Castleman Disease Presenting as Renal Hilar Mass

Background: We report a case of unicentric Castleman disease, a rare type of benign proliferation of lymphoid tissue. We present an uncommon disease that was managed effectively using laparoscopy. Case Presentation: A 32-year-old woman presented with left-sided flank pain. A large retroperitoneal mass was detected in the left renal hilum close to the renal vessels. Laparoscopic removal of the mass was effectively performed. The pathologic examination was in favor of a rare type of benign proliferation of lymphoid tissue compatible with Castleman disease. The patient was cured with no evidence of recurrence in 1-year follow-up. Conclusion: Transperitoneal laparoscopic approach is feasible and effective in the management of this disease and is curative

Sleep Pattern, Duration and Quality in Relation with Glycemic Control in People with Type 2 Diabetes Mellitus

Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial

Purpose: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Materials and Methods: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Results: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49mm2) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Conclusion: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times

Overall Survival and Functional Results of Prostate-Sparing Cystectomy

Purpose: To compare two matched groups of men with bladder transitional cell carcinoma (TCC) who underwent prostate-sparing cystectomy (PSC) or conventional radical cystoprostatectomy (CRC). Materials and Methods: Twenty-three men who have undergone PSC with the diagnosis of EODGGHU�7&&��7D±7���IURP������WR������LQ�7HKUDQ��,UDQ�ZHUH�LQFOXGHG�LQ�WKH�VWXG\�DV�WKH�H[- perimental group. The control group composed of 27 men with comparable tumor characteristics and age range, who had non-nerve-sparing radical cystoprostatectomy and orthotopic ileal W pouch reconstruction in the same center. All the procedures were performed by the same surgical group under the supervision of different attending staff. Results: Mean follow-up period was 39 months in PSC and 35 months in CRC group. The 5-year overall survival was 47% and 30% in PSC and CRC groups, respectively. Median survival was 48 months in PSC and 36 months in CRC group, using Kaplan-Meier survival analysis (P > .05). Impotence was observed in 16.6% in PSC and in 83.3% in CRC group (P� ��������0HDQ�,QWHUQDWLRQDO�,QGH[�RI�(UHFWLOH�)XQFWLRQ���VFRUH�RI�WKH�36&�JURXS�ZDV� 19.8 compared with 5.7 in the CRC group (P = .003). Only one patient in each group was completely incontinent. Urethral anastomosis stricture occurred in 2 patients in CRC group. Conclusion: Patients who underwent PSC did not show decreased overall survival compared to CRC, which provided better functional results. Keywords: urinary bladder neoplasms, transitional cell carcinoma, cystectomy, male, prognosis, adverse effect

Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. Tis study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day afer surgery using sonography and plain radiography. Results. Te mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. Te mean stone burden was 504 ± 350 mm2. Te mean duration of surgery was 43 ± 21 minutes. Te early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. Te mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden signifcantly predicted positive residual stones. Fifeen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classifcation. Tere was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate

The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017 : a systematic analysis for the Global Burden of Disease study 2017

Background: Stomach cancer is a major health problem in many countries. Understanding the current burden of stomach cancer and the differential trends across various locations is essential for formulating effective preventive strategies. We report on the incidence, mortality, and disability-adjusted life-years (DALYs) due to stomach cancer in 195 countries and territories from 21 regions between 1990 and 2017. Methods: Estimates from GBD 2017 were used to analyse the incidence, mortality, and DALYs due to stomach cancer at the global, regional, and national levels. The rates were standardised to the GBD world population and reported per 100 000 population as age-standardised incidence rates, age-standardised death rates, and age-standardised DALY rates. All estimates were generated with 95% uncertainty intervals (UIs). Findings: In 2017, more than 1·22 million (95% UI 1·19–1·25) incident cases of stomach cancer occurred worldwide, and nearly 865 000 people (848 000–885 000) died of stomach cancer, contributing to 19·1 million (18·7–19·6) DALYs. The highest age-standardised incidence rates in 2017 were seen in the high-income Asia Pacific (29·5, 28·2–31·0 per 100 000 population) and east Asia (28·6, 27·3–30·0 per 100 000 population) regions, with nearly half of the global incident cases occurring in China. Compared with 1990, in 2017 more than 356 000 more incident cases of stomach cancer were estimated, leading to nearly 96 000 more deaths. Despite the increase in absolute numbers, the worldwide age-standardised rates of stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with improved Socio-demographic Index. Globally, 38·2% (21·1–57·8) of the age-standardised DALYs were attributable to high-sodium diet in both sexes combined, and 24·5% (20·0–28·9) of the age-standardised DALYs were attributable to smoking in males. Interpretation: Our findings provide insight into the changing burden of stomach cancer, which is useful in planning local strategies and monitoring their progress. To this end, specific local strategies should be tailored to each country's risk factor profile. Beyond the current decline in age-standardised incidence and death rates, a decrease in the absolute number of cases and deaths will be possible if the burden in east Asia, where currently almost half of the incident cases and deaths occur, is further reduced. Funding: Bill & Melinda Gates Foundation

Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021–30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050. Methods In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model. Findings Globally, 595 million (95% uncertainty interval 535–656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8–8·4) of the global population, and an increase of 132·2% (130·3–134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4–89·9) for knee, 48·6% (35·9–67·1) for hand, 78·6% (57·7–105·3) for hip, and 95·1% (68·1–135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7–557·2) per 100 000 in 2020, a 9·5% (8·6–10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3–510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8–6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0–9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI –1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling. Interpretation Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin