Changes in prostate cancer incidence,mortality and survival in relation to prostate specific antigen testing in New South Wales,Australia

BackgroundTo examine changes in prostate cancer incidence and mortality rates, and 5-year relative survival, in relation to changes in the rate of prostate specific antigen (PSA) screening tests and the use of radical prostatectomy (RP) in the Australian population.MethodsProstate cancer stage-specific incidence rates, 5-year relative survival and mortality rates were estimated using New South Wales Cancer Registry data. PSA screening test rates and RP/Incidence ratios were estimated from Medicare Benefits Schedule claims data. We used multiple imputation to impute stage for cases with “unknown” stage at diagnosis. Annual percentage changes (APC) in rates were estimated using Joinpoint regression.ResultsTrends in the age-standardized incidence rates for localized disease largely mirrored the trends in PSA screening test rates, with a substantial ‘spike’ in the rates occurring in 1994, followed by a second ‘spike’ in 2008, and then a significant decrease from 2008 to 2015 (APC −6.7, 95% CI −8.2, −5.1). Increasing trends in incidence rates were observed for regional stage from the early 2000s, while decreasing or stable trends were observed for distant stage since 1993. The overall RP/Incidence ratio increased from 1998 to 2003 (APC 9.6, 95% CI 3.8, 15.6), then remained relatively stable to 2015. The overall 5-year relative survival for prostate cancer increased from 58.4% (95% CI: 55.0–61.7%) in 1981–1985 to 91.3% (95% CI: 90.5–92.1%) in 2011–2015. Prostate cancer mortality rates decreased from 1990 onwards (1990–2006: APC −1.7, 95% CI −2.1, −1.2; 2006–2017: APC −3.8, 95% CI −4.4, −3.1).ConclusionsOverall, there was a decrease in the incidence rate of localized prostate cancer after 2008, an increase in survival over time and a decrease in the mortality rate since the 1990s. This seems to indicate that the more conservative use of PSA screening tests in clinical practice since 2008 has not had a negative impact on population-wide prostate cancer outcomes.     

Cardiac surgery in 260 octogenarians: a case series

Background

The elderly undergo cardiac surgery more and more frequently, often present multiple comorbidities, assume chronic therapies, and present a unique physiology. Aim of our study was to analyze the experience of a referral cardiac surgery center with all types of cardiac surgery interventions performed in patients ≥80 years old over a six years’ period.

Methods

A retrospective observational study performed in a university hospital. 260 patients were included in the study (3.5% of the patients undergoing cardiac surgery in the study period).

Results

Mean age was 82 ± 1.8 years. Eighty-five percent of patients underwent elective surgery, 15% unplanned surgery and 4.2% redo surgery. Intervention for aortic valve pathology and coronary artery bypass grafting were performed in 51% and 46% of the patients, respectively. Interventions involving the mitral valve were the 26% of the total, those on the tricuspid valve were 13% and those on the ascending aortic arch the 9.6%. Postoperative low output syndrome was identified in 44 patients (17%). Mortality was 3.9% and most of the patients (91%) were discharged from hospital in good clinical conditions. Hospital mortality was lower in planned vs unplanned surgery: 3.8% vs 14% respectively. Chronic obstructive pulmonary disease (OR 9.106, CI 2.275 – 36.450) was the unique independent predictor of mortality.

Conclusions

Clinicians should be aware that cardiac surgery can be safely performed at all ages, that risk stratification is mandatory and that hemodynamic treatment to avoid complications is expected.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2253-15-15) contains supplementary material, which is available to authorized users.     

New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality

BackgroundThe development of new-onset atrial fibrillation in sepsis has been associated with adverse outcomes.MethodsA systematic literature search was conducted to retrieve articles that investigated the association of new-onset atrial fibrillation in patients diagnosed with sepsis. The primary outcome of interest was the pooled risk ratio (RR) of in-hospital mortality in patients with new-onset atrial fibrillation and sepsis.ResultsSix studies included 3100 patients with new-onset atrial fibrillation in sepsis and 36,900 patients without new-onset atrial fibrillation in sepsis. The pooled RR for in-hospital mortality was 1.45 (95 % CI 1.32–1.60, p < 0.00001, I^2 =24 %). New-onset atrial fibrillation was also associated with increased ICU mortality, ICU and in-hospital length of stay and stroke. New-onset atrial fibrillation occurred more in the elderly, those with a prior history of cardiovascular and respiratory disease, and those with increased severity of illness.ConclusionProspective randomised trials are needed to clarify the significance of new-onset atrial fibrillation in sepsis, optimal treatment strategies for these patients, and the benefit of systemic anticoagulation. Physicians should be aware that new-onset atrial fibrillation in sepsis is not merely an observed temporary arrhythmia but a marker of poor prognosis and should be managed accordingly.     

Tree dieback and regeneration in secondary Acacia zanzibarica woodlands on an abandoned cattle ranch in coastal Tanzania

Questions: Bush encroachment is a major problem when African savanna ecosystems are used for cattle ranching. How do secondary woodlands develop after ranching is abandoned? What are the patterns and rates of tree mortality and regeneration? Location: Mkwaja Ranch (now part of Saadani National Park) in coastal Tanzania. Methods: Ninety‐seven circular plots (4‐m radius) were set in secondary Acacia zanzibarica woodland along a gradient of tree density. Variables relating to tree and grass layers and soil characteristics of plots were recorded. Seedlings were counted twice in the wet seasons, and resprouts once. Tree flowering and pod production were assessed during the fruiting season, while survival of trees initially present was recorded after 12 and 32 months. Interrelationships among variables were investigated using multiple linear regression, binary logistic regression and mixed effects models. Results: After 32 months, over one‐third of trees in plots had died. Most died after fire, especially on heavy soils, and mortality was significantly related to the tree live biomass ratio and soil conditions. Seed production was very low, especially in denser stands. Numbers of seedlings correlated with soil and grass variables but not with seed rain. Half of trees killed above‐ground produced coppice shoots from the base; in contrast, root suckering was independent of topkill. By the end of the study, no seedlings survived and no resprouts emerged above the grass layer. Conclusions: A. zanzibarica woodlands at Mkwaja Ranch were able to develop because of ranching, and can only persist under intensive grazing. The woodlands do not represent a successional stage towards forest and will probably revert to predominantly grassland vegetation within 10–20 years unless grazing pressure from wild ungulates increases considerably and/or fire regimes change.     

食物供应量对转红色荧光蛋白基因唐鱼 生存和生长的影响

选取雄性杂合子转红色荧光蛋白基因唐鱼(Tanichthys albonubes)(简称:转基因唐鱼)与雌性非转基因唐鱼交配产卵,出膜7d后,在水温(25.0 ±2.0)℃条件下,选择健康仔鱼进行饱食(食物供应量高)、半饥饿(食物供应量中)和饥俄(食物供应量低)3种处理,结果显示:(1)出膜后7～72 d的唐鱼饱食组与半...     

The impact of <Emphasis Type="Italic">Solanum elaeagnifolium</Emphasis>, an invasive plant in the Mediterranean,on the flower visitation and seed set of the native co-flowering species <Emphasis Type="Italic">Glaucium flavum</Emphasis>

The sprouting response types of 1,151 cork oak (Quercus suber) trees one and half years after a wildfire in southern Portugal were characterised. It was hypothesised that different response types should occur according to the following conceptual model: an increased level of damage (fire severity) on a sprouting tree that suffered a crown fire was expected to be reflected in a sequence of four alternative events, namely (a) resprouting exclusively from crown, (b) simultaneous resprouting from crown and base, (c) resprouting exclusively from base and (d) plant death. To assess whether the level of expected damage was influenced by the level of protection from disturbance, we explored the relationships between response types and tree size, bark thickness and cork stripping, using an information-theoretic approach. The more common response type was crown resprouting (68.8% of the trees), followed by plant death (15.8%), simultaneous resprouting from crown and base (10.1%) and basal resprouting (5.3%). In agreement with the conceptual model, trees which probably suffered a higher level of damage by fire (larger trees with thinner bark; exploited for cork) died or resprouted exclusively from base. On the other hand, trees that were well protected (smaller trees with thicker bark not exploited for cork) were able to rebuild their canopy through crown resprouting. Simultaneous resprouting from the crown and base was determined mainly by tree size, and it was more common in smaller trees.     

Elevated CO2 and O3 effects on fine-root survivorship in ponderosa pine mesocosms

Atmospheric carbon dioxide (CO₂) and ozone (O₃) concentrations are rising, which may have opposing effects on tree C balance and allocation to fine roots. More information is needed on interactive CO₂ and O₃ effects on roots, particularly fine-root life span, a critical demographic parameter and determinant of soil C and N pools and cycling rates. We conducted a study in which ponderosa pine (Pinus ponderosa) seedlings were exposed to two levels of CO₂ and O₃ in sun-lit controlled-environment mesocosms for 3 years. Minirhizotrons were used to monitor individual fine roots in three soil horizons every 28 days. Proportional hazards regression was used to analyze effects of CO₂, O₃, diameter, depth, and season of root initiation on fine-root survivorship. More fine roots were produced in the elevated CO₂ treatment than in ambient CO₂. Elevated CO₂, increasing root diameter, and increasing root depth all significantly increased fine-root survivorship and median life span. Life span was slightly, but not significantly, lower in elevated O₃, and increased O₃ did not reduce the effect of elevated CO₂. Median life spans varied from 140 to 448 days depending on the season of root initiation. These results indicate the potential for elevated CO₂ to increase the number of fine roots and their residence time in the soil, which is also affected by root diameter, root depth, and phenology.     

Musical chairs mortality functions: density-dependent deaths caused by competition for unguarded refuges

Structural refuges within which prey can escape from predators can be an important limiting resource for the prey. In a manner that resembles the childhood game of musical chairs, many prey species rapidly retreat to shared, unguarded refuges whenever a predator threatens, and only when refuges are relatively abundant do all prey individuals actually escape. The key feature of this process is that the per capita prey mortality rate depends on the ratio of prey individuals to refuges. We introduce a new class of mortality functions with this feature and then demonstrate statistically that they describe field mortality data from a well-studied coral reef fish species, the Caribbean bridled goby Coryphopterus glaucofraenum, substantially better than do several mortality functions of more conventional form. J. F. Samhouri and R. R. Vance contributed equally to this work.     

Serum and Cerebrospinal Fluid Magnesium Levels, Glasgow Coma Scores, and In-Hospital Mortality in Patients with Acute Stroke

The aim of this study was to determine the relationship between serum and cerebrospinal fluid (CSF) magnesium (Mg⁺²) levels, Glasgow Coma Scores (GCS), and 7-day mortality in acute stroke patients. Patients with acute ischemic or hemorrhagic stroke arriving within the first 3 h of symptoms were included in the study. The control group consisted of healthy volunteers. GCS was determined, and blood and CSF samples were taken in order to establish serum and CSF glucose, Mg⁺², sodium, potassium, calcium, and chlorine levels. Mortality was recorded at 7 days after admission. CSF Mg⁺² in the ischemic infarct group was significantly lower than in the control group (p = 0.006). CSF Mg⁺² in the ischemic infarct patients with a GCS ≤ 8 were significantly lower (p = 0.002) than controls and in ischemic infarct patients with a GCS ≥9. In the ischemic stroke patients, CSF Mg⁺² and GCS were significantly correlated (r = 55, p = 0.031). CSF Mg⁺² levels in ischemic stroke patients who died within 7 days were significantly lower than controls, ischemic stroke patients who survived, and hemorrhagic stroke patients who died (p = 0.002, p = 0.042, and p = 0.005, respectively). Low CSF Mg⁺² levels in patients with acute ischemic stoke at admission predicted a higher 1-week mortality.