −2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004). ConclusionsIn conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US's role in reducing unnecessary biopsies.

Potassium levels and short-term outcomes in heart failure with mildly reduced ejection fraction

ObjectiveThe study investigates the prognostic impact of dyskalemias in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). BackgroundAlthough dyskalemias represent a common complication in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), data concerning the prevalence and prognostic impact of dyskalemias in HFmrEF is limited. MethodsConsecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of potassium levels was assessed comparing patients with K > 3.3 to ≤4.5 mmol/L, ≤3.3 mmol/L and > 4.5 mmol/L. The primary endpoint was all-cause mortality at 30 days. Results2079 patients with HFmrEF and potassium measurement were included (median potassium level: 4.4 mmol/L; mean 4.2 mmol/L). 84 % of patients hospitalized with HFmrEF presented with potassium levels in the norm range, 8 % with hypokalemia and 8 % with hyperkalemia, respectively. The risk of all-cause mortality at 30 days was higher in patients with hyperkalemia compared to patients with normokalemia (7 % vs 4 %; log rank p = 0.026), whereas the presence of hypokalemia (6 %; log rank p = 0.075) was not significantly associated with the risk of 30-days all-cause mortality. Compared to patients with normokalemia, the presence of hyperkalemia was still associated with an increased risk of 30-day all-cause mortality within a multivariable Cox regression analysis (HR = 2.002; 95 % CI 1.004–3.992; p = 0.049). ConclusionIn patients hospitalized with HFmrEF, hyperkalemia – but not hypokalemia – was independently associated with an increased risk of all-cause mortality at 30 days.