Objectives To explore the relationship between diet, mission phase, urinary calcium, and urinary oxalate during long‐duration spaceflight. Subjects and Methods Dietary intake of calcium and oxalate and 24‐h urine parameters from 12 astronauts during long‐duration spaceflight while consuming controlled diets were analysed. Mixed‐effects models assessed differences in urinary calcium and oxalate levels, adjusting for daily intake of calcium and oxalate, and for in‐flight status relative to pre‐flight status. Results From pre‐flight to in‐flight, median urinary calcium increased from 178.9 to 270.3 mg/day ( P < 0.01) and urinary oxalate from 37.9 to 42.3 mg/day ( P < 0.05). Post‐flight, urinary calcium decreased to 185.8 mg/day ( P < 0.01) and urinary oxalate to 31.5 mg/day ( P < 0.01), relative to in‐flight values. Dietary oxalate remained similar pre‐flight and in‐flight (382.0 vs 339.4 mg/day; P ≥ 0.05) but decreased post‐flight to 241.6 mg/day ( P < 0.01). Adjusted in‐flight urinary oxalate was 10.71 mg/day higher than pre‐flight and increased by 0.050 mg/day per 1‐mg/day increase in dietary oxalate (95% confidence interval 0.036–0.064; P < 0.001); dietary calcium was not associated with urinary oxalate ( P ≥ 0.05). Conclusions Hyperoxaluria was observed during long‐duration spaceflights and persisted throughout the in‐flight phase under controlled dietary conditions. Although high dietary oxalate was the strongest predictor, evidence of inter‐individual susceptibility was observed, with some astronauts exhibiting elevated oxalate pre‐flight levels, which increased further during flight. Assessment of oxalate content in current astronaut food systems, mitigation of dietary oxalate load through timed calcium intake, and further investigation of microgravity‐related effects on oxalate absorption and metabolism are required.
Objectives Our objective was to quantify changes in the global burden of prostate, bladder, kidney and testicular cancers from 1990 to 2023 and to assess demographic contributions and characterize geographic, age‐specific and modelled risk‐attributable patterns. Materials and Methods We analysed Global Burden of Disease 2023 estimates for incidence, deaths and disability‐adjusted life‐years (DALYs). Age‐standardised incidence rates and death rates were summarised using estimated annual percentage change. We incorporated 95% uncertainty intervals (UIs), decomposed changes in counts into population growth, population ageing and age‐specific rate effects, assessed 2021–2023 changes, and repeated country rankings after excluding locations with an implied population <1 million. Results In 2023, the four cancers accounted for approximately 2.47 million incident cases, 0.88 million deaths and 18.1 million DALYs. Prostate cancer contributed 1.41 million incident cases (95% UI 1.19–1.63 million) and 469 000 deaths (95% UI 413 000–526 000). From 1990 to 2023, age‐standardised incidence rates increased for testicular cancer (estimated annual percentage change 0.98%, 95% confidence interval [CI] 0.89–1.07) and kidney cancer (0.27%, 95% CI 0.13–0.41), was stable for prostate cancer, and decreased for bladder cancer; age‐standardised death rates decreased for all four cancers. Together, population growth and ageing accounted for the most increases in incident cases, whereas declining age‐specific rates offset deaths from prostate, bladder, kidney and testicular cancers. Small‐jurisdiction leaders changed materially in the population‐threshold sensitivity analysis. In 2023, all modelled risks accounted for 34.6% (95% UI 29.7–39.8) of bladder cancer DALYs and 27.1% (95% UI 17.0–36.7) of kidney cancer DALYs but only 1.6% (95% UI −5.6 to 6.8) of prostate cancer DALYs. Conclusion The growing absolute burden of these cancers was predominantly demographic, but cancer‐specific and geographic trajectories differed. Testicular cancer added a young‐adult, rising‐incidence component to the conventional older‐age urological cancer profile. Rankings for small populations require cautious interpretation, and prevention priorities should reflect cancer‐specific risk patterns.
OBJECTIVES To determine the prevalence of programmed death ligand 1 (PD-L1) expression in penile squamous cell carcinoma (PSCC) and evaluate its associations with clinicopathological features and survival outcomes. PATIENTS AND METHODS A systematic review was carried out using PubMed, the Excerpta Medica dataBASE (EMBASE), Scopus, Web of Science and Cochrane. Random-effects meta-analysis synthesised prevalence, hazard ratios (HRs) for overall survival (OS) and cancer-specific survival (CSS), and odds ratios (ORs) for lymph node metastases (LNM) and tumour characteristics. Meta-regression was caried out for pre-specified moderators. RESULTS A total of 16 studies (1634 patients) were included, with median follow-up of 44 months. The pooled PD-L1 prevalence was 53% (95% confidence interval [CI] 44-62%) with substantial between-study heterogeneity. PD-L1 positivity was associated with worse CSS (HR 1.94, 95% CI 1.54-2.44; P < 0.001) but not OS (HR 1.28, 95% CI 0.89-1.86; P = 0.2). PD-L1 positivity was associated with higher tumour stage (pathological T stage [pT]1 vs pT2-4, OR 1.67, 95% CI 1.22-2.29, P = 0.001), higher tumour grade (Grade 1 vs Grade 2-3, OR 2.60, 95% CI 1.94-3.5, P < 0.001), and LNM (OR 2.32, 95% CI 1.57-3.42, P < 0.001). Sensitivity testing and meta-regression did not materially alter pooled effects. CONCLUSIONS Programmed death ligand 1 is associated with adverse clinicopathological features and worse CSS in PSCC. Prospective validation is required to assess its independent prognostic value. Similarly PD-L1's predictive value for immunotherapy benefit cannot be determined from the current evidence and requires evaluation with treatment-specific prospective studies.
