Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic drugs. Guidelines for the proper use of SGLT2 inhibitors recommend caution regarding urinary tract infections ...(UTIs). However, little evidence has been reported on the relationship between SGLT2 inhibitors and UTIs in large epidemiological studies. We investigated (1) the relationship between diabetes mellitus (DM) and UTIs and (2) the relationship between SGLT2 inhibitor prescriptions and the likelihood of developing UTIs in patients with DM, using a nationwide Japanese health insurance claims database by MDV analyzer®. We found that the incidence of UTIs was significantly higher among patients with DM than among those without DM (odds ratio (OR), 1.71; 95% confidence interval (CI), 1.69–1.72, for male; OR, 1.90; 95% CI, 1.89–1.92 for female). In contrast, in male patients with DM, the prescription of SGLT2 inhibitors was negatively associated with the likelihood of developing UTIs (OR, 0.74; 95% CI, 0.72–0.75). Among female patients with DM, there was no significant difference in the incidence of UTIs with or without an SGLT2 inhibitor prescription (OR, 0.99; 95% CI, 0.96–1.01). Subgroup analyses by age confirmed similar relationships between SGLT2 inhibitor prescriptions and UTIs, except for female patients aged ≤39 years, in whom SGLT2 inhibitor prescription was negatively associated with the likelihood of developing UTIs. In conclusion, our analysis of a nationwide claims database found no evidence that SGLT2 inhibitors increase UTIs in Japanese patients with DM, regardless of sex or age.
Background
Squamous cell carcinoma antigen (SCC-Ag) and carcinoembryonic antigen (CEA) are widely used in clinical practice to predict the prognosis of patients with esophageal squamous cell ...carcinoma (ESCC). However, their predictive values for prognosis are controversial. This study determined optimal cutoff values of serum SCC-Ag and CEA concentrations for predicting postoperative recurrence of ESCC, which enabled selection of high-risk patients.
Methods
The study retrospectively analyzed 427 patients who underwent curative resection for ESCC. The optimal cutoff values of preoperative SCC-Ag and CEA concentrations for predicting postoperative recurrence were determined using combined analysis of hazard ratios and sensitivities for recurrence. Using the optimal cutoff value, the study evaluated survival, recurrence patterns, and temporal changes in marker concentrations.
Results
The preoperative SCC-Ag concentration of 1.1 ng/ml was the optimal cutoff value for predicting postoperative recurrence, whereas precise cutoff values could not be determined for preoperative CEA concentrations. High preoperative SCC-Ag concentrations (> 1.1 ng/ml), which were significantly associated with more aggressive tumor phenotypes and shorter disease-free survival, were identified as an independent prognostic factor in the multivariable analysis. High preoperative SCC-Ag concentrations were significantly associated with greater prevalence of lung/pleura and local recurrences. Normalization of serum SCC-Ag concentrations after neoadjuvant treatment or esophagectomy was not associated with a decreased risk of postoperative recurrence.
Conclusions
The optimal cutoff value of preoperative SCC-Ag concentrations that predicted recurrence of ESCC was 1.1 ng/ml, illuminating the utility of serum SCC-Ag concentrations as an easily measurable tool for selecting a perioperative management strategy.
To investigate the longitudinal association of urgency urinary incontinence (UUI) with loss of independence (LOI) or death among independent community-dwelling older adults.
Population-based cohort ...study.
The Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), Minami-Aizu Town and Tadami Town, Fukushima, Japan.
A total of 1,580 participants aged ≥65 years who underwent a health check-up conducted by LOHAS in 2010.
Exposure was defined as the presence of UUI, which was measured by a questionnaire based on the definition of UUI from the International Continence Society. The primary outcome was defined as incidence of LOI or death. After the check-up in 2010, the outcome was monitored until March 2014. A multivariable Cox proportional hazard analysis was performed to estimate the hazard ratio for the outcome. Ten potential confounders were adjusted in the analysis. Furthermore, we defined the secondary outcomes as two separate outcomes, LOI and death, and performed the same analysis.
Among all participants, 328 reported UUI. The incidence rates of the outcome were 20.4 and 11.4 (per 1,000 person-years) among participants with and without UUI, respectively. After multivariable adjustment, those who experienced UUI showed a substantial association with LOI or death (HR, 1.65; 95% CI, 1.01-2.68). However, they did not show such an association with LOI alone (HR, 1.07; 95% CI, 0.49-2.33). On the other hand, those with UUI exhibited a substantial association with death (HR, 2.23; 95% CI, 1.22-4.31).
In this study, UUI was associated with the occurrence of LOI or death; however, UUI is not associated with the occurrence of LOI alone among independent community-dwelling older adults. Our results suggest that there may be a difference between UUI-associated diseases that cause LOI and those that cause death.
Objectives
To determine the influence of the early unclamping technique on the risk of renal artery pseudoaneurysm during robot‐assisted laparoscopic partial nephrectomy.
Methods
From January 2013 to ...October 2014, 96 patients underwent robot‐assisted laparoscopic partial nephrectomy for renal masses at Tokyo Women's Medical University Hospital, Tokyo, Japan. Computed tomography angiography was carried out 3–4 days after surgery. Early in the series, renal hilum was left unclamped and renorrhaphy was subsequently carried out (conventional unclamping technique). An early unclamping technique has been used since November 2013.
Results
A total of 61 patients underwent robot‐assisted laparoscopic partial nephrectomy with early unclamping, and 35 patients underwent robot‐assisted laparoscopic partial nephrectomy with conventional unclamping. Ischemia time was significantly shorter in the early unclamping group (16.5 vs 23.1 min; P < 0.01). The early unclamping group showed a significantly lower incidence of asymptomatic renal artery pseudoaneurysm relative to the conventional unclamping group (11.4% vs 28.6%; P = 0.03). Multivariate analysis showed that the early unclamping technique was a significant independent factor in reducing the risk of renal artery pseudoaneurysm (hazard ratio 0.27; P = 0.01).
Conclusions
The present findings suggest that an early unclamping technique might reduce ischemic time and risk of renal artery pseudoaneurysm. The absence of arterial bleeding before renorrhaphy is likely to be a key step in preventing renal artery pseudoaneurysm during robot‐assisted laparoscopic partial nephrectomy.
Background
Patients undergoing subtotal esophagectomy for esophageal cancer frequently experience postoperative pneumonia. Development of preoperatively determined predictors for postoperative ...pneumonia will facilitate identifying high-risk patients and will assist with informing patients about their risk of postoperative pneumonia, enabling physicians to estimate with greater accuracy, will result in tailoring perioperative management.
Methods
Postoperative pneumonia was defined according to the revised Uniform Pneumonia Score. We analyzed the data for 355 patients to compare 32 potential predictive variables associated with postoperative pneumonia after subtotal esophagectomy.
Results
Forty-one patients (11.5%) had postoperative pneumonia. Preoperative cholinesterase (ChE) concentrations demonstrated the greatest area under the curve value (0.662) to predict postoperative pneumonia (optimal cutoff value = 217 IU/l). Univariate analysis identified a continuous value of preoperative ChE concentration as a significant risk factor for postoperative pneumonia (
P
= 0.0014). Multivariable analysis using factors potentially relevant to pneumonia revealed that preoperative ChE concentration was one of independent risk factors for pneumonia after esophagectomy (
P
= 0.008). Patients with low ChE concentrations were at increased risk of postoperative pneumonia in most patient subgroups. Moreover, the odds ratios of low ChE concentrations were highest in patients undergoing neoadjuvant treatment. A combination of preoperative serum ChE concentrations and Brinkman index stratified patients into low, intermediate, and high risk of postoperative pneumonia.
Conclusions
Our findings indicate that preoperative ChE concentrations, particularly in combination with Brinkman index, may serve simply as a determined predictor of pneumonia after subtotal esophagectomy and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.
Background
Inflammation plays a critical role in the development and progression of cancers. We evaluated the clinical significance of the preoperative modified systemic inflammation score (mSIS) to ...predict long-term outcomes of patients with esophageal squamous cell carcinoma (ESCC).
Methods
We included 443 patients who underwent curative resection of ESCC. The mSIS was formulated according to the serum albumin level (ALB) and lymphocyte-to-monocyte ratio (LMR) as follows: mSIS 0 (ALB ≥ 4.0 g/dL and LMR ≥ 3.4), mSIS 1 (ALB < 4.0 g/dL or LMR < 3.4), and mSIS 2 (ALB < 4.0 g/dL and LMR < 3.4).
Results
Patients were categorized into preoperative mSIS 0 (
n
= 165), mSIS 1 (
n
= 183), and mSIS 2 (
n
= 95) groups. Preoperative mSIS was significantly associated with age, preoperative body mass index, and pathological disease stage. The disease-specific survival times of patients in preoperative mSIS 0, 1, and 2 sequentially shortened (
P
= 0.009), and mSIS 2 was identified as an independent prognostic factor (hazard ratio 2.63, 95% confidence interval 1.33–5.27,
P
= 0.0053). In most patient subgroups, the mSIS was associated with greater risk of disease-specific death. A stepwise increase in the prevalence of hematogenous recurrences was directly proportion to the mSIS. When patients were subdivided by mSIS before neoadjuvant treatment, there were no significant differences in disease-specific survival.
Conclusions
Our findings demonstrate that the preoperative mSIS may serve as a powerful prognosticator of ESCC that definitively stratifies clinical outcomes as well as a tool for selecting treatment strategies.
Background
Recurrence after radical resection of esophageal squamous cell carcinoma (ESCC) is common. Limited evidence is available about the differences in clinical characteristics, risk factors, ...and prognostic significance between nodal and distant recurrence of thoracic ESCC.
Patients and Methods
We retrospectively analyzed 341 patients who underwent radical resection of thoracic ESCC and experienced (1) initial recurrence only in lymph nodes (
n
= 39), (2) recurrence only at distant organs (
n
= 57), or (3) no recurrences (
n
= 245) after follow-up ≥ 24 months. Clinicopathological characteristics, survival times, and risk factors were compared between the nodal and distant recurrence groups.
Results
The median follow-up time was 57.8 months. Metastasectomy as initial treatment for the recurrence was performed for six (15.4%) patients in the nodal recurrence group and one patient in the distant recurrence group. Compared with the nodal recurrence group, patients with distant recurrence had significantly shorter disease-free survival hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.10–2.57,
P
= 0.0169, postrecurrence survival (HR 1.77, 95% CI 1.01–3.10,
P
= 0.0476), and overall survival (HR 1.98, 95% CI 1.12–3.51,
P
= 0.0193). The distant recurrence group had significantly larger macroscopic tumor size and more advanced pathological T stage than the nodal recurrence group, whereas preoperative treatment, tumor location, number of fields dissected, tumor differentiation, lymphatic involvement, and vessel invasion were not significantly different between the two groups.
Conclusions
Survival times and recurrence risk factors differed between patients with nodal and distant recurrence after radical resection of thoracic ESCC.
Abstract
Purpose
To investigate the feasibility of continuing aspirin therapy in patients with renal tumours undergoing robot-assisted laparoscopic partial nephrectomy.
Methods
This retrospective, ...single-centre study included 106 patients receiving aspirin therapy who underwent robot-assisted laparoscopic partial nephrectomy. The patients were divided into two groups, including those continuing and discontinuing aspirin therapy, and their surgical outcomes were compared. To minimise potential bias, variables including patient and tumour characteristics were adjusted using 1:1 propensity score matching.
Results
Aspirin therapy was used for ischaemic heart disease in 38 patients (36%), cerebrovascular disease in 21 (20%) and others in 47 (44%). Of the 106 patients, 49 were classified to the continuing group and 57 to the discontinuing group. After matching, 24 patients were included in each group. The surgical outcomes, such as changes in the estimated glomerular filtration rate, estimated blood loss, and surgical margin positivity rate, were not significantly different between the groups. In addition, no significant difference was observed in haemoglobin level changes during surgery (continuing: −2.3 g/dl; discontinuing: −1.7 g/dl, P = 0.0676) and haemorrhagic complications (continuing: 8%; discontinuing: 4%, P = 0.500). Multivariate analysis of predictors for haemoglobin level decrease >2 g/dl or haemorrhagic complications showed that, whereas tumour complexity was an independent predictor, continuation or discontinuation of aspirin therapy was not.
Conclusion
The surgical outcomes of robot-assisted laparoscopic partial nephrectomy between patients continuing and discontinuing aspirin therapy were not significantly different, thus suggesting the feasibility of continuing aspirin therapy in selected Japanese patients.
This study showed that patients continuing aspirin therapy had similar surgical outcomes, including estimated blood loss, bleeding complications, decreased haemoglobin level during surgery and postoperative length of hospital stay, to those discontinuing aspirin therapy. These findings suggest that aspirin therapy can be continued in selected patients undergoing robot-assisted laparoscopic partial nephrectomy.
Little is known about the fall risk of older adults with overactive bladder, especially in the absence of urgency incontinence. We evaluated the impacts of overactive bladder with and without urgency ...incontinence (overactive bladder wet and overactive bladder dry) on the fall risk in older adults, and investigated the importance of overactive bladder as a predictor of falls by using tree based models.
This prospective cohort study included 630 community dwelling, independent older adults 75 years old or older who attended a health checkup in 2017 with a 1-year followup. The associations of overactive bladder dry and overactive bladder wet with a fall history, and future fall risk compared to no overactive bladder were assessed using logistic regression models. The contribution of overactive bladder as a predictor of falls was examined using a random forest and decision tree approach.
Of the 577 analyzed participants (median age 79 years), 273 (47%) were men. The prevalence of overactive bladder dry and overactive bladder wet at baseline was 15% and 14%, respectively. Multivariable logistic regression analysis revealed that both overactive bladder dry and overactive bladder wet were associated with a higher likelihood of prior falls (adjusted ORs vs no overactive bladder 2.03 and 2.21, respectively; 95% CI 1.23-3.37 and 1.29-3.78, respectively). Among the 363 participants without a fall history, the adjusted ORs (95% CIs) of overactive bladder dry and overactive bladder wet for the occurrence of falls during the 1-year followup were 2.74 (1.19-6.29) and 1.35 (0.47-3.87), respectively. The tree based approach used for all participants showed that overactive bladder was an important predictor of falls in adults without a fall history, and the model had 83.6% accuracy and 81.8% AUC.
Overactive bladder, even in the absence of urgency incontinence, is an important predictor of falls in older adults with a low absolute fall risk.
Abstract Objective The purpose of this study was to investigate the correlation between the controlling nutritional status (CONUT) score and survival of patients with localized urothelial carcinoma ...of the upper urinary tract treated with radical nephroureterectomy (RNU). Methods and materials We retrospectively enrolled 107 patients. CONUT score was calculated based on the serum albumin concentration, lymphocyte count, and total cholesterol concentration. Patients were classified into 2 groups based on CONUT score. Relapse-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) after RNU were compared between the 2 groups, and predictors of survival were analyzed using Cox proportional hazards regression models. Results For CONUT score, the area under the curve was 0.588 and the optimal cutoff value was 3. Twenty-four patients (22.4%) had high CONUT scores. The patients with high CONUT scores had significantly shorter 5-year RFS, CSS, and OS than did those with low CONUT scores (RFS: 50.1% vs. 66.0%; CSS: 28.1% vs. 71.7%; OS: 26.4% vs. 66.8%; all P <0.05). Results of the multivariable analysis, after adjustment for factors such as pT stage, pN stage, tumor grade, presence of lymphovascular invasion, and C-reactive protein level, revealed that CONUT score was an independent predictor of CSS (hazard ratio HR = 5.44, P = 0.0016) and OS (HR = 2.90, P = 0.0214) and showed marginal significance for predicting RFS (HR = 2.26, P = 0.0581). Conclusions Preoperative CONUT score helps predict survival in patients with localized urothelial carcinoma of the upper urinary tract treated with RNU.
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