Natural Experiment Examining Impact of Aggressive Screening and Treatment on Prostate Cancer Mortality in Two Fixed Cohorts from Seattle Area and Connecticut

To determine whether the more intensive screening and treatment for prostate cancer in the Seattle≠Puget Sound area in 1987≠90 led to lower mortality from prostate cancer than in Connecticut

Oxygen-Carrier Development of Calcium Manganite–Based Materials with Perovskite Structure for Chemical-Looping Combustion of Methane

The present work is related to the upscaling of calcium manganite–based oxygen-carrier materials, which have a perovskite structure, both with respect to the use of inexpensive raw materials, i.e., instead of pure chemicals, and the upscaling of production to multitonne batches. Results are presented from the two different stages of material development, i.e., raw material selection and upscaling. The evaluation involves both operation in chemical-looping combustor units of 300 W and 10 kW, and material characterization. In the latter unit, the gas velocities in the riser and in the grid-jet zone of the gas distributor come close to gas velocities of industrial-scale units and, therefore, this unit is also used to assess particle lifetime. Results from the various chemical-looping combustion units and oxygen-carrier materials produced from various raw materials of both high and low purity show that very high degrees of fuel conversion can be reached while achieving very high oxygen-carrier lifetimes. The composition of the oxygen-carrier materials seems robust and flexible with respect to the precursors used in its manufacturing

Hyperlipidemia is a risk factor for osteonecrosis in children and young adults with acute lymphoblastic leukemia

TesisLa intoxicación con plomo es un problema de trascendental importancia para la salud pública por sus efectos en la calidad de vida de las personas, particularmente de los niños expuestos. La presente investigación fue de tipo descriptivo transversal y se realizó con la finalidad de determinar los niveles de plomo sanguíneo en los habitantes del Centro Poblado de Taca, durante los meses de junio y julio de 2013. Participaron del estudio 42 personas voluntarias: 32 varones y 10 mujeres, cuya media de edad fue de 33,23 años (rango: 21-72 años). Se tomaron muestras de sangre mediante venopunción previo consentimiento informado, utilizando tubos al vacío con anticoagulante, se mantuvieron bajo refrigeración a 8 °C, se trataron con mezcla sulfonítrica - ácido nítrico concentrado a ebullición lenta en un equipo de digestión y luego leídas en un espectrofotómetro de absorción atómica Thermo Scientific ¡CE 3300 a 217 nm. Se obtuvieron los siguientes resultados: todos los sujetos estudiados presentan algún grado de contaminación con plomo, encontrándose un nivel de plumbemia medio de 26,62 ug/dl y los niveles de plomo en sangre de varones y mujeres de 18 a 72 años de edad, encontrándose medias de 33,96 y 3,16 ug/dl, respectivamente, existiendo relación entre el género y plumbemia (p<0,05). El nivel de plomo en sangre de los habitantes del Centro Poblado de Taca, Distrito Canaria, Provincia de Víctor Fajardo, se incrementa en función del tiempo de residencia, por lo que existe relación entre estas dos variables (P<0,05)

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men:A Danish Nationwide Cohort Study

Background  Although men are considered at high risk for recurrent venous thromboembolism (VTE), sex-specific data on prognostic factors are lacking. We estimated the cumulative recurrence risks associated with clinical characteristics and comorbidities known or suspected to be associated with the development of VTE recurrence: major surgery, trauma, history of cancer, rheumatic disorder, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, chronic renal disease, varicose veins, alcohol-related diseases, and arterial hypertension. Methods  We linked nationwide Danish health registries to identify all incident VTE in- and outpatients in men from 2008 through 2018. Recurrent VTE risk 2 years after anticoagulant discontinuation was calculated using the Aalen-Johansen estimator, stratified by age above/below 50 years. Results  The study included 13,932 men with VTE, of whom 21% ( n  = 2,898) were aged <50 years. For men aged <50 years with at least one of the clinical characteristics, 2-year recurrence risk ranged from 6% (major surgery) to 16% (history of cancer). For men ≥50 years with at least one of the characteristics, recurrence risk ranged from 7% (major surgery) to 12% (ischemic heart disease, chronic obstructive pulmonary disease, and chronic renal disease). Men aged <50 and ≥50 years without the clinical characteristics all had a recurrence risk of 10%. Discussion  We demonstrated a 2-year recurrence risk of at least 6%, regardless of age category and disease status, in this nationwide cohort of men with VTE. The recurrence risk must be balanced against bleeding risk. However, the high recurrence risk across all subgroups might ultimately lead to greater emphasis on male sex in future guidelines focusing on optimized secondary VTE prevention

Health care utilisation preceding relapse or second malignant neoplasm after childhood acute lymphoblastic leukaemia:a population-based matched cohort study

OBJECTIVES: To investigate health care utilisation including both primary and secondary health care 6 months before the diagnosis of a relapse or a second malignant neoplasm (SMN) in survivors of childhood acute lymphoblastic leukaemia (ALL). DESIGN AND SETTING: A Danish population-based matched cohort study linking multiple nationwide registries. PARTICIPANTS: Participants were recruited from a total of 622 childhood ALL 2.5-year event-free survivors diagnosed between 1994 and 2015. Cases were survivors developing a relapse or an SMN and references were survivors still in first remission. Each case was matched with five references on age, sex, treatment protocol and risk group. PRIMARY OUTCOME MEASURES: Consultations in general practice and hospital the last 6 months before relapse or SMN. Cases and references were compared with monthly incidence rate ratios (IRRs) from negative binomial regression models. RESULTS: Of the 622 childhood ALL survivors, 60 (9.6%) developed a relapse (49) or an SMN (11) and 295 matched references were identified. Health care utilisation in general practice increased among cases the last month before the event compared with references with an IRR of 2.71 (95% CI 1.71 to 4.28). Data showed a bimodal structure with a significantly increased number of visits 4, 5 and 6 months before the event. Hospital health care utilisation increased 2 months before the event in cases with an IRR of 5.01 (3.78 to 6.63) the last month before the event and an IRR of 1.94 (1.32 to 2.85) the second-last month comparing cases and references. CONCLUSIONS: Survivors of childhood ALL developing a relapse or an SMN have a short period of increased health care utilisation before diagnosis. At hospital, this might be explained by pre-diagnostic examinations. In general practice, data suggest a bimodal structure with children later developing a relapse having more contacts also half a year before the relapse, suggesting that there could be early warnings

Who and when should we screen for prostate cancer? Interviews with key opinion leaders

Prostate cancer screening using prostate-specific antigen (PSA) is highly controversial. In this Q & A, Guest Editors for BMC Medicine's 'Spotlight on Prostate Cancer' article collection, Sigrid Carlsson and Andrew Vickers, invite some of the world's key opinion leaders to discuss who, and when, to screen for prostate cancer. In response to the points of view from the invited experts, the Guest Editors summarize the experts' views and give their own personal opinions on PSA screening

Long-Term Management of Pulmonary Embolism:A Review of Consequences, Treatment, and Rehabilitation

The concept of pulmonary embolism is evolving. Recent and emerging evidence on the treatment of specific patient populations, its secondary prevention, long-term complications, and the unmet need for rehabilitation has the potential to change clinical practice for the benefit of the patients. This review discusses the recent evidence from clinical trials, observational studies, and guidelines focusing on anticoagulation treatment, rehabilitation, emotional stress, quality of life, and the associated outcomes for patients with pulmonary embolism. Guidelines suggest that the type and duration of treatment with anticoagulation should be based on prevalent risk factors. Recent studies demonstrate that an anticoagulant treatment that is longer than two years may be effective and safe for some patients. The evidence for extended treatment in cancer patients is limited. Careful consideration is particularly necessary for pulmonary embolisms in pregnancy, cancer, and at the end of life. The rehabilitation and prevention of unnecessary deconditioning, emotional distress, and a reduced quality of life is an important, but currently they are unmet priorities for many patients with a pulmonary embolism. Future research could demonstrate optimal anticoagulant therapy durations, follow-ups, and rehabilitation, and effective patient-centered decision making at the end of life. A patient preferences and shared decision making should be incorporated in their routine care when weighing the benefits and risks with primary treatment and secondary prevention

Validation of the Khorana score for predicting venous thromboembolism in 40 218 patients with cancer initiating chemotherapy

The Khorana score is recommended for guiding primary venous thromboembolism (VTE) prophylaxis in cancer patients, but its clinical utility overall and across cancer types remains debatable. Also, some previous validation studies have ignored the competing risk of death, hereby potentially overestimating VTE risk. We identified ambulatory cancer patients initiating chemotherapy without other indications for anticoagulation using Danish health registries and estimated 6-month cumulative incidence of VTE stratified by Khorana levels. Analyses were conducted with and without considering death as a competing risk using the Kaplan-Meier method vs the cumulative incidence function. Analyses were performed overall and stratified by cancer types. Of 40 218 patients, 35.4% were categorized by Khorana as low risk (score 0), 53.6% as intermediate risk (score 1 to 2), and 10.9% as high risk (score ≥3). Considering competing risk of death, the corresponding 6-month risks of VTE were 1.5% (95% confidence interval [CI], 1.3-1.7), 2.8% (95% CI, 2.6-3.1), and 4.1% (95% CI, 3.5-4.7), respectively. Among patients recommended anticoagulation by guidelines (Khorana score ≥2), the 6-month risk was 3.6% (95% CI, 3.3-3.9). Kaplan-Meier analysis overestimated incidence up to 23% compared with competing risk analyses. Using the guideline-recommended threshold of ≥2, the Khorana score did not risk-stratify patients with hepatobiliary or pancreatic cancer, lung cancer, and gynecologic cancer. In conclusion, the Khorana score was able to stratify ambulatory cancer patients according to the risk of VTE, but not for all cancer types. Absolute risks varied by methodology but were lower than in key randomized trials. Thus, although certain limitations with outcome identification using administrative registries apply, the absolute benefit of implementing routine primary thromboprophylaxis in an unselected cancer population may be smaller than seen in randomized trials