Prevalence of endotoxemia after surgery and its association with ICU length of stay

INTRODUCTION: The aim of this observational study was to investigate the prevalence of endotoxemia after surgery and its association with ICU length of stay. METHODS: 102 patients admitted to a university ICU after surgery were recruited. Within four hours of admission, functional data were collected and APACHE II severity score calculated. Arterial blood samples were taken and endotoxemia was measured by chemiluminescence (Endotoxin Activity (EA)). Patients were stratified according to their endotoxin levels (low, intermediate and high) and according to their surgical procedures. Differences between endotoxin levels were assessed by ANOVA, accepting P < 0.05 as significant. Data are expressed as mean +/- SD. RESULTS: EA levels were low in 68 (66%) patients, intermediate in 17 (17%) and high in 17 (17%). Age (61 +/- 17 years) and APACHE II score 8.3 +/- 3.7 (P = 0.542) were not significantly different in the three EA groups. Functional parameters on admission were similar between EA groups: white blood cells 11093 +/- 4605 cells/mm3 (P = 0.385), heart rate 76 +/- 16 bpm (P = 0.898), mean arterial pressure 88.8 +/- 13.6 mmHg (P = 0.576), lactate 1.18 +/- 0.77 mmol/L (P = 0.370), PaO2/FiO2 383 +/- 109 mmHg (P = 0.474). Patients with high levels of EA were characterized by longer length of stay in the ICU: 1.9 +/- 3.0 days in the low EA group, 1.8 +/- 1.4 days in intermediate and 5.2 +/- 7.8 days in high group (P = 0.038). CONCLUSIONS: 17% of our patients were characterized by high levels of endotoxemia as assessed by EA assay, despite their low level of complexity on admission. High levels of endotoxin were associated with a longer ICU length of stay

Diseño y elaboración de bases de datos de consulta on-line de ayuda a la docencia en las Ciencias Sociales

Memoria ID-0197. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2016-2017

Adverse Pathological Findings at Radical Prostatectomy following Active Surveillance: Results from the Movember GAP3 Cohort.

Background: Little is known about the consequences of delaying radical prostatectomy (RP) after Active Surveillance (AS) according to stringent or wider entry criteria. We investigated the association between inclusion criteria and rates, and timing of adverse pathological findings (APFs) among patients in GAP3 cohorts. Methods: APFs (GG &ge; 3, pT &ge; 3, pN &gt; 0 and positive surgical margins [R1]) were accounted for in very low-risk (VLR: grade group [GG] 1, cT1, positive cores &lt; 3, PSA &lt; 10 ng/mL, PSA density [PSAD] &lt; 0.15 ng/mL/cm3) and low-risk (LR: GG1, cT1-2, PSA &le; 10 ng/mL) patients undergoing subsequent RP. The Kaplan&ndash;Meier method and log&ndash;rank test analyzed APF-free survival. Stratified mixed effects models analyzed association. Results: Out of 21,169 patients on AS, 1742 (VLR: 721; LR: 1021) underwent delayed RP. Most (60.8%) did not have APFs. APFs occurred more frequently (44.6% vs. 31.7%; OR 1.54, p &lt; 0.001) and earlier (median time: 40.3 vs. 62.6 months; p &lt; 0.001) in LR patients, and consisted of pT &ge; 3 (OR 1.47, p = 0.013) or R1 (OR 1.80, p &lt; 0.001), but not of GG &ge; 3 or node involvement. Age (OR 1.05, p &lt; 0.001), PSAD (OR 23.21, p = 0.003), and number of positive cores (OR 1.16, p = 0.004) were independently associated with APFs. Conclusions: AS stands as a safe option for low-risk patients, and most do not have APFs at surgery. Wider entry criteria are associated with pT3 and R1. The prognostic implications remain uncertain

Cross-cultural differences in men on active surveillance’ anxiety: a longitudinal comparison between Italian and Dutch patients from the Prostate cancer Research International Active Surveillance study

Background: Men diagnosed with localized prostate cancer (PCa) on active surveillance (AS) have shown to cope with anxiety caused by living with an ‘untreated cancer’ and different factors can influence the tolerance level for anxiety in these patients. The present study analyzes Italian (Milan) and Dutch (Rotterdam) men prospectively included in the Prostate cancer International Active Surveillance (PRIAS) trial, aiming to explore whether socio-demographic factors (i.e. age, relationship status, education, nationality) may be relevant factors in conditioning the level of anxiety at AS entry and over time. Methods: Italian and Dutch men participating in the IRB-approved PRIAS study, after signing an informed consent, filled in the Memorial Anxiety Scale for PCa (MAX-PC) at multiple time points after diagnosis. A linear mixed model was used to assess the relationship between the level of patient’s anxiety and time spent on AS, country of origin, the interaction between country and time on AS, patients’ relationship status and education, on PCa anxiety during AS. Results: 823 MAX-PC questionnaires were available for Italian and 307 for Dutch men, respectively. Median age at diagnosis was 64 years (IQR 60–70 years) and did not differ between countries. On average, Dutch men had a higher total MAX-PC score than Italian men. However, the level of their anxiety decreased over time. Dutch men on average had a higher score on the PCa anxiety sub-domain, which did not decrease over time. Minimal differences were observed in the sub-domains PSA anxiety and fear of recurrence. Conclusion: Significant differences in PCa anxiety between the Italian and Dutch cohorts were observed, the latter group of men showing higher overall levels of anxiety. These differences were not related to the socio-demographic factors we studied. Although both PRIAS-centers are dedicated AS-centers, differences in PCa-care organization (e.g. having a multidisciplinary team) may have contributed to the observed different level of anxiety at the start and during AS. Trial registration This study is registered in the Dutch Trial Registry (www.trialregister.nl) under NL1622 (registration date 11-03-2009), ‘PRIAS: Prostate cancer Research International: Active Surveillance—guideline and study for the expectant management of localized prostate cancer with curative intent’

Prostate cancer patients on active surveillance: is physical activity associated with health-related quality of life?

The benefits of physical activity (PA), even of low intensity, on disease progression, urinary symptoms, psychological wellbeing, and health-related quality of life (HRQoL) of prostate cancer (PCa) patients have been documented by several studies (Richman 2011; Chipperfield 2014; Thorsen 2008). To our knowledge, there are no studies investigating the effects of PA on HRQoL among PCa patients in Active Surveillance (AS). The present research aimed to study the relationship between the level of PA performed by patients in AS and their HRQoL

Lifestyle interventions to improve the quality of life of men with prostate cancer: A systematic review of randomized controlled trials

Improving quality of life is a key issue for patients with prostate cancer (PCa). Lifestyle interventions could positively impact the quality of life of patients. However, there is no clear-cut understanding of the role of diet, exercise and risky behaviour reduction in improving the quality of life of men with PCa. The aim of this review was to systematically summarize randomized controlled trials on lifestyle in PCa patients with quality of life as main outcome. 17 trials were included. Most of them referred to exercise interventions (71%) and involved men undergoing androgen deprivation therapy (47%). Exercise studies yielded the greater amount of positive results on quality of life outcomes (67%), followed by dietary interventions (50%) and combined lifestyle interventions (33%). In particular, supervised exercise programs with resistance training sessions were the ones producing greater convincing evidence for benefits on quality of life. Further studies with high methodological quality providing adequate information to develop evidence-based, personalized lifestyle interventions that can effectively ameliorate PCa-related quality of life are needed

ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND QUALITY OF LIFE IN PROSTATE CANCER PATIENTS FOLLOWING ACTIVE SURVEILLANCE

Introduction Active surveillance (AS) can be an attractive and feasible management option for patients with low-grade, low-volume prostate cancer (PCa) (Dall’Era et al., 2008). It is still unclear if living with an untreated cancer can lower the quality of life (QoL) of these patients (Daubenmier et al., 2006). Few studies investigated those aspects and explored the factors that are able to hinder or improve the QoL in these patients (Bellardita et al., 2014). In particular, there is a paucity of studies investigating the potential of health-promoting behaviors, such as engaging in greater physical exercise, in improving QoL and wellbeing of men with PCa in AS (Daubenmier et al., 2006). The purpose of the present study was to investigate the association between physical activity and QoL in patients with PCa in AS. Methods Pca patients enrolled in the Prostate cancer Research International: AS (PRIAS) protocol and accepting to participate in an ancillary study on QoL were invited to participate. At 10 month after the diagnosis, patients were asked to complete self-reported validated questionnaires assessing physical activity (through the International Physical Activity Questionnaire - IPAQ) and generic and disease-specific health-related QoL (through the Short Form 36 - SF-36 – and the Functional Assessment of Cancer Therapy scale Prostate Version - FACT-P). Descriptive analyses were conducted and stepwise multiple regression analyses were performed to examine the impact of exercise type and activity on QoL scores. Statistical significance was established at p < .05. Results 81 patients with a mean age of 64 years (SD=7; 42-79 years) accepted to participate. Analyses showed that patients engaging in more physical activity experience greater physical wellbeing (FACT-P) (p=0.018; R2=0.085; F=5.294; ß=0.291) and higher mental health scores (SF-36) (p=0.025; R2=0.071; F=5.268; ß=0.266). In particular, patients doing greater vigorous activity reported greater FACT-P functional wellbeing (p=0.025; R2=0.08; F=5.253; ß =0.273). Conclusion The present study indicated that almost the 10% of variance of physical, mental, and functional QoL of Pca men in AS can be explained by changes in physical exercise. Our results, although preliminary and limited by small sample and effect size, highlight the importance to recommend lifestyle change in AS clinical practice and to focus upon strategies to support maintenance of exercise activity to sustain QoL of Pca patients in AS

FACING UNTREATED PROSTATE CANCER ON ACTIVE SURVEILLANCE: WHO IS AT RISK FOR INCREASED ANXIETY?

Introduction. “Living with untreated prostate cancer (PCa)” may cause distress in men on Active Surveillance (AS). We aimed to evaluate PCa-related anxiety (anx) over the first 2 years on AS. Patients and Methods. Between 2007-2014, 207 patients (pts) progressively completed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), a self-report tool providing 4 indexes: PCa anx, PSA anx, fear of recurrence, MAX-PC total score. Assessment was conducted at entrance in AS protocol (T0), 2 months before first re-biopsy from diagnostic one (T1), after re-biopsy (T2) and 1 year after re-biopsy (T3). Cronbach’s α was calculated to estimate internal consistency for each index. Descriptive analyses were performed. Wilcoxon test was used to detect statistically significant changes over time. Results. Mean age of sample at diagnosis was 64 years (SD=7; 42-79 yrs). Figure 1 shows results of descriptive analyses. The majority of pts had low scores in all the subscales and the MAX-PC total index (skewness>0). Cronbach’s α was ≥ 0.70 for all indexes, indicating good internal consistency. Wilcoxon test showed statistically significant reductions in MAX-PC total score (61% of pts, p=0,0006) and PCa anx (58% of pts, p=0,0012) between T1 and T2. Conclusions. This is the first study to report on PCa-related anx over the first 2 years on AS, which emerged as favourably low. Internal consistency analyses showed that MAX-PC is reliable tool to assess anxiety in men on AS despite it was developed for patients undergoing radical prostatectomy. Further research is needed to confirm its validity in the population of AS pts. In particular for “fear of recurrence”, originally designed to measure worry for cancer relapse after radical treatment. Yet, items seem to be properly applicable to fear for disease progression. The concurrence of decrease in anx with the first re-biopsy highlights a potentially reassuring role of the AS monitoring scheme