Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients

Objective: Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.Methods: Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.Results: Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947).Conclusion: TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.

Pediatric hepatocellular carcinoma

Pediatric hepatocellular carcinoma (HCC) is the second common malignant liver tumor in children after hepato-blastoma. It differs from the adult HCC in the etiological predisposition, biological behavior and lower frequency of cirrhosis. Perinatally acquired hepatitis-B virus, hepa-torenal tyrosinemia, progressive familial intrahepatic cho-lestasis, glycogen storage disease, Alagille's syndrome and congenital portosystemic shunts are important predis-posing factors. Majority of children (87%) are older than 5 years of age. Following mass immunization against hepatitis-B, there has been a drastic fall in the incidence of new cases of pediatric HCC in the Asia-Pacific region. Management is targeted on complete surgical removal either by resection or liver transplantation. There is a trend towards improving survival of children transplanted for HCC beyond Milan criteria. Chemotherapeutic regi-mens do not offer good results but may be helpful for down-staging of advanced HCC. Surveillance of children with chronic liver diseases with ultrasound and alpha-fetoprotein may be helpful in timely detection, intervention and overall improvement in outcome of HCC.

Vertically acquired hepatitis C virus infection:Correlates oftransmission and disease progression

The worldwide prevalence of hepatitis C virus(HCV)infection in children is 0.05%-0.4% in developed countries and 2%-5% in resource-limited settings, where inadequately tested blood products or un-sterile medical injections still remain important routes of infection. After the screening of blood donors, motherto-child transmission(MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%. Maternal HIV co-infection is a significant risk factor for MTCT and anti-HIV therapy during pregnancy seemingly can reduce the transmission rate of both viruses. Conversely, a high maternal viral load is an important, but not preventable risk factor, because at present no anti-HCV treatment can be administered to pregnant women to block viral replication. Caution is needed in adopting obstetric procedures, such as amniocentesis or internal fetal monitoring, that can favor fetal exposure to HCV contaminated maternal blood, though evidence is lacking on the real risk of single obstetric practices. Mode of delivery and type of feeding do not represent significant risk factors for MTCT. Therefore, there is no reason to offer elective caesarean section or discourage breast-feeding to HCV infected parturients. Information on the natural history of vertical HCV infection is limited. The primary infection is asymptomatic in infants. At least one quarter of infected children shows a spontaneous viral clearance(SVC) that usually occurs within 6 years of life. IL-28 B polymorphims and genotype 3 infection have been associated with greater chances of SVC. In general, HCV progression is mild or moderate in children with chronic infection who grow regularly, though cases with marked liver fibrosis or hepatic failure have been described. Non-organ specific autoantibodies and cryoglobulins are frequently found in children with chronic infection, but autoimmune diseases or HCV associated extrahepatic manifestations are rare.

Casing life prediction using Borda and support vector machine methods

Eight casing failure modes and 32 risk factors in oil and gas wells are given in this paper. According to the quantitative analysis of the influence degree and occurrence probability of risk factors, the Borda counts for failure modes are obtained with the Borda method. The risk indexes of failure modes are derived from the Borda matrix. Based on the support vector machine （SVM）, a casing life prediction model is established. In the prediction model, eight risk indexes are defined as input vectors and casing life is defined as the output vector. The ideal model parameters are determined with the training set from 19 wells with casing failure. The casing life prediction software is developed with the SVM model as a predictor. The residual life of 60 wells with casing failure is predicted with the software, and then compared with the actual casing life. The comparison results show that the casing life prediction software with the SVM model has high accuracy.

Food groups, diet quality and colorectal cancer risk in the Basque Country

BACKGROUND The results obtained to date concerning food groups,diet quality and colorectal cancer(CRC)risk vary according to criteria used and the study populations.AIM To study the relationships between food groups,diet quality and CRC risk,in an adult population of the Basque Country(North of Spain).METHODS This observational study included 308 patients diagnosed with CRC and 308 ageand sex-matched subjects as controls.During recruitment,dietary,anthropometric,lifestyle,socioeconomic,demographic and health status information was collected.Adherence to the dietary recommendations was evaluated utilizing the Healthy Eating Index for the Spanish Diet and the MedDietScore.Conditional logistic regressions were used to evaluate the associations of food group intakes,diet quality scores,categorized in tertiles,with CRC risk.RESULTS The adjusted models for potential confounding factors showed a direct association between milk and dairy products consumption,in particular high-fat cheeses[odds ratio(OR)third tertile vs first tertile=1.87,95%confidence intervals(CI):1.11-3.16],and CRC risk.While the consumption of fiber-containing foods,especially whole grains(OR third tertile vs first tertile=0.62,95%CI:0.39-0.98),and fatty fish(OR third tertile vs first tertile=0.53,95%CI:0.27-0.99)was associated with a lower risk for CRC.Moreover,higher MD adherence was associated with a reduced CRC risk in adjusted models(OR third tertile vs first tertile=0.40,95%CI:0.20-0.80).CONCLUSION Direct associations were found for high-fat cheese,whereas an inverse relation was reported for fiber-containing foods and fatty fish,as well as adherence to a Mediterranean dietary pattern.

Demand for hospital emergency departments：a conceptual understanding

BACKGROUND： Emergency departments （EDs） are critical to the management of acute illnessand injury, and the provision of health system access. However, EDs have become increasinglycongested due to increased demand, increased complexity of care and blocked access to ongoingcare （access block）. Congestion has clinical and organisational implications. This paper aims todescribe the factors that appear to infl uence demand for ED services, and their interrelationships asthe basis for further research into the role of private hospital EDs.DATA SOURCES： Multiple databases （PubMed, ProQuest, Academic Search Elite and ScienceDirect） and relevant journals were searched using terms related to EDs and emergency health needs.Literature pertaining to emergency department utilisation worldwide was identified, and articlesselected for further examination on the basis of their relevance and signifi cance to ED demand.RESULTS： Factors influencing ED demand can be categorized into those describing thehealth needs of the patients, those predisposing a patient to seeking help, and those relating topolicy factors such as provision of services and insurance status. This paper describes the factorsinfl uencing ED presentations, and proposes a novel conceptual map of their interrelationship.CONCLUSION： This review has explored the factors contributing to the growing demand forED care, the infl uence these factors have on ED demand, and their interrelationships depicted in theconceptual model.

Gastric cancer in women: A regional health-center seven year retrospective study

AIM: To investigate whether regional geography influences ethnic and gender trends for the development of gastric cancer(GC).METHODS: This retrospective analysis of the INVISION patient database at Louisiana State University Health Sciences Center-Shreveport(LSUHSC-S), a southern United States regional hospital, was performed from 2005-2011. Using the international statistical classification of diseases 9(ICD-9), inpatient, day surgery outpatient, and emergency outpatient diagnosis codes entered into medical records were used to identify GC patients. For each study year, the patients were evaluated for age, ethnicity, and gender, and each patient was counted only once throughout the study. Subsequent patient encounters were counted as visits and separated by inpatient and clinic visits. Complex or severe disease may require more frequent and intensive clinical management; therefore, we evaluated annual clinic visits as "surrogate markers" of disease severity. Finally, we studied the primary diagnosis for Helicobacter pylori(H. pylori) infection(ICD-9 code 41.86) as an additional factor that might increase the risk of GC.RESULTS: A total of 285 patients were diagnosed with GC at LSUHSC-S between 2005 and 2011. African Americans(181 patients, 89 males and 92 females, 63.5% of total patients) had significantly higher frequencies of GC diagnosis compared with non-Hispanic whites(104 patients, 54 males and 50 females, 36.5% of total patients), at a ratio of 1.74(P = 0.002). Within each ethnic group, men and women were diagnosed at approximately equal annual rates. Our findings differed significantly from United States national trends, which found that African American females and white females had lower risks for GC than their corresponding male counterparts. The United States national trend between 2005 and 2011 showed that African Americans males had a higher incidence of GC, with an annual mean(per 100000) of 16.31 ± 0.76 compared with white males(9 ± 0.1, P < 0.001), African American females(8.7 ± 0.34, P < 0.001) and white females(4.05 ± 0.07, P < 0.001). Among the GC patients, the number of clinic visits was highest among African American males(195.1 ± 28.1), who had significantly more clinic visits than African Americans females(123 ± 13.02, P < 0.05), white males(41.57 ± 4.74, P < 0.001) and white females(35 ± 8.9, P < 0.001). Similar trends were found for inpatient visits, with an annual mean of 11.43 ± 1.5 forAfrican American males, followed by African American females(7.29 ± 1.36), white males(2.57 ± 0.69) and white females(1.57 ± 0.612). African American males had significantly more inpatient visits than white males(P < 0.001), and African American females had more inpatient visits than white females(P < 0.01). African American patients showed the highest frequency of H. pylori positive status, with approximately 72% vs 28% for the white patients. CONCLUSION: Increase in GC diagnoses among women at LSUHSC-S is significantly higher than United States national averages, suggesting local geographic and socioeconomic influences may alter GC disease course.

Literature review of type 2 diabetes mellitus among minority Muslim populations in Israel

This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus(T2DM) for the Arab andBedouin populations of Israel. T2 DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2 DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the world's leading information systems and deals with the management of chronic diseases such as diabetes. The program's baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel.

Staging laparoscopy improves treatment decision-makingfor advanced gastric cancer

AIM To evaluate the clinical value of staging laparoscopyin treatment decision-making for advancedgastric cancer （GC）.METHODS： Clinical data of 582 patients with advancedGC were retrospectively analyzed. All patientsunderwent staging laparoscopy. The strength ofagreement between computed tomography （CT） stage,endoscopic ultrasound （EUS） stage, laparoscopic stage,and final stage were determined by weighted Kappastatistic （Kw）. The number of patients with treatmentdecision-changes was counted. A χ 2 test was used toanalyze the correlation between peritoneal metastasisor positive cytology and clinical characteristics.RESULTS： Among the 582 patients, the distributions ofpathological T classifications were T2/3 （153, 26.3%）,T4a （262, 45.0%）, and T4b （167, 28.7%）. Treatmentplans for 211 （36.3%） patients were changed after staging laparoscopy was performed. Two （10.5%） of19 patients in M1 regained the opportunity for potentialradical resection by staging laparoscopy. Unnecessarylaparotomy was avoided in 71 （12.2%） patients. Thestrength of agreement between preoperative T stageand final T stage was in almost perfect agreement （Kw= 0.838; 95% confidence interval （CI）： 0.803-0.872;P 〈 0.05） for staging laparoscopy; compared with CTand EUS, which was in fair agreement. The strengthof agreement between preoperative M stage andfinal M stage was in almost perfect agreement （Kw= 0.990; 95% CI： 0.977-1.000; P 〈 0.05） for staginglaparoscopy; compared with CT, which was in slightagreement. Multivariate analysis revealed that tumorsize （≥ 40 mm）, depth of tumor invasion （T4b）, andBorrmann type （Ⅲ or Ⅳ） were significantly correlatedwith either peritoneal metastasis or positive cytology.The best performance in diagnosing P-positive wasobtained when two or three risk factors existed.CONCLUSION： Staging laparoscopy can improvetreatment decision-making for advanced GC anddecrease unnecessary exploratory laparotomy.

Population-based survey of prevalence,causes,and risk factors for blindness and visual impairment in an aging Chinese metropolitan population

AIM： To assess the prevalence, causes, and risk factors for blindness and visual impairment among elderly （〉60 years of age） Chinese people in a metropolitan area of Shanghai, China. METHODS： Random cluster sampling was conducted to identify participants among residents ≥60 years of age living in the Xietu Block, Xuhui District, Shanghai, China. Presenting visual acuity （PVA） and best-corrected visual acuity （BCVA） were checked by the Early Treatment Diabetic Retinopathy Study （ETDRS） visual chart. All eligible participants underwent a comprehensive eye examination. Blindness and visual impairment were defined according to World Health Organization （WHO） criteria. RESULTS： A total of 4190 persons （1688 men and 2502 women） participated in the study, and the response rate was 91.1%. Based on PVA, the prevalence of blindness was 1.1% and that of visual impairment was 7.6%. Based on BCVA, the prevalence of blindness and visual impairment decreased to 0.9% and 3.9%, respectively. Older （〉80 years of age） women, with low educational levels and smoking habits, exhibited a significantly greater chance for blindness and visual impairment than did those with high educational levels and no smoking habits （P〈0.05）. Based on PVA and BCVA, the main causes of blindness were cataract, myopic maculopathy, and age-related macular degeneration （AMD）. CONCLUSION： Our findings help to identify the population in need of intervention, to highlight the need for additional eye healthcare services in urban China.

Risks of incident heart failure with preserved ejection fraction in Chinese patients hospitalized for cardiovascular diseases

Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.

Angiotensinogen gene polymorphism and ischemic stroke in East Asians:A meta-analysis

OBJECTIVE： To investigate the association between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians. DATA RETRIEVAL： A computer-based online search was conducted in PubMed, Google scholar, China National Knowledge Infrastructure database between January 1990 and April 2012 for relevant studies. The key words were angiotensinogen or AGT, polymorphism or genetic and ischemic stroke or cerebral infarction. SELECTION CRITERIA： Case-controlled studies addressing the correlation between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians were included. The distribution of genotypes in the included studies was tested for Hardy-Weinberg equilibrium. Quality evaluation of the included studies was conducted by two physicians. Statistical analyses were carried out using Stata 12.0 software for meta-analysis. Heterogeneity tests, sensitivity analysis and publication bias were also conducted. MAIN OUTCOME MEASURES： The association between angiotensinogen gene M235T polymorphism and ischemic stroke risk in East Asians was assessed. RESULTS： Six relevant studies involving 891 patients with ischemic stroke and 727 controls were included in this meta-analysis. Results showed that there was a significant association between angiotensinogen gene M235T polymorphism and the risk of ischemic stroke in East Asians （T vs. M odds ratio （OR） = 1.54, 95% confidence interval （CI） = 1.10-2.16; TT vs. MM： OR = 2.24, 95%CI = 1.37-3.66; TT vs. MT： OR = 1.76, 95%CI = 1.41-2.20; MM ＋ MT vs. TT： OR = 0.57, 95%CI -= 0.46-0.70）. Sensitivity analysis confirmed that the study results were stable and reliable, with no publication bias. CONCLUSION： The angiotensinogen gene M235T polymorphism is associated with ischemic stroke in East Asians, and the TT genotype and T allele are risk factors for ischemic stroke.

Relationship between the number of endothelial progenitor cell and the severity of coronary artery disease

Background Previous studies have suggested that patients with low endothelial progenitor cell （EPC） counts and impaired endothelial colony forming acti patients with high EPC counts and favorable wty colo have a higher incidence for cardiovascular events compared to ny forming activity. The pathophysiological basis for this finding may be an insufficient endothelial cell repair by EPC. The objective of this study was to determine whether the number of EPCs in peripheral blood was associated with the presence and severity of angiographic stenosis in patients of the late phase after acute myocardial infarction （AMI）. Methods One hundred and one patients undergoing cardiac catheterization in our hospital were enrolled in the study. The number of circulating EPCs was measured by a fluorescent-activated cell sorter （FACS）. Patients with acute coronary syndromes were excluded. Results Compared with patients with normal coronary artery, the number of circulating EPCs was s reduced among patients in the late phase after AMI （P 〈 0.01） We also found that compared with ignificantly the control group, the number of EPCs of single-vessel stenosis group and multi-vessel stenosis group were significantly reduced （P = 0.005 ; P = 0.001 ）. Conclusions The number of EPCs in the peripheral blood is decreased in patients of the late phase after AMI. The EPCs number correlated with angiographic stenosis severity, which suggests that endothelial injury in the deficient circulating EPCs may affect the severity of the heart disorder and the clinical presentations.