Tag Archives: PD 0332991

br Results br Discussion For entrapment

Results

Discussion
For entrapment neuropathies, US has proven to be a valuable tool in diagnosing the site of entrapment and the possible underlying etiology, and has become an important tool complementary to clinical electrophysiology (Beekman and Visser 2004; Bianchi et al. 1999; Cartwright and Walker 2013; Lee and Healy 2005; Martinoli et al. 2000; Nakamichi and Tachibana 2003). In the vicinity of the entrapment site, the nerve may be focally thickened. Thus, analysis of nerve cross-sectional areas plays a crucial role in US examinations. We measured the cross-sectional areas of the UN, SBUN and DBUN in US still images. The results we obtained for the UN are in agreement with existing studies of patients (Cartwright and Walker 2013; Kerasnoudis and Pitarokoili 2014; Peeters et al. 2004; Sugimoto et al. 2013). Measurements of the cross-sectional areas of the DBUN and SBUN have not yet been presented. Our data on these PD 0332991 may serve as a reference for further, more detailed US characterizations of UN branches within the UT (Table 1). We emphasize that these measurements are based on 21 cadaver specimens. Because there are no significant differences in the dimensions of the UN from existing data, we assume that our ex vivo measurements of the DBUN and SBUN might be similar to in vivo measurements.
The majority of UTSs are caused by local compressing masses or trauma and, thus, require surgical intervention (Chen and Tsai 2014). Conservative therapy is primarily indicated in UTS with mild sensory symptoms, subsequent to repetitive trauma, strain or direct pressure on the UT. Such lesions usually are type 2 according to Wu et al. (1985) and are located in zone 3 of the UT according to Gross and Gelberman (1985). In the conservative management of carpal tunnel syndrome, perineural injection of corticosteroids has proven to be successful (Marshall et al. 2007). Perineural injection of corticosteroids is not an established therapeutic option in the management of UTS. There are no clinical trials because feasibility studies are lacking. To our knowledge, our study is the first to prove that in cadavers, perineural injection of fluids into the UT can be performed without damaging blood vessels, tendons or the UN and its branches. Thus, our study can be the basis for designing potentially tolerable clinical trials with the prospect of ensuring delivery of the injection agent to the relevant nerve.
The UT is a confined space with densely packed contents. Exact positioning of the injection needle without image guidance could easily lead to an erroneous intra-neural or intra-vasal application of corticosteroids or could even cause a direct lesion on nerve fascicles (Frederick et al. 1992). The intra-neural application of a crystalline corticosteroid could have neurotoxic effects or even induce the formation of a nerve granuloma. An injection erroneously made into the ulnar artery or ulnar veins could give rise to such far-reaching complications as emboli and necrosis (Berthelot et al. 2013; Kim and Park 2014). Only US guidance allows constant visualization of the needle tip and, thus, controlled application of an injection fluid with adequate spatial resolution. It can help to reduce the number of needle passes required to position the needle tip correctly right at the neural sheath while avoiding blood vessels. As a consequence, a US-guided injection also makes it possible to decrease the volume of fluid injected (Koscielniak-Nielsen 2008; Porter and Inglefield 1993). The latter is of particular relevance in the UT. Because the anatomic boundaries of the UT are composed of tendons, ligaments and dense connective tissue, the UT walls do not elastically expand after injection of a large volume. In such an event, the large injection volume could increase the pressure on the nerve and thus aggravate the entrapment. With respect to previously published effective injection doses in carpal tunnel syndrome, we assume that technically an injection volume of 1 mL could contain a therapeutically effective dose of corticosteroids (Marshall et al. 2007).

Centralization of prostatectomy has been a controversial

Centralization of prostatectomy has been a controversial topic in oncologic urology [32,33]. Although the evidence existed that outcomes did improve with higher experience [1,2], and that these improved outcomes translated to reduced costs of care [8], questions remained as to how these could be realized in practice. Our view, as supported by these results, is one of incremental shift in where prostatectomies are done, starting with geographies where higher experience is readily available. We do not prescribe a specific volume cutoff, as this is a moving target affected by multiple factors such as training and technology. However, it is reasonable to attempt to improve the outcomes for the patients and the health care system by redirecting some of the surgeries as described here.

Conclusions

Acknowledgment
This project was supported in part by the National Cancer Institute Core Grant P30 CA014089.

Introduction
Prostate cancer (PCa) is the most common malignancy in men and the second leading cause of cancer-related mortality among European men [1]. Radical prostatectomy (RP) and PD 0332991 therapy are the standard of care for clinically localized PCa, although up to 40% of patients subsequently experience biochemical recurrence (BCR) [2]. Nomograms can predict BCR before and after RP, although their accuracy remains suboptimal [3].
Body fat is typically measured using body mass index (BMI) that is calculated using body weight and height. According to the World Health Organization definitions, overweight and obese status are defined using BMI values of≥25 and≥30kg/m², respectively. It has been hypothesized that both overweight and obese status can affect the carcinogenic, endocrine, and biochemical microenvironments, which subsequently lead to tumor development and progression [4]. Several studies have evaluated the effects of overweight and obese status on PCa incidence, pathological features, and BCR after RP. Those studies revealed that increasing BMI values were associated with a higher incidence of PCa, as well as adverse pathological features at the diagnosis [5]. Furthermore, a recent meta-analysis of 36,927 patients revealed that a 5-kg/m² increase in BMI was associated with a 16% increase in the risk of BCR after RP and radiation therapy [5]. However, that study was limited by the nonlinear relationship between BMI and BCR, which could not be addressed using conventional meta-analytical techniques. Moreover, other studies failed to identify a significant association between BMI and outcomes after RP [6,7]. Therefore, this study aimed to assess the association between BMI and BCR in a large international contemporary cohort of patients who underwent RP for PCa.

Patients and methods

Results

Discussion
Obesity is a major health issue in industrialized countries, and two-thirds of American adults are considered either overweight or obese based on their BMI. Obesity is also associated with an increased risk of death that is related to cardiovascular disease or diabetes or both. Furthermore, solid evidence now suggests that obesity is associated with a higher incidence of cancer and poor outcomes. Therefore, this study aimed to assess the prognostic value of overweight or obese status among a large multi-institutional contemporary cohort of patients who underwent RP for PCa. We found that both overweight and obese status were associated with a higher likelihood of having extracapsular extension and seminal vesicle invasion (features of biologically and clinically aggressive PCa). These results agree with the findings of previous studies, which revealed an association of BMI with adverse pathological features [4,5,7,8,10–13]. A recent meta-analysis also revealed a limited nonlinear correlation between BMI and BCR, with a critical limit at BMI = 33kg/m2. Based on the random-effects approach, all 26 studies that were included revealed that a 5kg/m2 increase in BMI was associated with a 16% higher risk of BCR [5]. The critical cutoff for BMI was≥30kg/m2 in this study.