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Sexual potency and erectile function are important quality of life metrics for many men and is a significant consideration when planning and treating prostate cancer. There are limited long-term data correlating post-implant dosimetry with patient-reported sexual toxicity outcomes following LDR prostate brachytherapy using Pd-103, specifically as it pertains to genital substructures. Our aim was to correlate dosimetric patterns with quality-of-life outcomes to determine if dose to the pudendal arteries and neurovascular bundles is a significant consideration when planning prostate LDR brachytherapy. We analyzed a prospectively collected IRB-approved database of men receiving LDR prostate brachytherapy between 11/2014-04/2019 at our institution. Patients received either LDR brachytherapy only, or combined with intensity-modulated radiation therapy (IMRT) to the prostate with or without pelvic lymph node coverage. Patients were given quality of life questionnaires at consultation and at subsequent follow up visits. Outcomes data related to sexual toxicity were evaluated based on the Sexual Health Inventory (SHIM) Questionnaire. The right/left pudendal arteries, and right/left neurovascular bundles (NVB) were contoured retrospectively on CT-MRI fusion sequences. Dosimetric data for each of the erectile substructures was analyzed. Statistical analyses included generalized linear mixed effects models with random intercept for patient to explore the association between dose and SHIM confidence. A total of 50 patients met criteria for inclusion in the analysis. 5 patients received combined IMRT to 45 Gy with Pd-103 (90-100 Gy) and 45 patients received Pd-103 monotherapy (125 Gy). Median follow-up was 18 months for 50 patients; 40 (80%) patients had follow-up greater than 2 years, and 15 (30%) greater than 5 years. There were 344 individual questionnaires completed. 28% of records reported low or very low confidence level (Question #1 of SHIM questionnaire). Likelihood of moderate-very high confidence increased up to 2 years after beginning of treatment (p = 0.052) and then subsequently decreased between 2- and 5 years post treatment (p = 0.042). NVB doses were not associated with SHIM confidence level. D100 greater than 150 cGy to either pudendal artery was associated with worse SHIM confidence score after treatment (p = 0.003). Sexual function is variable in the post treatment setting following definitive prostate radiation with Pd-103 LDR-brachytherapy. Avoiding pudendal artery dose may improve sexual outcomes and should be considered when planning prostate brachytherapy. Further investigation with a larger prospective, cohort may be warranted. [ABSTRACT FROM AUTHOR]

Background: While urine flow rate ≤0.5 ml kg-1 h-1 is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI) . The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI.Methods: Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification. Adjusted risk factors associated with AKI and urine flow rate were assessed.Results: Patients with AKI [n=149 (29.5%)] had lower urine flow rate than those without AKI (P<0.001). The relationship between urine flow and AKI risk was non-linear, with an inflection point at 1.5 ml kg-1 h-1 Among patients with urine flow <1.5 ml kg-1 h-1, every 0.5 ml kg-1 h-1 higher urine flow reduced the adjusted risk of AKI by 26% (95% CI 13-37; P<0.001). Urine flow rate during CPB was independently associated with the risk for AKI. Age up to 80 years and preoperative diuretic use were inversely associated with urine flow rate; mean arterial pressure on CPB (when <87 mmHg) and CPB flow were positively associated with urine flow rate.Conclusions: Urine flow rate during CPB <1.5 ml kg-1 h-1 identifies patients at risk for cardiac surgery-associated AKI. Careful monitoring of urine flow rate and optimizing mean arterial pressure and CPB flow might be a means to ensure renal perfusion during CPB.Clinical Trial Registration: ClinicalTrials.gov NCT00769691 and NCT00981474. [ABSTRACT FROM AUTHOR]

Background: Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP).Methods: One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score).Results: POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations.Conclusions: Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations. [ABSTRACT FROM AUTHOR]