Prevalence of diabetes mellitus after extra corporeal shock wave lithotripsy in 15 years follow-up.
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ABSTRACT:
SUBMITTER: Rashed FK
PROVIDER: S-EPMC5532896 | biostudies-other | 2017 Jul-Sep
REPOSITORIES: biostudies-other
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Project description:Previous studies have demonstrated that stone comminution decreases with increased pulse repetition frequency as a result of bubble proliferation in the cavitation field of a shock wave lithotripter (Pishchalnikov et al 2011 J. Acoust. Soc. Am. 130 EL87-93). If cavitation nuclei remain in the propagation path of successive lithotripter pulses, especially in the acoustic coupling cushion of the shock wave source, they will consume part of the incident wave energy, leading to reduced tensile pressure in the focal region and thus lower stone comminution efficiency. We introduce a method to remove cavitation nuclei from the coupling cushion between successive shock exposures using a jet of degassed water. As a result, pre-focal bubble nuclei lifetime quantified by B-mode ultrasound imaging was reduced from 7 to 0.3 s by a jet with an exit velocity of 62 cm s(-1). Stone fragmentation (percent mass <2 mm) after 250 shocks delivered at 1 Hz was enhanced from 22 ± 6% to 33 ± 5% (p = 0.007) in water without interposing tissue mimicking materials. Stone fragmentation after 500 shocks delivered at 2 Hz was increased from 18 ± 6% to 28 ± 8% (p = 0.04) with an interposing tissue phantom of 8 cm thick. These results demonstrate the critical influence of cavitation bubbles in the coupling cushion on stone comminution and suggest a potential strategy to improve the efficacy of contemporary shock wave lithotripters.
| S-EPMC3693448 | biostudies-literature
Project description:IntroductionWe determine the effect of patient characteristics (age, sex, and body mass index BMI) and stone characteristics (density, location, and size) by non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney and ureteric stones. We present this study to further enrich the knowledge of physicians towards the effect of different patient characteristics upon predicting extra-corporal shock wave lithotripsy success rates.MethodsWe evaluated 155 patients who received ESWL for renal and ureteric stone measuring 3-20 mm (mm), over a 3-month period. The stone size in millimeters, density in Hounsfield units (HU) and its location was determined on pre-treatment CT-KUB. ESWL was successful if post-treatment residual renal stone fragments were ≤3 mm and for ureteric stones should be totally cleared.ResultsThe overall success of ESWL treatment was observed in 65.8% of the 155 patients. There was no significant difference seen when the effect of patients age, sex and BMI were studied with ESWL outcome with P values were 0.155, 0.101 and 0.415 respectively. Also, stone location either in the kidney or ureter has no statistically significant effect on ESWL response rate. while stone density and size determined on CT KUB have statistically significant effect on the success rate of ESWL with a P-value of 0.002 and 0.000 respectively.ConclusionsThis study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL.
| S-EPMC8441084 | biostudies-literature
Project description:Most research on dietary patterns and health outcomes does not include longitudinal exposure data. We used an innovative technique to capture dietary pattern trajectories and their association with haemoglobin A1c (HbA1c), homeostasis model of insulin resistance (HOMA-IR) and prevalence of newly diagnosed diabetes.We included 4096 adults with 3-6 waves of diet data (1991-2006) and biomarkers measured in 2009 from the China Health and Nutrition Survey. Diet was assessed with three 24-h recalls and a household food inventory. We used a dietary pattern previously identified with reduced rank regression that positively predicted diabetes in 2006 (high in wheat products and soy milk and low in rice, legumes, poultry, eggs and fish). We estimated a score for this dietary pattern for each subject at each wave. Using latent class trajectory analysis, we grouped subjects with similar dietary pattern score trajectories over time into five classes.Three trajectory classes were stable over time, and in two classes the diet became unhealthier over time (upward trend in dietary pattern score). Among two classes with similar scores in 2006, the one with the lower (healthier) initial score had an HbA1c 1.64% lower (-1.64 (95% CI -3.17 to -0.11)) and non-significantly a HOMA-IR 6.47% lower (-6.47 (-17.37 to 4.42)) and lower odds of diabetes (0.86 (0.44 to 1.67)).Our findings suggest that dietary pattern trajectories with healthier scores longitudinally had a lower HbA1c compared with those with unhealthier scores, even when the trajectories had similar scores in the end point.
| S-EPMC4082755 | biostudies-literature
Project description:Purpose: In the years 1993-1996 a number of presumably false-positive breast cancer diagnoses were made by a pathologist in Essen. A follow-up, undertaken 15 years later, investigated how many women had tumour recurrence and/or metastasis or had died from breast cancer. Material and Methods: A total of 151 (68?%) out of 222 women could be traced. One hundred and forty-seven (66.2?%) of the 222 women were alive. The observed survival rate, number of recurrences and/or metastases, and number of deaths from breast cancer were compared with data from the Munich Tumour Registry. The number of breast cancer cases among daughters of the affected women was ascertained. Results: The total observed survival rate at follow-up after 15 years was 93?%, a much higher figure than the survival rate of 45?% given by the Munich Tumour Registry. Recurrence and/or metastasis or death from breast cancer occurred in 9/222 cases (4.1?%). The incidence for these events calculated according to data from the Munich Tumour Registry is 13?%. Two daughters (2.2?%) out of a total of 90 were diagnosed with breast cancer whereas, according to the German Cancer Research Centre, the expected rate would have been between 5 and 10?%. Conclusions: The results of our follow-up after 15 years show that more women survived than expected and that the number of recurrences and/or metastases and deaths due to breast cancer was lower than expected. Fewer daughters of affected women were diagnosed with breast cancer than expected. These results support our suspicion that not all women diagnosed with breast cancer by a pathologist in Essen actually had breast cancer.
| S-EPMC4168321 | biostudies-literature
Project description:A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P+(avg), incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P+(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury.
| S-EPMC3745501 | biostudies-other
Project description:BackgroundPatterns of survey response and the characteristics associated with response over time in longitudinal studies are important to discern for the development of tailored retention efforts aimed at minimizing response bias. The Millennium Cohort Study, the largest and longest running cohort study of military personnel and veterans, is designed to examine the long-term health effects of military service and experiences and thus relies on continued participant survey responses over time. Here, we describe the response rates for follow-up survey data collected over 15 years and identify characteristics associated with follow-up survey response and mode of response (paper vs. web).MethodPatterns of follow-up survey response and response mode (web, paper, none) were examined among eligible participants (n=198,833), who were initially recruited in four panels from 2001 to 2013 in the Millennium Cohort Study, for a follow-up period of 3-15 years (2004-2016). Military and sociodemographic factors (i.e., enrollment panel, sex, birth year, race and ethnicity, educational attainment, marital status, service component, service branch, pay grade, military occupation, length of service, and time deployed), life experiences and health-related factors (i.e., military deployment/combat experience, life stressors, mental health, physical health, and unhealthy behaviors) were used to examine follow-up response and survey mode over time in multivariable generalized estimating equation models.ResultsOverall, an average response rate of 60% was observed across all follow-up waves. Factors associated with follow-up survey response over time included increased educational attainment, married status, female sex, older age, military deployment (regardless of combat experience), and higher number of life stressors, mental health issues, and physical health diagnoses.ConclusionDespite the challenges associated with collecting multiple waves of follow-up survey data from members of the U.S. military during and after service, the Millennium Cohort Study has maintained a relatively robust response rate over time. The incorporation of tailored messages and outreach to those groups least likely to respond over time may improve retention and thereby increase the representativeness and generalizability of collected survey data.
| S-EPMC10492282 | biostudies-literature
Project description:BackgroundPrimary flexible ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (SWL) are treatment options in patients with renal calculi of 5-15 mm.ObjectiveTo compare effectiveness, complication rates, and pain scores between primary URS and SWL.Design setting and participantsBetween 2011 and 2016, patients with renal calculi between 5 and 15 mm were randomized to undergo either primary URS or SWL.Outcome measurements and statistical analysisStone-free rate and size of residual fragments assessed by computed tomography after 3 mo, complications, and pain scores were evaluated.Results and limitationsThe study was prematurely closed after randomizing 44 patients due to poor accrual. The 3-mo stone-free rate and mean residual stone size were, respectively, 61% and 1.8 mm after URS and 48% and 2.4 mm after SWL. Early post-treatment pain scores were significantly higher after URS than after SWL on day 1 (3.3 vs 1.6, p = 0.02) and day 7 (5.2 vs 3.4, p = 0.04), but were no longer detectable after 3 wk and 3 mo, respectively. One Clavien-Dindo grade II complication was observed after URS (5%) and SWL (4%), while one (4%) grade IIIb complication was observed after SWL.ConclusionsURS appears to be associated with higher early post-treatment discomfort, which could be associated with routine postoperative stenting. Owing to premature closure of this trial, the power was insufficient to formally compare URS and SWL; however, the present data might be informative to counsel patients about treatment outcomes and allow future meta-analyses.Patient summaryThis study was ended prematurely, but it contributes data about efficacy and side effects of different treatment options in patients with renal calculi.
| S-EPMC8317856 | biostudies-literature
Project description:PurposeShock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children.Materials and methodsWe reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed.ResultsWe identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01).ConclusionsUreteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.
| S-EPMC6103480 | biostudies-literature
Project description:BackgroundExtracorporeal shock wave lithotripsy (ESWL) is considered one of the best choices for the treatment of various kinds of urinary tract calculi, although it might cause acute kidney injury.ObjectiveTo measure the urinary long non-coding RNA-messenger RNA (LncRNA-mRNA) panel before and after ESWL to evaluate post-ESWL renal injury in a reliable and non-invasive method.Patients and methodsThe study included 60 patients with renal stones treated with ESWL and 30 healthy volunteers. Voided urine samples were obtained before, 2 h, and 1 day after ESWL. We measured the urinary level of LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) by real-time qPCR and compared the results with serum creatinine and eGFR.ResultsLncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were higher in patients with renal stones when compared with healthy volunteers. They showed a statistically significant increase in the level of LncRNA-mRNA panel in baseline and after ESWL treatment.ConclusionLncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were significantly elevated following ESWL treatment, highlighting the usefulness of urinary biomarkers in identifying patients at higher risk of developing renal injury after ESWL treatment.
| S-EPMC9166822 | biostudies-literature
Project description:Early shock wave lithotripsy is associated with higher stone-free rate compared to delayed treatment of ureteral stones, but may constitute overtreatment because ureteral stones can pass spontaneously. We studied the association between time to treatment and stone-free rate in patients with ureteral stones to determine optimal shock wave lithotripsy timing. We retrospectively analyzed 537 patients undergoing shock wave lithotripsy for ureteral stones. Patients were divided into five groups according to time from onset of symptoms to lithotripsy-urgent (0-3 days), early (4-30 days), late (31-60 days), long-delayed lithotripsy (≥ 61 days), and asymptomatic. Stone-free rates were compared among groups. Mean age and stone size were 55.6 ± 13.1 years and 7.48 ± 3.29 mm, respectively. Mean number of shock wave lithotripsy sessions and stone-free rate were 1.37 and 91.6%, respectively, in the overall population. Stone-free rates were 95.2%, 96.8%, 91.3%, 86.3%, and 82.7% in urgent, early, late, long-delayed lithotripsy, and asymptomatic groups, respectively. Long-delayed lithotripsy and asymptomatic groups had significantly more lithotripsy sessions and lower stone-free rate, compared to urgent and early lithotripsy groups. In multivariate analysis, time to lithotripsy [long-delayed lithotripsy (odds ratio: 0.273, p = 0.004) and asymptomatic nature (odds ratio: 0.236, p = 0.002)] and age (odds ratio: 0.959, p = 0.003) independently affected stone-free rate. In conclusion, time to lithotripsy is a strong predictive factor for stone-free status following shock wave lithotripsy. Urgent shock wave lithotripsy did not improve stone-free rate if performed within 1 month. However, time to shock wave lithotripsy > 2 months reduced likelihood of stone-free status.
| S-EPMC7778408 | biostudies-literature