Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To assess the effect of age and comorbidity on short‐term complications, long‐term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer. PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index. Short‐term postoperative complications, transfusion rate, duration of hospital stay, long‐term continence and oncological outcome were analysed by age and comorbidity classes. RESULTS Of the 2048 men, 297 were aged ≥70 years and 281 had a Charlson index of >0 (mainly diabetes 31%, chronic pulmonary disease 26%, prior other nonmetastatic cancer 16%, prior myocardial infarction 12%). Compared with younger men, senior men had significantly higher pathological stages and tumor grades. Of those 297 men aged ≥70 years, 90 (30.3%) developed biochemical relapse, none died from prostate cancer and five (1.7%) died from another cause over a median follow‐up of 5 years. The occurrence and severity of short‐term postoperative complications were more strongly related to comorbidity than chronological age. Multivariate analysis with stepwise regression confirmed that most important predictors of short‐term postoperative complications were a Charlson index of ≥2, prostate weight of >80 g, obesity and age of ≥70 years. Postoperative continence significantly declined with age (ranging from 87% in men aged <60 years to 67.5% in men aged ≥70 years). Predictors of long‐term incontinence were age of ≥70 years, obesity and need for perioperative transfusion. CONCLUSIONS LRP is feasible and effective in fit senior men (aged ≥70 years) with localized prostate cancer, including those at high risk of dying from it.     

Echo Doppler parameters predict response to cardiac resynchronization therapy

Background  Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure related morbidity and mortality. However, approximately 30% of patients do not respond to CRT. We investigated the usefulness of Echo Doppler parameters to predict reverse remodelling, functional improvement and mortality following CRT.
Materials and methods  Our population consists of 200 consecutive heart failure patients evaluated for ventricular dyssynchrony by echocardiography between February 1999 and May 2007 who subsequently received CRT. Patients were reassessed for signs of reverse remodelling after a mean follow-up of 10 months. Information on vital status was obtained from local registration authorities.
Results  Three parameters significantly predicted reverse remodelling in the logistic regression analysis: the Q-to-E-wave-delay (QED) at a cutoff of 550 ms (odds ratio 4·5, P -value 0·001), the interventricular mechanical delay (IVMD) at a cutoff of 60 ms (odds ratio 2·4, P -value 0·02), and the aortic electromechanical delay (A-EMD) at a cutoff of 140 ms (odds ratio 2·9, P -value 0·004). Furthermore, the QED and the IVMD also predicted all-cause mortality (hazard ratio 0·36, P -value 0·02 and 0·21, P -value 0·004, respectively). Adjustment for confounders did not alter the results.
Conclusions  The QED and IVMD predict reverse remodelling and survival following CRT. These parameters are easy to obtain, provide valuable prognostic information, and should thus be measured in CRT candidates evaluated by echocardiography.     

运用中医整体观综合治疗代谢综合征的探讨

整体观念是中医学的基本特点之一。通过西医、中医对代谢综合征的认识及其异同,明确代谢综合征的诊断,提出预防八法、综合治疗三大原则及五种方法。     

LINGO‐1 negatively regulates TrkB phosphorylation after ocular hypertension

The antagonism of LINGO‐1, a CNS‐specific negative regulator of neuronal survival, was shown to promote short‐term survival of retinal ganglion cell (RGC) in an ocular hypertension model. LINGO‐1 antagonists, combined with brain‐derived neurotrophic factor (BDNF), can increase the length of neuron survival through an unclear molecular mechanism. To determine the relationship between LINGO‐1 and BDNF/TrkB receptor in neuronal protection, we show here that LINGO‐1 forms a receptor complex with TrkB and negatively regulates its activation in the retina after ocular hypertension injury. LINGO‐1 antagonist antibody 1A7 or soluble LINGO‐1 (LINGO‐1‐Fc) treatment upregulates phospho‐TrkB phosphorylation and leads to RGC survival after high intraocular pressure injury. This neuronal protective effect was blocked by anti‐BDNF antibody. LINGO‐1 antagonism therefore promotes RGC survival by regulating the BDNF and TrkB signaling pathway after ocular hypertension.