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Remmers S, Helleman J, Nieboer D, Trock B, Hyndman ME, Moore CM, Gnanapragasam V, Shiong Lee L, Elhage O, Klotz L, Carroll P, Pickles T, Bjartell A, Robert G, Frydenberg M, Sugimoto M, Ehdaie B, Morgan TM, Rubio-Briones J, Semjonow A, Bangma CH, Roobol MJ. Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative. EUR UROL SUPPL 2022; 41:126-133. [PMID: 35813247 PMCID: PMC9257656 DOI: 10.1016/j.euros.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Active surveillance (AS) is a management option for men diagnosed with low-risk prostate cancer. Opinions differ on whether it is safe to include young men (≤60 yr) or men with intermediate-risk disease. Objective To assess whether reasons for discontinuation, treatment choice after AS, and adverse pathology at radical prostatectomy (RP; N1, or ≥GG3, or ≥pT3) differ for men ≤60 yr or those with European Association of Urology (EAU) intermediate-risk disease from those for men >60 yr or those with EAU low-risk disease. Design setting and participants We analyzed data from 5411 men ≤60 yr and 14 959 men >60 yr, 14 064 men with low-risk cancer, and 2441 men with intermediate-risk cancer, originating from the GAP3 database (21 169 patients/27 cohorts worldwide). Outcome measurements and statistical analysis Cumulative incidence curves were used to estimate the rates of AS discontinuation and treatment choice. Results and limitations The probability of discontinuation of AS due to disease progression at 5 yr was similar for men aged ≤60 yr (22%) and those >60 yr (25%), as well as those of any age with low-risk disease (24%) versus those with intermediate-risk disease (24%). Men with intermediate-risk disease are more prone to discontinue AS without evidence of progression than men with low-risk disease (at 1/5 yr: 5.9%/14.2% vs 2.0%/8.8%). Adverse pathology at RP was observed in 32% of men ≤60 yr compared with 36% of men >60 yr (p = 0.029), and in 34% with low-risk disease compared with 40% with intermediate-risk disease (p = 0.048). Conclusions Our descriptive analysis of AS practices worldwide showed that the risk of progression during AS is similar across the age and risk groups studied. The proportion of adverse pathology was higher among men >60 yr than among men ≤60 yr. These results suggest that men ≤60 yr and those with EAU intermediate-risk disease should not be excluded from opting for AS as initial management. Patient summary Data from 27 international centers reflecting daily clinical practice suggest that younger men or men with intermediate-risk prostate cancer do not hold greater risk for disease progression during active surveillance.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Corresponding author. Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. Tel. +31 10 703 2239; Fax: +31 10 703 5315.
| | - Jozien Helleman
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruce Trock
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew E. Hyndman
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Caroline M. Moore
- University College London, London, UK
- University College London Hospitals Trust, London, UK
| | | | | | - Oussama Elhage
- King's College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Carroll
- University of California San Francisco, San Francisco, CA, USA
| | - Tom Pickles
- University of British Columbia, BC Cancer Agency, Vancouver, BC, Canada
| | | | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Mark Frydenberg
- Monash University and Epworth HealthCare, Melbourne, Australia
| | | | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Todd M. Morgan
- University of Michigan, Ann Arbor, MI, USA
- Michigan Urological Surgery Improvement Collaborative (MUSIC), Ann Arbor, MI, USA
| | | | | | - Chris H. Bangma
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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de Lima SG, Eskaros A, Mihara K, Saifeddine M, Zijlstra A, Hyndman ME, Hollenberg MD. Organotypic & in vitro monolayer modeling of urothelial carcinoma gives different cellular responses to proteinase activated receptor (PAR) agonism/antagonism. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Roy S, Hyndman ME, Danielson B, Fairey A, Lee-Ying R, Cheung WY, Afzal AR, Xu Y, Abedin T, Quon HC. Active treatment in low-risk prostate cancer: a population-based study. ACTA ACUST UNITED AC 2019; 26:e535-e540. [PMID: 31548822 DOI: 10.3747/co.26.4953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Active surveillance instead of active treatment (at) is preferred for patients with low-risk prostate cancer (lr-pca), but practice varies widely. We conducted a population-based study to assess the proportion of patients who underwent at between January 2011 and December 2014, and to evaluate factors associated with at. Methods The provincial cancer registry was linked to administrative health datasets to identify patients with lr-pca and to acquire demographic, tumour, and treatment data. The primary outcome was receipt of at during the first 12 months after diagnosis, defined as any receipt of external-beam radiotherapy, brachytherapy, radical prostatectomy, cryotherapy, or androgen deprivation. Univariate and multivariate logistic regression were used to analyze the correlation between patient and tumour factors and at. Results Of 1565 patients with lr-pca, 554 (35.4%) underwent at within 12 months of diagnosis. Radical prostatectomy was the most common treatment (58%), followed by brachytherapy (29.6%). Younger age [odds ratio (or) 0.92; 95% confidence interval (ci): 0.91 to 0.94], lower score (≥3) on the Charlson comorbidity index (OR: 0.36; 95% ci: 0.19 to 0.68), T2 stage (or: 3.05; 95% ci: 2.03 to 4.58), higher prostate-specific antigen (psa) at diagnosis (or: 1.13; 95% ci: 1.06 to 1.21), radiation oncologist consultation (or: 3.35; 95% ci: 2.55 to 4.39), and earlier diagnosis year (2012 or: 0.46; 95% ci: 0.34 to 0.63; 2013 or: 0.45; 95% ci: 0.32 to 0.63; 2014 or: 0.33; 95% ci: 0.23 to 0.47) were associated with a higher probability of at. Conclusions This contemporary population-based study demonstrates that approximately one third of patients with lr-pca undergo at. Patients of younger age, with less comorbidity, a higher tumour stage, higher psa, earlier year of diagnosis, and radiation oncologist consultation were more likely to undergo at. Further investigation is needed to identify strategies that could minimize overtreatment.
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Affiliation(s)
- S Roy
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - M E Hyndman
- Southern Alberta Institute of Urology, Calgary, AB.,Department of Surgical Oncology, University of Calgary, Calgary, AB
| | - B Danielson
- Cross Cancer Institute, Edmonton, AB.,Department of Oncology, University of Alberta, Edmonton, AB
| | - A Fairey
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - R Lee-Ying
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - W Y Cheung
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
| | - A R Afzal
- Tom Baker Cancer Centre, Calgary, AB
| | - Y Xu
- Department of Community Health Sciences, University of Calgary, Calgary, AB
| | - T Abedin
- Tom Baker Cancer Centre, Calgary, AB
| | - H C Quon
- Tom Baker Cancer Centre, Calgary, AB.,Department of Oncology, University of Calgary, Calgary, AB
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Abstract
Diagnosis of bladder cancer is primarily made based on clinical presentation and then by direct visualization with cystoscopy. Despite the massive investments recently made to identify urinary-based assays that are able to diagnosis urothelial carcinoma, urine cytology and cystoscopy still remain the gold standard. Recently proof of principle studies have shown that noninvasive urine-based metabolomics, using high pressure liquid chromatography (HPLC) and nuclear magnetic resonance (NMR), may be able to accurately diagnosis bladder cancer. This review discusses the published studies investigating metabolomics and bladder cancer and the future potential of this developing field.
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Affiliation(s)
- Matthew E Hyndman
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Feng T, Yohannan J, Gupta A, Hyndman ME, Allaf M. Microperforations of surgical gloves in urology: minimally invasive versus open surgeries. Can J Urol 2011; 18:5615-5618. [PMID: 21504649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Surgical glove integrity is important in preventing wound infections and reducing patient mortality. Rates of perforations have been studied in many surgical subspecialties, but glove perforations specific to urology have not been investigated previously. This study aims to determine the incidence of glove perforations during urological surgeries and to investigate differences between open, laparoscopic, and endoscopic procedures. MATERIALS AND METHODS A total of 180 gloves were collected from various urological procedures performed at our institution: 59 from endoscopic, 72 from laparoscopic, and 49 from open cases. The gloves were tested for defects by both the water load test and electrical conductance testing. The frequency of defects for each type of procedure along with the length of wear, surgeon experience, and glove brand was analyzed. RESULTS Glove defects were detected in 29% of all cases. Microperforations encompassed the majority of the glove defects (23.3%) and were detected in 15.2%, 25.0 %, and 30.6% of the endoscopy, laparoscopic and open surgical cases, respectively. The frequency of perforations noted in the minimally invasive procedures was significantly different across the groups (p < 0.01). There was no statistical significant correlation between glove defects and operation time, surgeon experience, and glove brand. CONCLUSIONS The rates of glove perforation (29%) in urological procedures were higher than expected. Given the high rates of glove perforations found, double gloving in urological surgeries may offer a solution to the increased risk for cross contamination from microscopic perforations.
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Affiliation(s)
- Tom Feng
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD 21230, USA
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Hyndman ME, Parsons HG, Verma S, Bridge PJ, Edworthy S, Jones C, Lonn E, Charbonneau F, Anderson TJ. The T-786-->C mutation in endothelial nitric oxide synthase is associated with hypertension. Hypertension 2002; 39:919-22. [PMID: 11967250 DOI: 10.1161/01.hyp.0000013703.07316.7f] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the pathogenic mechanisms involved in predisposing individuals to hypertension are not well defined, evidence is accumulating that suggests a strong genetic transmission. Animal studies and some clinical investigations have revealed that aberrant NO production may be an important contributing factor. Indeed, a missense mutation in the endothelial NO gene caused by a Glu298Asp alteration has been strongly associated with essential hypertension, coronary artery spasm, and myocardial infarction. Recently, another point mutation caused by a T-786-->C transition in the 5'-flanking region of the endothelial NO synthase gene has been identified and, like the Glu298Asp mutation, is associated with coronary artery spasm. The present study was conducted to determine the effect of the T-786-->C point mutation on hypertension. We investigated the interaction between the endothelial NO synthase T-786-->C polymorphism and blood pressure in a large (n=705) clinically healthy population. Allele frequencies for the T and C alleles were 62% and 38%, translating into 39%, 46% and 15% of the population having the T/T, T/C, and C/C genotypes, respectively, for the T-786-->C point mutation. Subjects with the C/C genotype had significantly higher systolic blood pressures and were 2.16(95% confidence interval, 1.3 to 3.7) more likely to be hypertensive. Therefore, the -786 C/C genotype in NO synthase is a significant contributing factor for increasing the risk of essential hypertension.
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Affiliation(s)
- Matthew E Hyndman
- University of Calgary Department of Medicine, Calgary, Alberta, Canada
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Dumont AS, Hyndman ME, Dumont RJ, Fedak PM, Kassell NF, Sutherland GR, Verma S. Improvement of endothelial function in insulin-resistant carotid arteries treated with pravastatin. J Neurosurg 2001; 95:466-71. [PMID: 11565869 DOI: 10.3171/jns.2001.95.3.0466] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Insulin resistance and hypertension are independent risk factors for stroke. Endothelial dysfunction in response to risk factors and carotid artery (CA) disease are important in the pathogenesis of stroke. Pravastatin may have cholesterol-independent pleiotropic effects. In the present study the authors examined the effects of short-course pravastatin treatment on endothelial function in CAs obtained in control and insulin-resistant rats with fructose-induced hypertension. METHODS Thirty rats were divided into two experimental groups, in which 14 were fed a regular diet and 16 were fed a fructose-enriched diet for 3 weeks. The rats were then divided into four groups: control, pravastatin-treated control, fructose-fed, and pravastatin-treated fructose-fed. Pravastatin was administered (20 mg/kg/day) for 2 weeks. Excretion of the urinary nitric oxide (NO) metabolite nitrite (NO2-) was also assayed. The CAs from all rats were subsequently removed and assessed for endothelium-dependent and -independent vascular reactivity in vitro. The rats in the fructose-fed group were insulin resistant, hyperinsulinemic, and hypertensive relative to the rats in the control and pravastatin-treated control groups and exhibited diminished endothelium-dependent vasomotion and urinary NO2- excretion (p < 0.05), with preserved endothelium-independent vasomotion. Strikingly, pravastatin treatment restored endothelium-dependent vasomotion and urinary NO2- excretion in rats in the fructose-fed pravastatin-treated relative to the fructose-fed group (p < 0.05). CONCLUSIONS The authors report, for the first time, that pravastatin restores endothelial function in CAs from insulin-resistant rats with fructose-induced hypertension. These beneficial effects were ascribed to direct, cholesterol-independent vascular effects of pravastatin and are likely the result of augmentation of NO production. These data provide impetus for further investigation of nonlipid-lowering indications for pravastatin therapy in the prevention and treatment of CA disease.
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Affiliation(s)
- A S Dumont
- Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
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Hyndman ME, Bridge PJ, Warnica JW, Fick G, Parsons HG. Effect of heterozygosity for the methionine synthase 2756 A-->G mutation on the risk for recurrent cardiovascular events. Am J Cardiol 2000; 86:1144-6, A9. [PMID: 11074217 DOI: 10.1016/s0002-9149(00)01177-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased dietary intake of folate has been shown to significantly reduce the risk for fatal myocardial infarction, possibly by lowering homocysteine levels. We therefore investigated the association between recurrent cardiovascular events and a mutation in methionine synthase (2756 A-->G)--an enzyme directly involved in folate and homocysteine metabolism. This mutation significantly reduced the risk for recurrent cardiovascular events and elevated red blood cell folate levels.
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Affiliation(s)
- M E Hyndman
- Department of Medical Genetics, University of Calgary, Alberta, Canada
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Manns BJ, Burgess ED, Hyndman ME, Parsons HG, Schaefer JP, Scott-Douglas NW. Hyperhomocyst(e)inemia and the prevalence of atherosclerotic vascular disease in patients with end-stage renal disease. Am J Kidney Dis 1999; 34:669-77. [PMID: 10516348 DOI: 10.1016/s0272-6386(99)70392-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hyperhomocyst(e)inemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal function. Hyperhomocyst(e)inemia is common in patients with chronic renal failure. This study is designed to look for an association between hyperhomocyst(e)inemia and atherosclerotic vascular disease in patients with end-stage renal disease (ESRD). Two hundred eighteen patients undergoing hemodialysis were enrolled onto the study and had predialysis bloodwork performed for total homocyst(e)ine, red blood cell folate, and vitamin B(12) levels. A history of clinically significant atherosclerotic vascular disease (ischemic heart disease, cerebrovascular disease, or peripheral vascular disease) was elicited by patient questionnaire and verified by careful inpatient and outpatient chart review. Atherosclerotic vascular disease was present in 45.9% of patients. Mean homocyst(e)ine concentration was 26.7 micromol/L (95% confidence interval [CI], 25.0 to 28.4) overall. Mean homocyst(e)ine concentration was 28.6 micromol/L (95% CI, 25.6 to 31.7) and 25.0 micromol/L (95% CI, 23.2 to 26.8) in patients with and without atherosclerotic disease, respectively (P = 0.036). The adjusted odds ratio for atherosclerotic disease was 2.12 (95% CI, 1.03 to 4.39) for those subjects with a homocyst(e)ine level in the highest quartile compared with the lowest 3 quartiles. In the 126 men, the adjusted odds ratio for atherosclerotic disease was 3.4 (95% CI, 1. 24 to 9.42) for those with homocyst(e)ine levels in the highest quartile compared with the lowest 3 quartiles. No association was found between homocyst(e)ine level and atherosclerotic disease in women. In conclusion, there is an association between hyperhomocyst(e)inemia and atherosclerotic vascular disease in patients undergoing dialysis. Prospective studies need to further examine the relationship between homocyst(e)ine level and atherosclerosis in women with ESRD.
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Affiliation(s)
- B J Manns
- Departments of Medicine and Pediatrics and Medical Genetics, The University of Calgary, Canada
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Manns BJ, Burgess ED, Parsons HG, Schaefer JP, Hyndman ME, Scott-Douglas NW. Hyperhomocysteinemia, anticardiolipin antibody status, and risk for vascular access thrombosis in hemodialysis patients. Kidney Int 1999; 55:315-20. [PMID: 9893142 DOI: 10.1046/j.1523-1755.1999.00258.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vascular access failure is an important cause of morbidity in end-stage renal failure patients on hemodialysis. Currently, little is known about risk factors that predispose certain hemodialysis patients to recurrent access thrombosis. Hyperhomocysteinemia (common in patients with renal failure) predisposes people with normal renal function to recurrent and early-onset venous thrombosis, although the effect on vascular access thrombosis is currently unknown. Previous studies have suggested that high titers of IgG anticardiolipin antibody (IgG-ACA) predispose hemodialysis patients to access thrombosis. This cross sectional study was designed to assess for an association between two predictive variables, hyperhomocysteinemia and elevated titers of IgG-ACA, and vascular access thrombosis in patients undergoing chronic hemodialysis. METHODS Risk factors for vascular access thrombosis were documented, and the number of episodes of access thrombosis was recorded for the previous three years in patients undergoing hemodialysis. Midweek predialysis total homocysteine and IgG-ACA levels were measured in all subjects. RESULTS Of the 118 patients who were enrolled, 75.4% had a native arteriovenous fistula. Episodes of vascular access thrombosis were recorded for the previous three years; 34 (28.8%, 95% CI 20.9 to 37.9%) patients had 72 episodes of access thrombosis over the period of risk. Mean homocysteine levels were not significantly different between these 34 patients (28.6 micromol/liter, 95% CI 24.5 to 32.7) and the patients who had no episodes of graft thrombosis (29.8 micromol/liter, 95% CI 26.7 to 32.9). Sixty-seven unselected patients had IgG-ACA levels drawn for analysis, and all assays were negative. The only variable that was associated with a higher risk for graft thrombosis was the type of vascular access placed (odds ratio 4.0, 95% CI 1.6 to 9.6 for patients with a synthetic graft compared with those with an arteriovenous fistula). CONCLUSIONS No association was found between homocysteine levels or anticardiolipin antibody and vascular access thrombosis in our patient population.
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Affiliation(s)
- B J Manns
- Department of Medicine, and Department of Pediatrics and Medical Genetics, University of Calgary, Calgary, Alberta, Canada
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Dias VC, Bamforth FJ, Tesanovic M, Hyndman ME, Parsons HG, Cembrowski GS. Evaluation and intermethod comparison of the Bio-Rad high-performance liquid chromatographic method for plasma total homocysteine. Clin Chem 1998; 44:2199-201. [PMID: 9761258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- V C Dias
- University of Alberta Hospital, Edmonton, Canada.
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