130 research outputs found
Severity of erectile dysfunction and premature ejaculation positively correlate with aggression levels in men: insights from a large population-representative study
No full textThe effects of erectile dysfunction (ED) and premature ejaculation (PE) on men’s mental health are well-studied, but their link to aggression has been less explored. Thus, we measured associations between ED, PE, and aggression of men in a large representative cohort with well-balanced demographic characteristics. Participants completed computer-assisted web interviews with reliable questionnaires to assess ED, PE, and aggression. These included the five-item International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Aggression Module of the Hospital Anxiety and Depression Scale-Modified Version (A-HADS-M). A representative sample of adult men was generated based on the most recent census data, incorporating age and place of residence as quota controls, along with sample size calculations. We interviewed 3001 men, with a mean IIEF-5 score of 18.92 ± 5.04, a mean PEDT score of 7.15 ± 4.26, and a mean A-HADS-M score of 2.71 ± 1.64. We found that aggression was more prevalent in those with ED or PE (p < 0.001). The greater the severity of ED and PE, the greater was the intensity of aggression (Spearman’s rank correlation coefficients of −0.207, p < 0.001 and 0.19, p < 0.001 for ED and PE, respectively). Univariate regression models showed significant links between aggression and both ED and PE across age groups. Multivariate models confirmed that these associations were significant and independent of age, sociodemographic factors, comorbidities, and lifestyle habits (regression coefficients: −0.041, p < 0.001 for ED and 0.028, p < 0.001 for PE). Our findings convincingly demonstrated a consistent association between aggression, ED, and PE, warranting further investigation into the underlying mechanisms of these relationships
Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy
No full textINTRODUCTION
The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP).
METHODS
We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan-Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal 'Cut off' for CCI.
RESULTS
The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan-Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test.
CONCLUSION
Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP
Emphysematous pyelonephritis: time for a management plan with an evidence-based approach
No full textIntroduction: emphysematous
pyelonephritis (EPN) is a life-threatening necrotising kidney
infection, but there is no consensus on the best management.Methods: we
systematically reviewed previous articles published from 1980 to 2013
that included studies reporting on EPN, and applying the Cochrane
guidelines, we conducted a meta-analysis of the results.Results: in all, 32 studies were included, with results for 628 patients (mean age 56.6 years,
range 33.8–79.9). There were 462 women, outnumbering men by 3:1.
Diabetes was present in 85% of the cases. Fevers and rigor (74.7%),
pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was
associated with 54.4% of deaths while obstructive uropathy was
associated with 15.1% of deaths. Computed tomography was diagnostic in
all the cases. Percutaneous drainage (PCD) and medical management (MM)
alone were associated with a significantly lower mortality rate than was
emergency nephrectomy (EN), with an odds ratio (95% confidence
interval) for PCD vs. EN of 3.13 (1.89–5.16; P < 0.001), for EN vs. MM of 2.84 (1.62–4.99; P = 0.001), and of 0.91 (0.53–1.56; P = 0.73,
i.e., no difference) for PCD vs. MM. Open drainage also had a
significantly lower mortality rate than EN, with a ratio of 0.12
(0.02–0.91; P < 0.04).Conclusion: the
overall mortality rate was ≈18%; shock was associated with a high
mortality rate and therefore should be managed aggressively. PCD and MM
were associated with significantly higher survival rates than EN, and
therefore EN should only be considered if the patient does not improve
despite other treatments
Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis
No full textContex: centres
worldwide have been performing partial nephrectomies laparoscopically
for greater than a decade. With the increasing use of robotics, many
centres have reported their early experiences using it for
nephron-sparing surgery.Objective: to review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN).Evidence acquisition: an
online systematic review of the literature according to Cochrane
guidelines was conducted from 2000 to 2012 including studies comparing
RPN and LPN. All studies comparing RPN with LPN were included. The
outcome measures were the patient demographics, tumour size, operating
time, warm ischaemic time, blood loss, transfusion rates, length of
hospital stay, conversion rates, and complications. A meta-analysis of
the results was conducted. For continuous data, a Mantel-Haenszel
chi-square test was used; for dichotomous data, an inverse variance was
used. Each was expressed as a risk ratio with a 95% confidence interval p < 0.05 considered significant.Evidence synthesis: a total of 717 patients were included, 313 patients in the robotic group
and 404 patients in the laparoscopic group (seven studies). There was no
significant difference between the two groups in any of the demographic
parameters except for age (age: p = 0.006; sex: p = 0.54; laterality: p = 0.05; tumour size: p = 0.62, tumour location: p = 57; or confirmed malignant final pathology: p = 0.79). There was no difference between the two groups regarding operative times (p = 0.58), estimated blood loss (p = 0.76), or conversion rates (p = 0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p = 0.0008). There was no difference regarding postoperative length of hospital stay (p = 0.37), complications (p = 0.86), or positive margins (p = 0.93).Conclusions: in
early experience, RPN appears to be a feasible and safe alternative to
its laparoscopic counterpart with decreased warm ischaemia times noted
Feasibility study on fiber reinforced polymer cylindrical truss bridges for heavy traffic
No full textConsidering the recent increase in the use of fiber reinforced polymers in the civil engineering industry in general and in the bridge engineering industry in particular, as well as the recently more and more applied cylindrical truss bridge type, this research focuses on the question whether it is possible to combine fiber reinforced polymers as stand-alone structural material and this bridge type to construct a bridge suitable for heavy traffic as well as bicycle and pedestrian traffic. This research combines an extensive literature study on the use of fiber reinforced polymers for bridge engineering with a theoretical feasibility- and design-study on fiber reinforced polymer cylindrical truss bridges for heavy traffic. During the design study the spatial needs of all bridge users were defined to obtain an initial shape of the bridge. This shape was then optimized in several steps using finite-element-modeling and -analysis, yielding a final shape of the bridge. The behavior of this structure under design loads was then extensively investigated, again using finite element analysis, showing that the bridge could very well meet the self-derived deflection limit for fiber reinforced polymers at relatively low stress levels. Since fiber reinforced materials are a very diverse field of material, with hundreds of different compositions being available, the first result of this study was the choice of a suitable composite for further analysis. For this bridge design very high fiber content (>60%) carbon/epoxy composite was used. The main reason for this choice was the high modulus and -strength of the carbon fibers and the high durability and strength of the epoxy resin. A major reason of the slow implementation of fiber reinforced polymers in the bridge engineering industry are the worries concerning the lack of fire safety of the material. The literature study of this research showed however that it is possible to construct a heavy traffic full-FRP truss bridge, while complying with the known fire safety standards. The virgin FRP material can be adapted by several fire-protection measures; it turned out that a combination of intumescent gel-coating and low volume phosphorous filler systems works best in increasing the fire resistance and thereby providing a fire resistance class of R30 for hydrocarbon fire curve loading. The initial shape of the bridge was optimized in three stages: first several different truss topologies, which were derived with a parametric geometric model, were analyzed and compared using finite element analysis software, yielding the square truss with one diagonal as most efficient topology. In the next steps several grid sizes of this truss as well as several cross section dimensions were compared, again using finite element analysis software. An optimum was found between minimum material usage and minimum deflection, which reduced the material usage of the main load bearing elliptical truss by about 40% compared to the initial variant. The optimized structure was then fitted with the inner bridge deck supporting trusses as well as the cantilever trusses. The elliptical truss bridge performed very well considering the maximum deflections and stresses under Eurocode design loads and load combinations that were derived in finite element modeling software. When comparing the full-FRP bridge design with similar, existing steel structures, the maximum deformations and –stresses were considerably lower for the full-FRP bridge while only weighing about 60% of the steel structure. This research showed that the ‘new’ cylindrical truss bridge type is not only an aesthetically appealing structure but also performs structurally very well when combined with fiber reinforced polymer as structural material. It turned out that fiber reinforced polymers can be used as stand-alone structural material for medium span heavy traffic bridges. Next to that, this research clarified that there is no legitimate structural reason for the fact that fiber reinforced polymers are used relatively scarcely in the civil engineering- and bridge engineering industry compared to traditional building materials such as steel and concrete. Since this research is one of the first researches of its kind, using FRP as stand-alone structural material for a relatively new and complex bridge type, more research is needed in the field of high order connections for fiber reinforced polymer circular hollow sections. Next to that the possibility of the use of differently sized and shaped cross sections for the truss members should be investigated.Structural and Building EngineeringStructural EngineeringCivil Engineering and Geoscience
Secundaire spanningen in dwarsverbandstaven van stalen boogbruggen
No full textBijna alle stalen boogbruggen bestaan uit twee bogen die aan weerszijden van het brugdek staan. Om stabiliteit tegen knik uit het vlak van deze bogen te waarborgen worden deze bogen in de praktijk door middel van dwarsverbandstaven met elkaar verbonden. Deze verbandstaven hebben geen invloed op de primaire krachtsafdracht van de boogbrug en dienen enkel als stabiliteitselementen. De vraag rijst nu echter of deze dwarsverbanden niet net als de onderdelen van het brugdek aan veelvuldige spanningswisselingen en daarmee ook aan vermoeiing onderhevig zijn. Stalen boogbruggen zijn namelijk in bijna alle gevallen verkeersbruggen en krijgen daarom tijdens hun ontwerplevensduur te maken met miljoenen spanningswisselingen. Om een antwoord op de vraag te geven of de dwarsverbanden onderhevig zijn aan vermoeiing moet eerst worden onderzocht hoe groot de momenten zijn die in de dwarsverbanden optreden. Dit is in dit verslag onderzocht voor een vijftal belastinggevallen, te weten: belasting op de gehele brug, belasting over de halve brug (in lengterichting), belasting op de halve brug (op een hoofdligger), kruiselingse belasting en kwartbelasting. Daarnaast is ook onderzocht wat de invloed van verschillende dwarsverbandconfiguraties op de momenten in de verbanden is. Hiervoor zijn een vijftal dwarsverbandconfiguraties gemodelleerd, te weten: de rechte dwarsverbandconfiguratie, de kruis- dwarsverbandconfiguratie, de kruis- dwarsverbandconfiguratie met additionele rechte verbandstaven en de K- dwarsverbandconfiguratie. Met deze scala aan configuraties is het gehele spectrum afgedekt wat in de realiteit van toepassing is. Als laatste is onderzocht wat de invloed van de afmeting van de dwarsverbandstaven op de optredende momenten is. Hiervoor is de afmeting van de dwarsverbandstaven proportioneel gesteld aan het traagheidsmoment van de boogligger. Er zijn modellen gemaakt waarin de dwarsverbandstaven een traagheidsmoment van 5%-35% van het traagheidsmoment van de boogligger hebben. Dit is in stappen van 5% onderzocht. Daarmee is een totaal van 7 dwarsverbandafmetingen onderzocht. Als model is de Nootdorpspoorbrug voor over de A12 bij Nootdorp gebruikt. Deze is in het EEM- pakket MIDAS Civil gemodelleerd. Uit het onderzoek is gebleken dat er momenten in drie richtingen in de dwarsverbanden optreden; moment y, moment z, (torsie)moment x. Deze momenten worden met stijgende afmeting van de verbandstaven steeds groter. Dit is een bijna lineair verband. Tevens bleek dat de momenten een gemiddelde waarde van ca. 200-300kNm hebben, en daarmee 20%-40% van de optredende momenten in de boogligger bedragen. Tevens bleek dat de kruiselingse belastingconfiguratie het ongunstigst voor de gegenereerde momenten is. De dwarsverbandconfiguratie met het grootste materiaalverbruik en tevens de grootste stijfheid, de kruis- rechte- configuratie bleek gemiddeld het gunstigst te zijn, en de laagste momenten te veroorzaken. Concluderend kan men dus stellen dat het zeker aandacht verdient om de dwarsverbandstaven op vermoeiingssterkte te testen.Structural and Building EngineeringDesign and ConstructionCivil Engineering and Geoscience
Prognostic value of the systemic inflammation modified Glasgow prognostic score in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy: Results from a large multicenter international collaboration
No full textIntroduction and objectives: To evaluate the prognostic role of modified Glasgow prognostic score (mGPS) for the prediction of oncological outcomes in a retrospective large multicenter cohort of upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). Materials and methods: We retrospectively analyzed a multicenter cohort of patients treated with RNU for clinically nonmetastatic UTUC. Multivariable logistic regression analyses were performed to evaluate the ability of mGPS to predict nonorgan confined (NOC) disease and lymph-node involvement (LNI) at RNU. Multivariable Cox-regression models were performed to evaluate the preoperative and postoperative prognostic effect of mGPS on survival outcomes. Results: Overall, 2,492 patients were included in the study. Of these, 1,929 (77%), 530 (21%), and 33 (1%) had a mGPS of 0, 1, and 2, respectively. mGPS was associated with characteristics of tumor aggressiveness and independently predicted LNI and NOC at RNU (both P < 0.05). On univariable and multivariable Cox-regression analyses, higher mGPS was independently associated with recurrence-free, cancer-specific, and overall survival, both in a preoperative and in a postoperative setting. The inclusion of mGPS significantly improved the discrimination of a preoperative model for the prediction of oncologic outcomes compared to standard prognosticators. Conclusions: We found that mGPS is independently associated with clinicopathologic features and survival outcomes after RNU. Future studies should investigate the role of mGPS in a panel of preoperative markers for the prediction of NOC and LNI in UTUC patients, thus possibly improving the selection for perioperative systemic therapy
Long-term analysis of oncological outcomes after laparoscopic radical cystectomy in Europe: Results from a multicentre study by the European Association of Urology (EAU) section of Uro-technology
No full textLaparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis
No full textWhat's known on the subject? And What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese and non-obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non-obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non-obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non-obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.</p
Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer
No full textBackground: Serum albumin-to-globulin ratio (AGR) has been shown to be associated with poor prognosis in different malignancies. In this study we aimed to evaluate the predictive value of preoperative AGRfor oncological outcomes in patients with radiation recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) Methods: A retrospective review of 214 consecutive patients with radiation recurrent PCa who underwent SRP at five referral centers. Levels of albumin and globulin were obtained before SRPand used to calculate the preoperative AGRlevel. The optimal cut off value of preoperative AGRwas 1.4. Univariable and multivariable Cox regression analyses were performed. Results: Overall 89 (41.6%) patients had a low preoperative AGR. Low serum AGRwas associated with biochemical recurrence (BCR) in univariable Cox regression analysis (HR1.60, 95%CI1.06-2.43, P=0.026). When adjusted for the effects of established preoperative and postoperative clinicopathologic confounders in different multivariable Cox regression models, this association did not retain its statistical significance. Moreover, preoperative AGR was not associated with metastasis free survival (P=0.21), overall survival (P=0.91) or cancer specific survival (P=0.61). Conclusions: In patients with radiation recurrent PCa undergoing SRP, low preoperative AGRwas associated with the risk of BCRonly in univariable analysis. There was no association with metastasis or survival outcomes. Further studies are needed to evaluate this biomarker in the setting of primary PCa and to identify the patients most likely to benefit from a local therapy
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