Association between Androgen Deprivation Therapy and Risk of Dementia in Men with Prostate Cancer

The risk of dementia after androgen deprivation therapy (ADT) in patients with advanced prostate cancer (PCa) remains controversial. This study aimed to evaluate the association between ADT and the incidence of dementia in patients with PCa. We identified patients newly diagnosed with PCa in the National Health Insurance Database of Taiwan from 1 January 2002 to 30 June 2016 and in The Health Improvement Network of the United Kingdom (UK) from 1 January 1998 to 31 March 2018. We classified patients with PCa into ADT and ADT-naïve groups. Propensity score (PS) methods were used to minimize the differences in characteristics between the groups. We performed a Cox proportional hazard model to obtain the adjusted hazard ratio (HR) to compare the incidence of dementia between the groups. Our ADT group comprised 8743 and 73,816 patients in Taiwan and the UK, respectively, which were matched 1:1 to ADT-naïve patients by PS. The incidence rates of dementia in the ADT group were 2.74 versus 3.03 per 1000 person-years in the ADT naïve groups in Taiwan, and 2.81 versus 2.79 per 1000 person-years in the UK. There was no statistical difference between ADT and ADT-naïve groups (adjusted HR: 1.12; 95% confidence interval (CI): 0.87–1.43 in Taiwan and adjusted HR: 1.02; 95% CI: 0.85–1.23 in the UK). We found no association between the incidence of dementia and ADT in patients with advanced PCa in either database. Further studies are warranted to evaluate other possible triggers of incident dementia in patients receiving ADT for advanced PCa

Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: A 20-year experience

Objective: To investigate the trend of the posthepatectomy survival outcomes of hepatocellular carcinoma (HCC) patients by analysis of a prospective cohort of 1198 patients over a 20-year period. Background: The hospital mortality rate of hepatectomy for HCC has improved but the long-term survival rate remains unsatisfactory. We reported an improvement of survival results 10 years ago. It was not known whether there has been further improvement of results in recent years. Methods: The patients were categorized into two 10-year periods: period 1, before 1999 (group 1, n = 390) and period 2, after 1999 (group 2, n = 808). Patients in group 2 were managed according to a modified protocol and technique established in previous years. Results: The patients in group 2 were older and had a higher incidence of comorbid illness and cirrhosis. They had a lower hospital mortality rate (3.1% vs 6.2%, P = 0.012) and longer 5-year overall survival (54.8% vs 42.1%, P < 0.001) and disease-free survival rates (34.8% vs 24%, P = 0.0024). An improvement in the overall survival rate was observed in patients with cirrhosis, those undergoing major hepatectomy, and those with tumors of tumor-node-metastasis stages II, IIIA, and IVA. A significant increase in the survival rates was also seen in patients whose tumors were considered transplantable by the Milan criteria (72.5% vs 62.7%, P = 0.0237). Multivariate analysis showed a significantly more favorable patient survival for hepatectomy in period 2. Conclusions: A continuous improvement of survival outcomes after hepatectomy for HCC was achieved in the past 20 years even in patients with advanced diseases. Hepatectomy remains the treatment of choice for resectable HCC in a predominantly hepatitis B virus-based Asian population. © 2011 Lippincott Williams & Wilkins.postprin

Global epidemiology of hip fractures: a study protocol using a common analytical platform among multiple countries

INTRODUCTION: Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. METHODS AND ANALYSIS: This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. ETHICS AND DISSEMINATION: Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences

Molecular dynamics simulation of structural signals of shear-band formation in Zr46Cu46Al8 metallic glasses

201904 bcmaVersion of RecordPublishe

Drawing metro maps in concentric circles: a designer‐in‐the‐loop approach with visual examples

This article presents a proof-of-concept designer-in-the-loop schematic map drawing tool, based on the marriage of two approaches—manual and automated, which provides the technical interactivity of drawing tools between the user and the computer. We focus on concentric circle maps as opposed to the commonly used orthogonal mode representation, which is suggested by previous studies that it could promote better network learning. In comparison with existing methods, the proposed method is more compatible with the framework of effective map design from psychological and aesthetic perspectives, and a range of options can be provided in conjunction with users' preferences. We evaluated our approach on a set of iterations with case studies of Hong Kong metro with a group of three co-authors from the fields of geography, transport engineering, and education

Impact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients with Hepatocellular Carcinoma in a Tertiary Referral Center

Hypothesis: Preoperative fine-needle aspiration cytologic examination (FNAC) exerts a statistically significant adverse effect on long-term clinical outcome in patients with hepatocellular carcinoma (HCC). Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 828 patients with clinical suggestion of HCC received surgical treatment. Ninety-one patients underwent preoperative FNAC, suggesting HCC, and 737 patients did not. Main Outcome Measures: The resectability and histologic diagnoses of liver masses were evaluated in patients with and without preoperative FNAC. Clinicopathologic data and operative and survival outcomes of patients who underwent curative hepatic resection for HCC were compared between the FNAC and non-FNAC groups. Results: The resectability rates of the FNAC (81.3%) and non-FNAC (81.8%) groups did not differ (P=.91). Histologic examination of tumor confirmed HCC in 766 patients. The positive predictive value of preoperative FNAC was 96%, whereas that of preoperative imaging studies was 92% (P=.23). Among patients with nondiagnostic serum α-fetoprotein concentrations (≤400 ng/mL), 3% in the FNAC group (n=66) had benign liver diseases vs 9.5% in the non-FNAC group (n=432)(P=.09). Among patients with curative hepatic resection (70 in the FNAC group and 545 in the non-FNAC group), hospital mortality was 4% and 6% in the FNAC and non-FNAC groups, respectively. In the FNAC group, needle tract tumor seeding was not encountered. Excluding patients with preexisting and iatrogenic tumor rupture, intraperitoneal extrahepatic metastasis occurred in 1 patient (2%) in the FNAC group and in 30 (6%) in the non-FNAC group (P=.34). The cumulative 1-, 3-, and 5-year overall survival rates were 79%, 61%, and 48%, respectively, for the FNAC group and 75%, 55%, and 43% for the non-FNAC group (P=.77). The disease-free survival results of the groups were similar (P=.51). Conclusions: Preoperative FNAC has no statistically significant adverse effect on the operability, the possibility of extrahepatic tumor spread, or the long-term survival of patients with HCC. Preoperative FNAC may play a diagnostic role in selected patients with liver nodules on imaging studies when the serum α-fetoprotein concentration is not diagnostic.link_to_subscribed_fulltex

Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria

Background: There is a trend to offer liver transplantation to patients with hepatocellular carcinoma (HCC) with tumour status within the Milan criteria but with preserved liver function. This study aimed to evaluate the outcome of such patients following partial hepatectomy as primary treatment. Methods: A retrospective analysis was performed on all adult patients with HCC and tumour status within the Milan criteria undergoing partial hepatectomy at a single centre from 1995 to 2008. Their outcomes were compared with those of similar patients having right-lobe living donor liver transplantation (LDLT) as primary treatment. Results: A total of 408 patients with HCC were enrolled. Some 384 patients with a solitary tumour 5 cm or less in diameter had a better 5-year survival rate than 24 patients with oligonodular tumours (2-3 nodules, each 3 cm or less in size) (70·7 versus 46 per cent; P = 0·025). Multivariable analysis identified younger age (65 years or less), lack of postoperative complications, negative resection margin, absent microvascular invasion and non-cirrhotic liver as predictors of favourable overall survival. The 5-year survival rate of 287 younger patients with chronic liver disease and R0 hepatectomy was 72·8 per cent, comparable to that of 81 per cent in 50 similar patients treated by LDLT (P = 0·093). Conclusion: Partial hepatectomy for patients with HCC and tumour status within the Milan criteria achieved a satisfactory 5-year survival rate, particularly in younger patients with solitary tumours and R0 hepatectomy. Patients with oligonodular tumours have a worse survival and might benefit from liver transplantation. © 2011 British Journal of Surgery Society Ltd. Published by John Wiley and Sons Ltd.link_to_subscribed_fulltex