Abstract Objectives: Data were examined from women surveyed in the Canadian Longitudinal Study on Aging to evaluate whether menopause is an independent risk factor for the development of metabolic syndrome (MetS) or its components, including hypertension, central obesity, dyslipidemia, or elevated glycated hemoglobin. Methods: We conducted a cross-sectional analysis of women aged 45-85 years old that participated in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort collected from 2012 to 2015. Modified Poisson regression with robust error variance was used to estimate the crude and adjusted relative risks (aRRs) of MetS in postmenopausal women compared to premenopausal women. Results: Among 12,611 women analyzed, 10,035 (79.6%) had undergone menopause and 2,576 (20.4%) were premenopausal. Postmenopausal women were more likely to meet criteria for MetS compared to premenopausal women (32.6% vs 20.5%, P < 0.001). Using the MetS criteria with a lower waist circumference threshold, the prevalence of MetS was higher at 38.2% among postmenopausal women and 23.2% among premenopausal women ( P < 0.001). After adjusting for age, body mass index, and other covariates, the occurrence of menopause was not associated with a significantly higher relative risk of MetS, using the unified criteria for MetS (aRR 1.09 [95% CI: 0.99-1.19]). Women with menopause had a significantly higher relative risk of MetS when using criteria with a lower waist circumference (aRR 1.10 [95% CI: 1.01-1.19]). Menopause was also associated with a higher risk of impaired glucose tolerance (aRR 1.42 [95% CI: 1.26-1.59]), elevated blood pressure (aRR 1.12 [95% CI: 1.03-1.21]), and elevated triglycerides (aRR 1.17 [95% CI: 1.08-1.26]). Conclusion: Menopause is associated with an increased risk of MetS, independent of age. Lifestyle interventions targeted at women with MetS are known to prevent type 2 diabetes mellitus and cardiovascular risk. Perimenopause may be an important preventative care opportunity to assess metabolic risk factors and improve health and longevity of Canadian women.
Perivascular epithelioid cell tumours (PEComas) are rare mesenchymal tumours that are characterized by perivascular epithelioid cell differentiation and immunoreactivity to myogenic and melanocytic markers. These tumours can be classified as benign, uncertain malignant potential, or malignant. Because of the rarity of PEComas, their cause and clinical prognosis remain unclear. To the best of our knowledge, no reports in the literature describe a PEComa of the terminal ileum mesentery as a secondary tumour in an adult survivor of childhood embryonal rhabdomyosarcoma, let alone any childhood cancer. Here, we present the case of a 27-year-old man with a PEComa involving the mesentery of the terminal ileum. At the age of 5, he had been treated with a combination of chemotherapy and high-dose pelvic radiation therapy for embryonal rhabdomyosarcoma, most likely arising from the posterior bladder wall. During routine follow-up 22 years after this patient’s initial treatment, computed tomography imaging revealed a mass within the terminal ileum mesentery. The tumour was successfully treated with surgical resection, and pathology examination determined the mass to be a PEComa with uncertain malignant potential. This first case of a PEComa of the terminal ileum mesentery arising within a high-dose radiation therapy field as a secondary tumour in an adult survivor of childhood cancer highlights the importance of screening and surveillance in high-risk childhood cancer survivors treated with high-dose radiation therapy. Further research to build a better understanding of this remarkably rare tumour is warranted.
Risk-stratified life-long follow-up care is recommended for adult childhood cancer survivors (CCS) to ensure appropriate prevention, screening, and management of late effects. The identification of barriers to long-term follow-up (LTFU), particularly in varying healthcare service contexts, is essential to develop and refine services that are responsive to survivor needs. We aimed to explore CCS and healthcare professionals (HCP) perspectives of healthcare system factors that function as barriers to LTFU in British Columbia, Canada. We analyzed data from 43 in-depth interviews, 30 with CCS and 13 with HCP, using qualitative thematic analysis and constant comparative methods. Barriers to accessible, comprehensive, quality LTFU were associated with the following: (1) the difficult and abrupt transition from pediatric to adult health services, (2) inconvenient and under-resourced health services, (3) shifting patient-HCP relationships, (4) family doctor inadequate experience with late effects management, and (5) overdue and insufficient late effects communication with CCS. Structural, informational, and interpersonal/relational healthcare system factors often prevent CCS from initially accessing LTFU after discharge from pediatric oncology programs as well as adversely affecting engagement in ongoing screening, surveillance, and management of late effects. Understanding the issues faced by adult CCS will provide insight necessary to developing patient-centered healthcare solutions that are key to accessible, acceptable, appropriate, and effective healthcare.
Background The study objective was to describe radiation-induced vascular abnormalities, stroke prevalence, and stroke risk factors in survivors of childhood craniopharyngioma. Procedure Twenty survivors of childhood craniopharyngioma who received radiotherapy (RT) were included in the study. A clinical history, quality of life assessment, cognitive functioning assessment, magnetic resonance angiogram or computed tomography angiogram, fasting lipid profile, and fasting glucose or hemoglobin A1c test were obtained. Results Median age at diagnosis was 10.3 years and median age at time of study was 29.0 years. Vascular abnormalities were detected in six (32%) of 19 patients' angiograms (vascular stenosis, decreased artery size, aneurysm, cavernoma, and small vessel disease). Five (25%) of 20 patients experienced a stroke after RT. Median time since RT was 27.8 versus 9.1 years in patients with versus without vascular abnormalities (P = 0.02). A low level of high-density lipoproteiin (HDL) was present in 100% (5/5) of patients who had a post-RT stroke as compared with 13% (2/15) of patients who did not have any post-RT stroke (P = 0.02). Previous stroke had occurred in 0% (0/5) of patients receiving growth hormone (GH) replacement at the time of study, compared to 40% (6/15) of patients who were not receiving GH replacement (P = 0.09). Conclusions Patients with craniopharyngioma treated with RT have a high prevalence of stroke and vascular abnormalities, particularly those with low HDL and longer duration of time since RT. There is a trend to suggest that continual GH replacement may reduce the risk of stroke. These patients should undergo careful monitoring and aggressive modification of stroke risk factors.
Abstract Objective To perform a systematic review of success rates of trial of labor after cesarean (TOLAC) and maternal and neonatal outcomes in twin pregnancy versus elective repeat cesarean delivery (ERCD). Methods We searched MEDLINE, EMBASE, and Web of Science from data inception to May 2018 with no language or regional restrictions, to identify all studies that compared twin TOLAC and ERCD for maternal and/or neonatal outcomes. The Newcastle‐Ottawa Scale was used to assess the methodological quality of the included studies. We assessed the pooled relative risk and mean difference using a random‐effects model. The pooled event rates for successful VBAC, cesarean delivery for twin B after vaginal delivery of twin A, and uterine rupture were determined. Results Of the 841 citations identified, 10 were eligible for analysis (2336 TOLAC cases and 5763 ERCD cases). The pooled event rates for successful VBAC and uterine rupture during TOLAC were 72.2% (95% CI 59.7%‐83.2%) and 0.87% (95% CI 0.51%‐1.31%), respectively. TOLAC was associated with a significantly higher risk of neonatal death (RR 3.02 [95% CI 1.07‐8.54]) with no significant differences in mean gestational age at birth, NICU admission rates, or 5‐minute Apgar <7. Although the risk for maternal infectious morbidity was significantly lower with TOLAC (RR 0.48 [95% CI 0.25‐0.90]), risks of uterine dehiscence, blood transfusions, and hysterectomy were comparable. Conclusions Twin TOLAC is associated with a relatively high rate of successful vaginal delivery and a low risk of uterine rupture. The finding of higher neonatal mortality rates may be influenced by prematurity, but requires further investigation.
