High levels of stromelysin-3 correlate with poor prognosis in patients with breast carcinoma

Stromelysin 3 (ST3) is a matrix metalloprotease (MMP) expressed in fibroblast-like cells of most human invasive carcinomas. In this investigation, ST3 was measured by semiquantitative immunohistochemistry in III primary breast cancers. ST3 levels showed no correlation with tumor size, axillary-node status or tumor grade (Scarff-Bloom-Richardson system; SBR) but were significantly associated with higher nuclear grade (modified SBR). In addition, ST3 levels were significantly higher in ductal than in lobular cancers. Patients with high scores of ST3 staining had a shorter disease-free interval and shorter overall survival than patients with low scores. ST3 is thus one of the first MMPs to correlate with patient outcome in breast cancer. These findings are consistent with earlier clinical and experimental observations suggesting that ST3 contributes to breast-cancer progression. © 1996 Wiley-Liss, Inc.     

Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty.

OBJECTIVE: To estimate in patients with Staphylococcus aureus prosthetic joint infection after total hip arthroplasty (THA) or total knee arthroplasty (TKA) the microorganism-specific cumulative probability of treatment failure after prosthesis removal and delayed reimplantation arthroplasty. PATIENTS AND METHODS: All patients with S aureus THA or TKA infection, according to a strict case definition, who were treated with prosthesis removal and delayed reimplantation arthroplasty at Mayo Clinic Rochester between 1980 and 1991 were identified. The study group comprised patients who were free of infection at the time of reimplantation arthroplasty. This cohort was followed up until treatment failure, infection with another organism, prosthesis removal, death, or loss to follow-up occurred. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure. RESULTS: Among 120 S aureus prosthetic joint infections treated with prosthesis removal during the study period, 38 episodes (22 THA, 16 TKA) in 36 patients met the study inclusion criteria. After a median of 7.4 years (range, 0.9 year-16.4 years) of follow-up, treatment failure occurred in 1 (2.6%) of 38 episodes 1.4 years after reimplantation arthroplasty. The 5-year cumulative probability of treatment failure was 2.8% (95% confidence interval, 0%-8.2%). CONCLUSIONS: These data suggest that prosthesis removal and delayed reimplantation arthroplasty is an effective treatment to limit the recurrence of S aureus prosthetic joint infection, provided there is no evidence of infection at the time of reimplantation arthroplasty.     

Ultrahigh-pressure disordered eight-coordinated phase of Mg2GeO4: Analogue for super-Earth mantles

Mg₂GeO₄ is important as an analog for the ultrahigh-pressure behavior of Mg₂SiO₄, a major component of planetary interiors. In this study, we have investigated magnesium germanate to 275 GPa and over 2,000 K using a laser-heated diamond anvil cell combined with in situ synchrotron X-ray diffraction and density functional theory (DFT) computations. The experimental results are consistent with the formation of a phase with disordered Mg and Ge, in which germanium adopts eightfold coordination with oxygen: the cubic, Th₃P₄-type structure. DFT computations suggest partial Mg-Ge order, resulting in a tetragonal I4¯2d structure indistinguishable from I4¯3d Th₃P₄ in our experiments. If applicable to silicates, the formation of this highly coordinated and intrinsically disordered phase may have important implications for the interior mineralogy of large, rocky extrasolar planets.

A large number of exoplanets have been discovered in recent years, including many planets whose mean densities indicate that they have rocky interiors that may be up to 10 times more massive than the Earth (1). There is interest in understanding the mineralogy of the deep interiors of such bodies where the pressure at the core–mantle boundary is predicted to reach up to 1 TPa (2–4). Theoretical calculations suggest that silicate structures with partial or complete eightfold coordination of silicon by oxygen can be stabilized above 500 GPa (4). These pressures are expected to be reached within the mantles of rocky exoplanets of ∼4 Earth masses or greater (3, 4). Phase changes with accompanying changes in cation coordination number may strongly affect the structure, dynamics, and heat flow in exoplanet interiors (1, 5).Germanates are known to be good analogs for silicates, as they undergo similar phase transitions, but at lower pressures (6, 7). For example, the perovskite (Pv) to postperovskite (pPv) transition occurs near 65 GPa in MgGeO₃ (8), compared with ∼125 GPa in the corresponding silicate. Recently, a theoretical study examined ultrahigh-pressure transitions in the MgO-GeO₂ system and suggested that it can be an excellent analog system for ultrahigh-pressure phase transitions in silicate minerals (9). Those calculations predicted that MgGeO₃ pPv and MgO combine to form an eight-coordinated tetragonal phase of Mg₂GeO₄ (I4¯2d) at ∼175 GPa (9) (SI Appendix, Fig. S1). This transition pressure is experimentally accessible using a laser-heated diamond anvil cell. The same transition is predicted to occur at ∼490 GPa (4) in the silicate, which is beyond the limit of conventional, static compression techniques.Here, we report laser-heated diamond anvil cell experiments to pressures as high as 275 GPa and find that cubic, Th₃P₄-type (I4¯3d), or partially disordered I4¯2d Mg₂GeO₄ is synthesized under such conditions. Our computations suggest a gradual disordering from an ordered I4¯2d structure to a partially disordered structure (experimentally indistinguishable from disordered I4¯3d structure) at high temperatures. Structures containing disordered ions of very different valences, Ge⁴⁺ and Mg²⁺, are highly unusual but may occur in other high-pressure systems at high temperatures. The calculations also reveal the atomic structure and pressure–volume relationship of the disordered phase. The formation of the Th₃P₄-type or I4¯2d phase in the corresponding silicate at higher pressures would have important implications for the interior mineralogy of large, rocky extrasolar planets.     

Management of high grade renal trauma: 20-year experience at a pediatric level I trauma center

PURPOSE: In the last 20 years the management of high grade, blunt renal trauma at our institution has evolved from primarily an operative approach to an expectant nonoperative approach. To evaluate our experience with the expectant nonoperative management of high grade, blunt renal trauma in children, we reviewed our 20-year experience regarding evaluation, management and outcomes in patients treated at our institution. MATERIALS AND METHODS: We retrospectively studied all patients sustaining renal trauma between 1983 and 2003. Medical records were reviewed for mechanism of injury, assigned grade of renal injury, patient treatment, indications for and timing of surgery, and outcome. Injuries were categorized as either low grade (I to III) or high grade (IV to V). RESULTS: We reviewed the medical records of 164 consecutive children who sustained blunt renal trauma between 1983 and 2003. A total of 38 patients were excluded for inadequate information. Of the remaining 126 children 60% had low grade and 40% had high grade renal injuries. A total of 11 patients (8.7%) required surgical or endoscopic intervention for renal causes, including 2 for congenital renal abnormalities and 1 for clot retention. Eight patients (6.3%) required surgical intervention for isolated renal trauma, of whom 2 (1.6%) required immediate surgical intervention for hemodynamic instability and 6 (4.8%) were treated with a delayed retroperitoneal approach. Only 4 patients (3.2%) required nephrectomy. All patients receiving operative intervention had high grade renal injury. CONCLUSIONS: Initial nonsurgical management of high grade blunt renal trauma in children is effective and is recommended for the hemodynamically stable child. When a child has persistent symptomatic urinary extravasation delayed retroperitoneal drainage may become necessary to reduce morbidity. Minimally invasive techniques should be considered before open operative intervention. Early operative management is rarely indicated for an isolated renal injury, except in the child who is hemodynamically unstable.     

Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women

Objective

To develop and validate a nomogram for assessing bladder outlet obstruction (BOO) in women derived from concurrent P_det.Qmax and Q_max based on radiographic evidence of increased urethral resistance.

Patients and Methods

Retrospective analysis of prospectively acquired video‐urodynamics and clinical data of 185 women (development cohort) was performed. The P_det.Qmax were plotted against Q_max and cluster analysis was performed to determine an axis that best divided the definitively obstructed and unobstructed. Using data from a further 350 women (validation cohort), the sensitivity and specificity of the derived criterion was calculated. Finally, the data from both groups was pooled together and using binary logistic regression analysis, a nomogram was produced.

Results

Of the 535 patients in the two cohorts, (122 [22.8%]) demonstrated radiographic evidence of BOO. Cluster analysis identified the axis that best separates the radiographically obstructed and unobstructed as P_det.Qmax = 2*Q_max. Using the data from the validation cohort, the sensitivity and specificity for this was calculated as 0.94 and 0.93, respectively. A nomogram, representing the probability of BOO for concurrent P_det.Qmax and Q_max measurements was derived by pooling data from both cohorts. Alternatively, a female BOO index (BOOIf) may be calculated mathematically using the formula BOOIf = P_det.Qmax ? 2.2*Q_{max, that is,} BOOIf < 0, <10% probability of obstruction, BOOIf > 5 likely obstructed (50%) and If BOOIf > 18, obstruction almost certain (>90%).

Conclusion

A female BOO nomogram (the SG nomogram) with high sensitivity and specificity is proposed. The nomogram can be used to stratify the degree of BOO or assess response to treatment.