bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study
Authors: Pragt Hanna , van Melle Joost P. , Mariani Massimo A. , Verkerke Gijsbertus J. , Ebels Tjark 
Published: March 2019

Objective: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. Methods: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured. Results: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min). Conclusion: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.
Thermomechanical and in vitro biological characterization of injection-molded PLGA craniofacial plates
Authors: Pimenta de Melo Liliane , Contessi Negrini Nicola , Farè Silvia , de Mello Roesler Carlos Rodrigo , de Mello Gindri Izabelle , Salmoria Gean Vitor 
Published: March 2019

Purpose: To evaluate the thermomechanical and in vitro biological response of poly(lactic-co-glycolic acid) (PLGA) plates for craniofacial reconstructive surgery. Methods: PLGA 85/15 craniofacial plates were produced by injection molding by testing two different temperatures (i.e., 240°C, PLGA_lowT, and 280°C, PLGA_highT). The mechanical properties of the produced plates were characterized by three-point bending tests, dynamic mechanical analysis, and residual stress. Crystallinity and thermal transitions were investigated by differential scanning calorimetry. Finally, in vitro cell interaction was evaluated by using SAOS-2 as cell model. Indirect cytotoxicity tests (ISO 10-993) were performed to prove the absence of cytotoxic release. Cells were then directly seeded on the plates and their viability, morphology, and functionality (ALP) checked up to 21 days of culture. Results: A similar performance of PLGA_lowT and PLGA_highT plates was verified in the three-point bending test and dynamic mechanical analyses. Also, the two processing temperatures did not influence the in vitro cell interaction. Cytotoxicity and ALP activity were similar for the PLGA plates and control. Cell results demonstrated that the PLGA plates supported cell attachment and proliferation. Furthermore, energy-dispersive X-ray spectroscopy revealed the presence of sub-micron particles, which were identified as inorganic mineral deposits resulting from osteoblast activity. Conclusion: The present work demonstrated that the selected processing temperatures did not affect the material performance. PLGA plates showed good mechanical properties for application in craniofacial reconstructive surgery and adequate biological properties.
Return to Play and Performance Perceptions of Baseball Players After Isolated SLAP Tear Repair
Authors: Douglas Lonnie , Whitaker John , Nyland John , Smith Patrick , Chillemi Filippo , Ostrander Roger , Andrews James 
Published: March 2019

Background: Variable return-to-play (RTP) rates have been reported after surgical repair of superior labral anterior-posterior (SLAP) tears in baseball players. Many studies, however, have not controlled for concomitant shoulder injuries. Purpose/Hypothesis: The purpose of this study was to evaluate rates of RTP and return to previous or higher performance level (RTPP) and long-term outcomes after isolated SLAP tear repair. The hypothesis was that improved outcomes would be identified compared with previous reports. Study Design: Case series; Level of evidence, 4. Methods: The records of 232 players who underwent isolated SLAP tear repair from 2004 to 2014 were reviewed. A total of 98 players who were at least 12 months out from surgery were identified. Through telephone interviews, participants completed the Western Ontario Shoulder Instability Index (WOSI) and Veterans RAND 12-Item Health Survey (VR-12) and answered scripted questions about RTP, RTPP, and current symptoms. Results: Of the 98 players who met the inclusion criteria, 73 (74.5%) participated. The mean age at the time of surgery was 19.8 ± 2.9 years. The mean follow-up time was 86.2 ± 25.1 months overall; it was 84.4 ± 24.4 months for pitchers and 90.3 ± 26.7 months for other position players, ( P = .40). There were 10 professional, 36 collegiate, and 27 high school players. Most players perceived successful RTP (83.6%), including 80.0% of pitchers and 91.3% of other position players ( P = .23). However, RTPP rates were lower, at 52.3% (n = 26) and 78.3% (n = 18) for pitchers and other position players, respectively ( P = .03). Pitchers were younger at the time of surgery (19.3 ± 3.0 vs 20.8 ± 3.0 years, respectively; P = .03) and had greater perceived shoulder and general health impairments compared with other position players ( P ≤ .02). Players who perceived successful RTPP had better WOSI of the healthy shoulder and individual physical, sports, lifestyle, and emotion scores compared with players who did not perceive successful RTPP. Conclusion: After the surgical repair of isolated type II or greater SLAP tears, other position players displayed superior RTP (91.3% vs 80.0%, respectively) and RTPP (78.3% vs 52.3%, respectively) rates than pitchers. Long-term follow-up suggests that pitchers may perceive greater long-term impairments than other position players and are less likely to return to their previous or higher performance level.
Evaluation of preoperative prostate magnetic resonance imaging for cancer control and neurovascular tissue preservation during robotic radical prostatectomy.
Authors: Gold Samuel A , Lebastchi Amir H , Bloom Jonathan , Mehralivand Sherif , Gomella Patrick H , Sanford Thomas , Hale Graham , Valera Vladimir , Ball Mark Wayne , Merino Maria J , Choyke Peter L. , Turkbey Baris , Pinto Peter A. 
Published: March 2019

101 Background: Prostate multi-parametric magnetic resonance imaging (mpMRI) can precisely depict prostate cancer (PCa) location and adverse pathologic features. Surgeons can utilize this information to maximize sparing of the neurovascular bundles (NVBs) during radical prostatectomy (RP) while avoiding a positive surgical margin (PSM). We detail the technique of using preoperative mpMRI to quantify its effect regarding nerve-sparing and rates of PSMs. Methods: A prospectively maintained database was queried for robotic-assisted RPs (RARPs) with preoperative mpMRI between 2007-2017. Imaging margin risk factors (iMRF) were defined on mpMRI as frank extraprostatic extension (EPE), possible EPE, and capsular irregularity (capsular bulge, lesion-capsule contact, or lesion adjacency to the neurovascular bundles). Surgical adjustments to nerve-sparing technique (full sparing, partial sparing, and wide excision) were made based on these findings. Results: Five hundred thirty-two patients comprising 1041 prostate sides were included for analysis. Overall, PSM rate was found in 80/1041 (7.7%) sides of the prostate. iMRF were seen in 313/1041 (30.1%) prostate sides, for which adjustments were made in 244/313 (78.0%) of these. In the 69/244 (22.0%) cases where full nerve-sparing was performed despite iMRF, PSM rate was 20/69 (29%) compared to 33/244 (13.5%), p = 0.002. MRI-guided surgical adjustments decreased PSM risk by 68% and 15% in pT3 and pT2 cases, respectively. On multivariable analysis, logPSA (odds ratio [OR] 4.06, [95% CI 2.40-12.3], p < 0.001) and iMRF (OR 1.78, [95% CI 1.01-3.16], p = 0.047) were significantly associated with PSM while nerve-sparing adjustment was significantly associated with decreased risk of PSM (OR 0.38 [95% CI 0.22-0.66], p = 0.001). Conclusions: MRI effectively detects risks for PSM and guides surgical adjustments to decrease PSM rates. As prostate MRI is more frequently acquired for PCa screening and biopsy, we show its additional value for RP planning and potentially improved outcomes.
Efficacy and toxicity from phase II study of dose escalation to intraprostatic tumor nodule in localized prostate cancer.
Authors: Murray Julia , Alexander Emma , Tree Alison , McNair Helen , Hansen Vibeke , Gao Annie , Thomas Karen , DeSouza Nandita M , Dearnaley David P. 
Published: March 2019

102 Background: Intra-prostatic boost to dominant nodule is an attractive method for biological dose augmentation. Aim of study was to assess clinical feasibility of radiation boost to mp-MRI visible tumour using external beam radiotherapy. We report a planned analysis of toxicity and efficacy in the first two dose cohorts in this study. Methods: DELINEATE (ISRCTN04483921) was a single centre prospective phase 2 multi-cohort study including standard (Cohort A (A): 74Gy/37F) and moderately hypofractionated (Cohort B (B): 60Gy/20F) prostate image-guided IMRT regimens. Patients treated in A and B received integrated boost of 82Gy and 67Gy to mp-MRI-visible lesions. 55 patients were recruited to A and 158 patients recruited to B; the first 50 sequentially treated patients in B were included in analysis. Duration of androgen deprivation therapy was at clinician discretion. Primary endpoint was RTOG late toxicity at 1 year. Secondary endpoints included acute and late toxicity timepoints and biochemical relapse (BCR) free survival, using Phoenix definition. Treatment related toxicity was measured by RTOG, CTCAE v4 scales, IPSS and EPIC-26. Results: Between July 2011 and January 2015, 105 patients were treated within A&B. Median follow up for A was 74.5 months and 52 months for B. Median age was 71 years (range 57-80). In A and B, there were 27% and 40% of patients respectively classified with NCCN high risk disease. Cumulative RTOG toxicity in Table. 6 patients had BCR (5 patients: A and 1 patient: B). Within A, 1 patient had pelvic nodal progression and 1 local progression; patient in B had local progression. Conclusions: Delivery of intra-prostatic boost to dominant nodule is feasible with acceptable toxicity and good efficacy. Intra-prostatic boost is now part of the randomised phase 3 PIVOTALboost trial (ISRCTN80146950). Clinical trial information: 04483921. [Table: see text]
“Management Migration” in United States patients diagnosed with localized prostate cancer from 2010-2015.
Authors: Butler Santino , Franco Idalid Ivy , Mahal Amandeep R , Sanford Nina Niu , Trinh Quoc-Dien , Rebbeck Timothy , Nguyen Paul L. , D'Amico Anthony Victor , Mahal Brandon Arvin Virgil 
Published: March 2019

11 Background: National guidelines have increasingly supported active surveillance/watchful waiting (AS/WW) in low- and favorable intermediate-risk prostate cancer (PCa). It is unknown how these changes have influenced national management patterns across localized PCa. Therefore, we sought to define the U.S. trends in management of localized PCa across National Comprehensive Cancer Network (NCCN) risk groups. Methods: Using the novel and non-public Surveillance, Epidemiology, and End Results Program Prostate with AS/WW Database, we identified 164,760 men diagnosed with localized PCa and actively treated with either AS/WW, radical prostatectomy [RP], or radiation therapy [RT] from 2010-2015. Rates of initial management type over time, stratified by NCCN risk-category, were determined. Multivariable logistic regression defined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for receipt of each initial management type, with year of diagnosis (2010-2015) as the independent variable of interest (Year 2010 = referent). Results: AS/WW utilization increased from 14.5% to 42.1% from 2010-2015 in low-risk disease (AOR 4.50 [95% CI 4.17–4.86, P < 0.001]); conversely, RT and RP decreased from 38.0% to 26.6% (AOR 0.55 [0.51–0.59, P < 0.001]), and from 47.4% to 31.3% (AOR 0.50, [0.47-0.54, P < 0.001]), respectively (all Ptrends< 0.001). AS/WW increased in intermediate-risk disease from 5.78% to 9.60% (AOR 1.83 [1.67–2.00, P < 0.001]) and RT also decreased from 42.4% to 39.8% (AOR 0.81 [0.77–0.85], P < 0.001; Ptrends< 0.001)—Yet, there was no change in RP (51.8% vs. 50.6%; AOR 1.03 [0.98–1.09, P = 0.254]). Notably, while RP for high-risk disease increased from 38.0% to 42.8% (AOR 1.41 [1.30–1.53, P < 0.001]), RT decreased from 60.1% to 55.0% (AOR 0.71 [0.65–0.77, P < 0.001]; Ptrends< 0.001). Conclusions: These findings capture the rapidly shifting landscape of management for localized PCa and are suggestive of “management migration”—where down-trending RP utilization in low-risk disease (in the setting of up-trending AS/WW) may drive non-evidence based management bias toward RP over RT in higher risk disease. These national patterns serve as a targetable trend that should be addressed.
Outcomes in a cohort of patients with a Gleason score 6 on radical prostatectomy specimen.
Authors: Le Bihan Elodie , Lebacle Cedric Michel , Bessede Thomas , de la TAILLE Alexandre , Salomon Laurent , Irani Jacques 
Published: March 2019

112 Background: This retrospective study evaluates the outcome of a cohort of patients who had a radical prostatectomy with GS 6 on the prostatic specimen. Methods: Consecutive cases were extracted from prostatectomy database of 2 teaching hospitals between 2000 and 2006 for a prostate cancer and were scored GS 6 on the specimen. Overall, specific, metastasis and PSA progression-free survivals were analyzed. Cox model was used to evaluate predictive factors. PSA progression was defined by a level of 0.2 ng/mL or above. Results: Mean age of the 616 analyzed patients was 62.8 yrs (SD 6.4). Mean initial PSA was 8.2 ng/mL (SD 8.0). In 46 cases (7.5%) grade 4 was described on pre-operative prostatic biopsies. Median total tumor length (TTL) was 3 mm (IQ 7.7). Pelvic lymphadenectomy was performed in 213 cases and no positive lymph node was diagnosed. Positive margin (R1) was diagnosed in 79 patients (12.8%). pT3a and pT3b stages were described in 65 and 11 cases (10.5% and 1.8%) respectively. Mean follow-up (FU) was 57.2 months (SD 48). None of the 4 deaths were attributed to prostate cancer. PSA progression was observed in 73 patients (11.8%) of whom 48 had a secondary treatment. One patient developed metastasis. Independent predictive factors of PSA progression were TTL on prostatic biopsy (p = 0.007), R1 status (p = 0.005) and seminal vesicles invasion (p = 0.005). Center, initial PSA, number of positive cores and GS on prostatic biopsy were not associated with outcome. Conclusions: No specific mortality was observed in this cohort of prostatectomy GS 6 prostate cancer patients with the limitation of an insufficient FU. The number of positive cores on pre-operative prostatic biopsies was not predictive of outcome which calls into question its use as criterion for active surveillance.
Hospitalization after prostate biopsy in Iceland: Results from a nationwide study.
Authors: Ã“lafsdÃ³ttir Birgitta , Hilmarsson Rafn , Fridriksson Jon Orn , Gudmundsson Sigurdur , Gudjonsson Sigurdur 
Published: March 2019

113 Background: The best method to confirm prostate cancer diagnosis is by performing a transrectal ultrasound guided biopsy. This procedure does not come without risks as international reports suggest that frequency of hospitalization after biopsy are increasing. This study aimed to estimate incidence and risk factors for hospitalization after prostate biopsy in Iceland. Methods: Every patient in Iceland who had undergone a prostate biopsy during the years 2013-2017 was included in the study. Primary outcome measure was hospitalization within fifteen days from the biopsy. We also studied the type of infectious agents and resistance to ciprofloxacin or trimethoprim. Multivariable logistic regression model was used to identify risk factors for hospitalization. Results: Of 2076 men who had prostate biopsies 59 (2.8%) were hospitalized within fifteen days. Of these men 45 (76.3%) were hospitalized because of infection, 6 (10.2%) were hospitalized because of bleeding and 8 (13.5%) were hospitalized for other reasons. Risk factor for hospitalization was higher age (OR 1.06 p < 0.001). An antibiotic prescription within 6 months of biopsy was a protecting factor (OR 0.57 p = 0.04). E.coli was the most common infectious agent (73.3%). Pseudomonas, Staphylococcus and Streptococcus dysgalactiae where other agents. Of those admitted to hospital with infection 57.1% of the agents were resistant to ciprofloxacin and 54% to trimethoprim. 31.4% of the infectious agents were resistant to both antibiotics. Conclusions: Despite the invasive nature of the procedure and increasing bacterial antibiotic resistance the rate of hospitalization was relatively low (2.8%). Antibiotic resistance to ciprofloxacin or trimethoprim might prompt a change in common prophylactic practice and a need for new clinical practice guidelines in Iceland.
The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy.
Authors: Ghanem Ahmed I. , Khalil Remonda M , Khedr Gehan Abd Elatti , Tang Amy , Elsaid Amr A. , Chetty Indrin , Movsas Benjamin , Elshaikh Mohamed A. 
Published: March 2019

114 Background: Life expectancy is very essential in deciding treatment options in men with prostate cancer (PCa); however, the impact of comorbidities on outcomes is not well-established. We investigated the influence of Charlson Comorbidity Index (CCI) on survival endpoints in men with localized PCa who were treated with prostate radiotherapy (RT). Methods: Men with intermediate and high risk PCa who were treated with definitive RT between 1/2007 and 12/2012 were included. Groups were created according to their baseline CCI score at diagnosis into no, mild and severe comorbidity (CCI 0, 1 or 2+). The groups were then compared based on patients’ characteristics and prognostic factors. Kaplan-Meier curves and Uni/multivariate analyses (MVA) were used to examine the impact of CCI groups on overall (OS), disease specific (DSS), and biochemical relapse free (BRFS) survival. Results: 257 patients were identified after excluding low risk, metastatic cases and those with inadequate follow up. Median follow-up was 92 months (range: 2-135) and median age was 73 years (range: 48-85). 53% of the cases were black and 67% were of intermediate risk. Median RT dose was 76 Gy and 47% received androgen deprivation therapy. CCI groups 0, 1 and 2+ encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively. Groups were generally well-balanced. 10 and 15 years OS was significantly different across CCI groups (76% & 53%, 46% & 31% and 55% & 14%, for CCI-0, 1 and 2+ respectively; p < 0.001). CCI-0 had better DSS than CCI-2+ ( p = 0.03) with no difference for CCI-0 vs 1 ( p = 0.1). BRFS was non-different among CCI groups ( p = 0.99). On MVA, increased CCI was deterministic for OS ( p < 0.001) after adjusting for age, Gleason’s score and T-stage. For DSS, only age and T3 vs T1/2 were independently prognostic ( p < 0.001); whereas CCI-1 vs 0 was only marginal ( p = 0.05). Conclusions: Higher CCI was a significant predictor of shorter OS in intermediate and high-risk PCa. Baseline comorbidities should be taken into consideration during patient counselling for treatment options and in designing prospective trials for men with localized prostate cancer.
Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.
Authors: Miura Noriyoshi , Noda Terutaka , Nishimura Kenichi , Fukumoto Tetsuya , Yanagihara Yutaka , Miyauchi Yuki , Kikugawa Tadahiko , Oka Akihiro , Ninomiya Iku , Hashine Katsuyoshi , Saika Takashi 
Published: March 2019

120 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.