Background: Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. Objective: In our study we evaluated accuracy of four pre-operative models (GP score, PRIX, D’Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. Methods: Age, preoperative total prostate specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value > 0.2 ng / dl twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1, 3 and 5 year (yr) BCR-free rates of the patients were determined for each model. Also the accuracy of four predictive models for predicting 1, 3 and 5-yr BCR was evaluated. Results: For all pre-operative models there was statistically significant difference between risk groups in BCR free rates at 1, 3 and 5-yr after RP (p<0.001). The Harrell’s concordance index for 1-yr BCR predictions was 0,802, 0,831, 0,773 and 0,745 for the GP score, PRIX, CAPRA and D’Amico and respectively. For 3-yr BCR predictions it was 0,798, 0,791, 0,723 and 0,714 for the GP score, PRIX, CAPRA and D’Amico and respectively. Finally, The Harrell’s concordance index for 5-yr BCR predictions was 0,778, 0,771, 0,702 and 0,693 for the GP score, PRIX, CAPRA and D’Amico and respectively. Conclusion: In prediction of BCR, accuracy of GP scoring and PRIX seems slightly higher than CAPRA and D’Amico risk classification. Surely our results should be supported by head to head comparisons with in other larger cohorts

Objectives: Multimorbidity and polypharmacy in older adults always increase the prevalence of potentially inappropriate medications (PIMs) and affect the quality of life of the older adults. The purposes of this study were aimed to investigate the prevalence of PIMs prescription and the most frequent PIMs among outpatients according to Beers criteria and to explore related risk factors for PIMs prescription. Methods: The cross-sectional retrospective study was conducted among elderly outpatients in Chengdu (a city in China) from January 2018 to December 2018. The 2015 Beers criteria was used to assess PIMs in elderly outpatients. Univariate analysis and multivariate logistic regression analysis were adopted to determine the factors that may affect the prevalence of PIMs in elderly outpatients. Results: A total of 15523 patient prescriptions were enrolled, of which 4654 (29.98%) were identified with at least one PIM based on Beers criteria, and 6460 PIMs were detected. Of these PIM prescriptions, 76.32% were detected to receive 1 PIM, 16.54% were detected to receive 2 PIMs, and only 7.13% were found to have at least 3 PIMs. Benzodiazepines (2371, 50.95%), diuretics (1197, 25.72%), and selective serotonin reuptake inhibitors (439, 9.43%) were three common types of drugs that were the most frequent PIMs used. Sex, age, number of diseases, number of medications, and diseases or disease states were risk factors for PIMs in outpatients. Conclusion: The results of the study showed that the phenomenon of PIM was common among elderly outpatients in Chengdu. Risk factors for PIM in elderly outpatients include gender, age, number of diseases, number of medications, and sleep disorder.

Background Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Purpose To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (> 65 years) and 0.9% in the younger population (< 65 years). These prevalence rates are different from estimates provided by the US CDC for those aged > 65 years (9%) and age < 65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.

Purpose: Pancreatic cancer (PC) is a devasting disease of which mortality almost parallels its incidence. Pancreatic cancer tissue may express aberrantly methylated NPTX2, but it is unclear what the consequences of this are. The purpose of the present study was to assess the diagnostic performance of methylated NPTX2 in PC diagnosis. Methods: We conducted a comprehensive search of PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and the Cochrane Library for published studies from inception to July 15, 2020. Using STATA 13.0, diagnostic OR (DOR) and AUC (Area Under the Curve of Receiver Operating Characteristic) were calculated to evaluate the diagnostic efficacy. Results: Nine studies were found eligible for the meta-analysis. The overall results of DOR and AUC were 11 (95%CI: 4-26) and 0.80, respectively. These data indicate that aberrantly methylated NPTX2 can correctly predict PC. Subgroup analysis revealed that quantitative real-time methylation-specific PCR (QMSP) had the highest diagnostic value for differentiating pancreatic cancer from chronic pancreatitis using a laboratory method. Furthermore, the detection of hypermethylated NPTX2 found in plasma was suggested to be a promising diagnostic biomarker, though a meta-analysis was not feasible due to the limited number of samples. The Deeks’ funnel map revealed no obvious public bias in the literature. Conclusion: aberrantly methylated NPTX2 has high sensitivity and specificity for the diagnosis of pancreatic cancer. However, further research is required to validate the use of methylated NPTX2 as a biomarker in the clinical diagnosis of pancreatic cancer.

Background: We studied whether significant differences in care gaps exist between specialists and PCPs. Methods: GOAL Canada enrolled patients with CVD or familial hypercholesterolemia (FH) and LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy. During follow-up, physicians received online reminders of treatment recommendations based on Canadian Guidelines. Results: A total of 177 physicians (58% PCPs) enrolled 2009 patients; approximately half of the patients were enrolled by each physician group. Patients enrolled by specialists were slightly older (mean age 63 years vs. 62), female (45% vs. 40%), Caucasian (77% vs. 65%), and had a slightly higher systolic pressure and lower heart rate. Patients enrolled by specialists had less frequent history of familial hypercholesterolemia, diabetes, hypertension, chronic kidney disease and liver disease but more frequent history of coronary artery disease, atrial fibrillation and premature family history of CVD. There was no significant baseline difference in LDL-C, HDL-C, or non-HDL-c, although total cholesterol and triglycerides were slightly higher in patients managed by PCPs. At baseline, PCPs were more likely to use statins (80% vs.73%, p=0.0002) and other therapies such as niacin or fibrate (10% vs. 6%, p=0.0006) but similar use of ezetimibe (24% vs. 27%, p=0.15). At the end of follow up, specialists used less statins (70% vs. 77%, p=0.0005) and other therapies (6% vs. 10%, p=0.007) but more ezetimibe (45% vs. 38%, p=0.01) and the same frequency of PCSK9i (28% vs. 27%, p=0.65). The proportion of patients achieving the recommended LDL-C level of 2.0 mmol/L or below (primary endpoint) was similar at last available visit between specialists and PCPs (44% vs. 42%, p=0.32). Conclusion: Despite minor differences in the clinical profile of their patients, both PCPs and specialists actively participate in the management of lipid lowering therapy in high risk CVD patients and experience similar challenges and care gaps.

Purpose To evaluate the effect of risk factors and selected surgical methods on operative and oncological results of patients undergoing radical prostatectomy (RP) with high-risk prostate cancer (HRPC). Methods Retrospective analysis of patients, who underwent RP for HRPC from 13 urology centers between 1990 to 2019, was performed. Groups were created according to the risk factors of D’Amico classification. Patients with one risk factor were included in group 1 where group 2 consisted of patients with two or three risk factors. Results A total of 1519 patients were included in this study and 1073 (70.6%) patients assigned to group 1 and 446 (29.4%) patients to group 2. Overall (biochemical and/or clinical and/or radiological) progression rate was 12.4% in group 1 and 26.5% in group 2 (p =0.001). Surgical procedure was open RP in 844 (55.6%) patients and minimally invasive RP in 675 (44.4%) patients (laparoscopic and robot-assisted RP in 230 (15.1%) and 445 (29.3%) patients, respectively). Progression rates were similar in different types of operations (p=0.22). Progression rate was not significantly different in patients who either underwent pelvic lymph node dissection (PLND) or not in each respective group. Conclusion RP alone is an effective treatment in the majority of patients with HRPC and PLND did not affect the progression rates after RP. According to the number of preoperative high-risk features, as the number of risk factors increases, there is a need for additional treatment.

Purposes: The present meta-analysis compared the postoperative visual performance of primary intraocular lens (IOL) implantation and primary aphakia in cataract infants. Methods: We performed a systematic literature search in PubMed, EMBASE and Science Direct. Postoperative visual acuity (VA) and complications were extracted and pooled. Results: Four randomized controlled trails (RCTs) and seven retrospective studies were included. The postoperative VA in primary IOL group was better than that in primary aphakia group [MD=-0.12, 95% CI: (-0.19, -0.05), p=0.91]. There was no significant difference in the incidence of glaucoma, retinal detachment and nystagmus between primary IOL group and primary aphakia group [OR=1.27, 95% CI: (0.79, 2.05), p=0.84 for glaucoma; OR=0.49, 95%CI: (0.07, 3.30), p=0.34 for retinal detachment;; OR=1.11, 95%CI: (0.62, 1.98), p=0.73 for nystagmus]. Analysis of unilateral subgroup indicated there were fewer infants with strabismus in primary IOL group compared with primary aphakia group [OR=0.40, 95% CI: (0.21, 0.79), p=0.46]. The primary IOL group needed more visual axis opacification (VAO) clearing than primary aphakia group [OR=9.33, 95%CI: (5.21, 16.73), p=0.27]. Conclusion: Primary IOL implantation provided more visual benefits. IOL implantation may decrease the incidence of strabismus in comparison with primary aphakia in unilateral subgroup. However, these advantages could be offset by a higher VAO clearing surgery.

Purpose Only 25% of oesophageal adenocarcinoma (OAC) patients have a pathological response to neo-adjuvant therapy (NAT) before oesophagectomy. Early response assessment using PET imaging may help guide management of these patients. We performed a systematic review and meta-analysis to synthesise the evidence detailing response rate and diagnostic accuracy of early PET-CT assessment. Methods We systematically searched several databases including MEDLINE and Embase. Studies with mixed cohorts of histology, tumour location, and a repeat PET-CT assessment after more than one cycle of NAT were excluded. Reference standard was pathological response, defined by Becker or Mandard classifications. Primary outcome was metabolic response rate after one cycle of NAT defined by a reduction in maximum standardised uptake value (SUVmax) of 35%. Secondary outcome was diagnostic accuracy of treatment response prediction, defined as the sensitivity and specificity of early PET-CT using this threshold. Quality of evidence was also assessed. Random-effects meta-analysis pooled response rates and diagnostic accuracy. This study was registered with PROSPERO (CRD42019147034). Results Overall, 1341 articles were screened, and six studies were eligible for analysis. These studies reported data for 518 patients (aged 27-78 years; 452 [87.3%] were male) between 2005-2020. Pooled sensitivity of early metabolic response to predict pathological response was 77.2% (95%CI 53.2%-100%). Significant heterogeneity existed between studies (I2=80.6% (95%CI 38.9%-93.8%), p=0.006). Pooled specificity was 75.0% (95%CI 68.2%-82.5%), however no significant heterogeneity between studies existed (I2=0.0% (95%CI 0.0%-67.4%), p=0.73). Conclusion High-quality evidence is lacking, and few studies met the inclusion criteria of this systematic review. The sensitivity of PET using a SUVmax reduction threshold of 35% was suboptimal and varied widely. However, specificity was consistent across studies with a pooled value of 75.0%, suggesting early PET assessment is a better predictor of treatment resistance than of pathological response. Further research is required to define optimal PET-guided treatment decisions in OAC.

Objective: The impact of thyroid hormones within normal range on muscle mass remains unknown. We examined the association between new onset of low muscle mass (LMM) and thyroid hormones among euthyroid men and women with three different definitions of LMM in prospective cohort study. Methods: We performed a cohort study of 198,069 Korean adults (mean age of 39.2 years), free of LMM at baseline, who participated in a repeated screening examination and were followed-up annually or biennially for up to 6.3 years. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by an electrochemiluminescent immunoassay. Muscle mass was assessed using a bioelectrical impedance analyzer. LMM was defined as the appendicular skeletal muscle mass (ASM) by body weight (ASM/weight, LMM-W), height squared (ASM/height2, LMM-H) and BMI (ASM/BMI, LMM-B) of one standard deviation below the sex-specific mean for young reference group. Results: During a median follow-up of 3.1 years (interquartile range, 2.0-4.1 years), new-onset LMM-W, LMM-H, and LMM-B occurred in 17,856 (incident rate, 27.8 per 1,000 person-years), 8,307 (incident rate, 13.4 per 1,000 person-years), and 13,990 participants (incident rate, 24.5 per 1,000 person-years) in each. In euthyroid men, FT4 was inversely and FT3 positively associated with incident LMM-W in a dose-response manner. TSH and FT4 had inverse dose-response relationship with incident LMM-B. Incident LMM-H of euthyroid men has no apparent associations with any thyroid hormones. Euthyroid women had no dose-response relationship between thyroid hormones and any definition of LMM. Conclusions: Among euthyroid men, FT4 had inverse dose-response association with new onset of LMM defined with weight (LMM-W) and BMI (LMM-B). Height squared LMM (LMM-H) had no apparent relationship with any thyroid hormones. Euthyroid women had no dose-responsive association between thyroid hormones and incident LMM. Key words: appendicular skeletal muscle mass, low muscle mass, thyroid hormones, Cohort study

Objectives: To investigate lung volume and density in patients with SSc and changes in these parameters due to PF, using a software-aided image quantification method, and compare this with a matched healthy control group. Methods: Thoracic high-resolution computed tomography (HRCT) images of patients and controls were analyzed using Myrian XP Lung 3D software. Right, and left lung densities and volumes were calculated separately by a blinded operator. Results were analyzed between subgroups to investigate associations with the clinical features. Results: A total of 135 patients with SSc and 38 healthy controls (HC) were included. Characteristics of the SSc patients were 94 (69.6%) without PF, 85.4% female, mean age 49.8 (15.4) years; 41 (30.4%) with PF, 88.3% female, mean age 50.2 (11.5) years and HC group were 89.5% Female, mean age 52.2 (5.8) years. The right and left lung densities were significantly higher, and right and left lung volumes were significantly lower in the SSc patients with signs of fibrosis than those without and HC (p<0.001 and p<0.001; p=0.006 and p=0.002, respectively). After excluding patients with PF, right and left lung densities and volumes differed significantly between diffuse cutaneous SSc, limited cutaneous SSc, and HC (p=0.002 and p<0.001; p=0.045 and p=0.044, respectively). Patients who developed PF during follow-up had significantly lower baseline right and left lung densities than those who did not (p=0.018; p=0.014, respectively). Forced vital capacity and carbon monoxide diffusing capacity showed weak correlation with lung densities and volumes in patients without PF and moderate to high correlation in PF patients. Conclusion: Lung density and volume in SSc patients changed significantly in those with PF and those without. Quantitative information extracted by soft-ware aided methods may contribute more to the detection, screening, and risk prediction in SSc related PF.

Aims: The role of urodynamic studies in the diagnosis and prognosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains controversial. We evaluated the correlation of baseline voiding dysfunctions with long-term treatment outcome in a large cohort of patients with IC/BPS. Methods: We studied 211 patients with nonulcerative IC/BPS. All patients underwent video urodynamic examination at baseline to identify their voiding conditions and they received subsequent treatments. The primary endpoint was the global response assessment (GRA) at the current interview. Secondary endpoints included O’Leary-Sant score (OSS), Visual Analog Scale (VAS) for pain, and the rate of IC symptom flare-up. Results: Mean patient age was 56.8 ± 12.8 years and mean IC symptom duration was 16.0 ± 9.9 years. At baseline, 83 (39.3%) patients had a voiding problem and 62.7% had one to three comorbidities. The duration, comorbidity, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA, and flare-up rate were not significantly different among the different voiding subtypes. When we divided the patients by their voiding conditions of normal (n = 32) and hypersensitive bladder with (n = 76) and without (n = 103) voiding dysfunctions, only MBC (P = 0.002) and glomerulation (P = 0.021) demonstrated a significant difference. When we analyzed subgroups by GRA, patients with a GRA ≥ 2 had a significantly shorter disease duration. There also were significant associations between GRA and the changes in OSS and VAS (P < 0.001). Conclusions: Voiding dysfunctions in patients with non-Hunner IC/BPS do not affect long-term treatment outcome.

Background Obstructive Sleep Apnea (OSA) is a worldwide increasing syndrome, which, by promoting endothelial dysfunction, contributes to extend the cardiovascular risk. We evaluated the cardiovascular risk in a group of OSA patients. Methods A total of 185 OSA subjects (19 normal weight, 57 overweight, 109 obeses), seen at the Ambulatory of Sleep Disorders, during one year, entered the study. We assessed anthropometric features, polysomnographic findings, cardiovascular risk factors, smoking habit, Pulmonary Function Test, Arterial Blood Gas Analysis, Epworth Questionnaire, and Charlson Co-morbidities Index (CCI). Subjects were divided into three groups, according to their BMI: individuals with BMI ≥30 Kg/m2 (Group 1 n=109, mean age 61 ± 1; 74.3 % males), individuals with BMI ranging from 25.0 to 29.9 Kg/m2 defined as overweight subjects (Group 2 n=57, mean age 58.8 ± 1.4; 77% males) and subjects with a BMI ranging from 18.5 to 24.9 Kg/m2 defined normal weight subjects (Group 3 n=19, mean age 54.2 ± 2.3; 64,2% males). Results In the whole population, the percentage cardiovascular risk was weakly related with BMI (r=0.33; P<0.001), but not with AHI. The cardiovascular risk was strictly related to the obesity (p<0.00002), while the Epworth Questionnaire score and the Charlson Co-morbidity Index were respectively statistically higher in the group of obese individuals (p=0.006, p=0.00002) than in the other 2 Groups. When AHI values were stratified in tertiles, the percentage cardiovascular risk did not vary with increasing AHI values (Figure 2). Conclusions Further studies are required to investigate the pivotal role of inflammation due to obesity, and underlying increased cardiovascular risk in OSA patients.

Eltrombopag is a highly effective treatment for immune thrombocytopenia (ITP). Cases of durable remission after the discontinuation of eltrombopag in adult ITP have recently been reported; however, the frequency and mechanisms responsible for this phenomenon remain unknown. In the present study, we examined the phenotypes of lymphocytes in ITP to clarify whether they predict outcomes after the discontinuation of eltrombopag. We examined 56 adult newly diagnosed ITP patients treated with eltrombopag after a median time from diagnosis of 48 months. Among the 38 patients who achieved complete remission, eltrombopag was discontinued in 26. Among the 26 patients, 12 (46.2%) had an immediate relapse after discontinuing eltrombopag and 16 (53.8%) showed sustained response without additional ITP therapy, despite discontinuing eltrombopag, with a median follow-up of 52 months. No significant differences were observed in platelets, the median duration of eltrombopag, the absolute number of T, B, and NK cells at the initiation of eltrombopag between patients who sustained response and those who relapsed after discontinuing eltrombopag. However, the number of B and NK cells at the discontinuation of eltrombopag was higher in patients who sustained response than in those who relapsed (p=0.022 and p=0.012, respectively). The present results indicate that the absolute number of B (≥ 0.20 x 109/L) and NK (≥ 0.36 x 109/L) cells at the discontinuation of eltrombopag contributes to the prediction of outcomes.

Aims: To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). Methods: A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014-2019 in a single UK teaching hospital. Data was collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender, and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. Results: 700 patients were included in the primary analysis, 427 female and 273 males. 331 meet the criteria of rUTI. The median age was 64y(18-97). Imaging abnormalities were equally frequent in males 6.3%(15/241) and females 8%(30/380) and the majority noted in patients aged ≥55y, 30/45(66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5-7% regardless of age group and gender. Cystoscopy abnormalities (n=24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). 88%(21/24) were identified in patients ≥55y. There were no positive findings in women <55y. Applying baseline imaging but confining cystoscopy to those aged ≥55y and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8%(69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46%(29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. Conclusion: To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.

Aims: C-reactive protein (CRP) is commonly used for monitoring Surgical Stress Response (SSR) and detecting post-operative infectious complications. However, high CRP values can be associated to patient-related factors independently from complications. The aim of this study was to assess the relationship between visceral obesity (VO) and SSR after laparoscopic colorectal resection. Methods: Visceral adipose tissue (VAT) area was measured at CT images for 357 patients who underwent elective laparoscopic colorectal resection at our institution. Post-operative outcomes and CRP values were compared between VO and non-VO groups, defined according to VAT cut-offs. Univariate and multivariate analyses were conducted for factors affecting SSR. ROC curves were constructed to assess the most appropriate CRP values for identifying infectious complications in the VO and non-VO populations. Results: In the final cohort, 62.2% of patients were classified as VO. No differences were seen in post-operative outcomes and infectious complications. VO was associated with higher CRP values on post-operative day (POD)1, POD2, POD3, and POD5, considering both the overall cohort and patients without infectious complications. A positive correlation was found between VAT and CRP values on all PODs, and VO independently predicted increased CRP on POD1-3 in patients without infectious complications but not in those who developed complications. ROC curves analysis for POD3 CRP showed comparable accuracy for detection of infectious complications in both groups, though the optimal cut-off value was higher in VO group (154 vs. 136 mg/dl). Conclusions: Although VO is not associated to increased complications after laparoscopic colorectal resection, it independently predicts increased SSR risk. To achieve accurate identification of infectious complications, different cut-off values of POD3 CRP shall be used in VO and non-VO patients.

Objective To analyze the effect of nasopharyngeal ventilation on the detection rate of colorectal polyps in 200 middle-aged and elderly overweight patients during painless colonoscopy. Methods A total of 100 patients aged 50-75 years, body mass index (BMI) ≥24 or abdominal circumference ≥85 cm in males and ≥82 cm in females, without underlying diseases, who underwent nasopharyngeal ventilation during painless colonoscopy at physical examinations in our hospital from 2019 to 2020, were selected as the observation subjects (n = 100). The control sample area was determined by propensity matching according to the basic information characteristics presented by the observation group. 100 patients received mask oxygen at physical examinations were randomly selected in the control group (n = 100). Results The verification analysis after matching indicated that there were no intraoperative and postoperative adverse reactions, the number of intraoperative limb movements was less than 1, and the intestinal peristalsis intervals were more than 5s in both groups, without atropine intervention. Colonoscopy was performed by senior endoscopists with a withdrawal time of 6-8 min. When the intraoperative SpO2 was lower than 90% but higher than 85%, the patients in the observation group underwent nasopharyngeal ventilation while those in the control group received mask oxygen assisted chin-lift. As a result, the SpO2 was maintained higher than 90%. The detection rate of colorectal polyps was compared between the two groups. Conclusion The detection rate of colorectal polyps in the observation group was higher than that in the control group, with a statistically significant difference. It may result from the reduction of ineffective respiratory movement and intraoperative intestinal peristalsis in middle-aged and elderly overweight patients.

Purpose: To observe and describe the stiffness changes of the optic nerve in the patients with multiple sclerosis (MS) with or without optic neuritis and healthy adults via shear wave elastography (SWE). Methods: Seventy optic nerves from thirty-five patients with MS and sixty optic nerves from thirty healthy subjects were included prospectively in the study. The optic nerve (ON), optic disc (OD), and perineural area were evaluated with SWE and optic nerve sheat diameter (ONSD) was measured by ultrasound. Results The mean age of patients was 39.68 ± 9.99 years. There was no statistically significant difference between the groups in terms of ONSD, SWE ON, SWE OD, and SWE perineural area levels (p> 0.05). In the MS group; No statistically significant difference was found between patients with and without optic neuritis for the mean age, gender distribution, duration of MS, types of MS, ONSD, SWE ON, SWE OD, SWE perineural area, and Expanded Disability Status Scale (EDSS) scores (p> 0.05). No statistically significant difference in terms of ONSD, SWE ON, SWE OD, and SWE perineural area between the MS patients with or without optic neuritis and the control group (p> 0.05). Conclusion: Shear wave elastography measurements of the optic nerve, optic disc, and perineural area do not contribute to the evaluation of optic neuritis in a patient with MS.

Aims: The putative protective role of esRAGE for cardiac autonomic function (CAF) remain unclear. To address this question, the present study has assessed the relationship of serum AGEs, sRAGE and esRAGE, and tissue AGEs with CAF in a high-risk population without diabetes. Material and methods: Forty eight subjects of mean age 52.7±11.2years and mean BMI 28.4±6.3kg/m2, divided into 2 groups according to glucose tolerance: 16 with normal glucose tolerance (NGT) and 24 with prediabetes, were enrolled. A standard OGTT was performed. The glucose tolerance was defined according to 2006 WHO criteria. Fasting, 120-min glucose, lipids, creatinine and HbA1c were measured. eGFR was calculated (CKD-EPI). Fasting, 120-min insulin (ECLIA method), esRAGE, sRAGE and AGEs (ELISA method) were assessed. HOMA-IR was calculated. Tissue AGEs were assessed by skin autofluorescence (AGE-Reader, DiagnOpticsTM). CAF was evaluated with ANSAR, applying deep breathing, Valsalva and standing. Results: There was a significant decline in CAF in prediabetes in comparison to NGT. Serum and tissue AGEs, sRAGE and esRAGE levels were similar between groups. On the matrix analysis, both sympathetic and parasympathetic activity at baseline and after standing and sympathetic tone during Valsalva were positively related to esRAGE in prediabetes. Multivariate regression analysis showed that esRAGE is an independent contributor to sympathetic, parasympathetic and total autonomic tone in prediabetes accounting for about 28%, 34% and 35% of their variances, respectively. Conclusion: Our results have demonstrated that CAF is decreased in prediabetes. esRAGE, but not sRAGE, is reciprocally related to CAF, probably opposing the negative effects of glycation.