Prostate cancer detected after Holmium laser enucleation of prostate (HoLEP): significance of transrectal ultrasonography

Purpose

To identify predictors of incidental prostate cancer following Holmium laser enucleation of the prostate (HoLEP).

Methods

We retrospectively analyzed 458 consecutive patients who underwent HoLEP. Patients were classified into two groups: patients who received prostate biopsy prior to HoLEP (biopsy group, n = 174) and patients who did not (non-biopsy group, n = 284). The two groups were compared. Logistic regression analysis was performed to determine the predictive factors.

Results

A total of 27 patients (5.9 %) were incidentally diagnosed with prostate cancer. The incidence of prostate cancer was not significantly different between the two groups (biopsy group vs. non-biopsy group: 6.9 vs. 5.3 %, p = 0.48). Using multivariate analysis, a hypoechoic lesion identified by transrectal ultrasonography (TRUS) was the only predictor of incidental prostate cancer (odds ratio 2.829; 95 % confidence interval 1.061–7.539; p = 0.038). In the biopsy group, there were no significant differences in baseline characteristics including prostate size, prostate-specific antigen (PSA), PSA density, digital rectal examination (DRE) findings, and TRUS findings, between patients with and without prostate cancer. However, in the non-biopsy group, a hypoechoic lesion was found more frequently in patients with prostate cancer (prostate cancer vs. benign prostatic hyperplasia: 20.0 vs. 3.3 %, p = 0.02).

Conclusions

Prior negative prostate biopsy does not rule out the possibility of prostate cancer after HoLEP. The presence of a hypoechoic lesion on TRUS might be helpful to predict incidental prostate cancer after HoLEP in patients with normal PSA and negative DRE. Prostate biopsy prior to HoLEP should be considered in these patients.     

Clinical Outcomes in Patients with Non-Diagnostic Thyroid Fine Needle Aspiration Cytology: Usefulness of the Thyroid Core Needle Biopsy

Background

Patients with non-diagnostic thyroid fine needle aspiration cytology (FNAC) results undergo repeat FNAC or core needle biopsy (CNB) for definite diagnosis or surgical resection, or are followed up by clinical and ultrasound surveillance. We aimed at evaluating the risk of malignancy in patients with non-diagnostic FNACs and their clinical outcomes according to the follow-up modality.

Methods

We retrospectively reviewed 1,496 (8.8 %) cases with a non-diagnostic result on a first aspiration among 17,045 thyroid FNACs performed between October 2008 and August 2012. Of the non-diagnostic FNACs, 389 patients underwent a second FNAC; 125, CNB; and 89, thyroidectomy by clinical indication. The remaining patients were clinically followed up.

Results

The rate of a second non-diagnostic result was significantly higher on repeat FNAC than on CNB (33.2 vs. 2.4 %; p < 0.001). There was no significant difference in the malignancy risk among patients initially non-diagnostic, twice non-diagnostic, and thrice or more non-diagnostic, nor did this differ from the rate following CNB. No further malignancy was found in cases with ≥2 non-diagnostic CNBs. The malignancy risk was 51 % in those who underwent thyroidectomy. The sensitivity for detecting malignancy was 65 and 70 % for repeat FNACs and first CNBs, respectively, with no false positives seen in either test.

Conclusions

Approximately one-third of repeat FNACs after an initial non-diagnostic aspirate are non-diagnostic on repeat examination, and the malignancy risk may not reduce following repetitively non-diagnostic FNACs. However, a single CNB may be enough to exclude malignancy risk for patients with a non-diagnostic aspirate.     

External Validation of Online Predictive Models for Prediction of Cancer-specific Mortality and All-cause Mortality in Patients with Urothelial Carcinoma of the Urinary Bladder

Purpose

The objective of the study was to validate the previously reported lookup Table and Bladder Cancer Research Consortium (BCRC) nomogram in predicting cancer-specific mortality (CSM) and all-cause mortality (ACM) after radical cystectomy using an external cohort from South Korea.

Methods

The study comprised 409 patients. Discrimination was quantified with the concordance index. The relationship between the model-derived and actual CSM and ACM was graphically explored within calibration plots. Clinical net benefit was evaluated by decision curve analysis.

Results

Of the 409 patients, 147 (35.9 %) had died from various causes. One hundred two deaths were attributable to bladder cancer. For CSM at 5 years, the bootstrap-corrected concordance indices of the American Joint Committee on Cancer (AJCC) staging system, lookup Table, and BCRC nomogram were 71.8 % (95 % confidence interval [CI] 66.9–76.5), 73.0 % (95 % CI 67.9–78.0), and 76.2 % (95 % CI 71.6–80.9), respectively. For ACM at the same time point, the discrimination accuracies of these models were 70.7 % (95 % CI 66.7–74.6), 72.8 % (95 % CI 68.5–76.9), and 76.2 % (95 % CI 72.3–80.2), respectively. The calibration plots tended to exaggerate both survival outcomes in all models. When compared to the lookup Table as well as the AJCC staging system, the BCRC nomogram performed well across a wide range of threshold probabilities using decision curve analysis.

Conclusions

The BCRC nomogram was characterized by higher accuracy and larger potential clinical benefit compared to the lookup Table. However, there is a great need for additional models that consider outcomes of patients for whom the existing models do not apply.     

The first report on Amphipoda from Marian Cove,King George Island,Antarctic

This is a first account on amphipods from Marian Cove in Maxwell Bay, near the King Sejong Station, King George Island, the Antarctic. We have conducted a survey in 14 localities in the shallow sublittoral zone. A total of 22 amphipod species belonging to 12 families were identified. Six of these species were new for the whole Maxwell Bay. Our findings increase the amphipod fauna of Maxwell Bay from 55 to 61 species. The dominant species in the shallow sublittoral zone of Marian Cove were: Cheirimedon femoratus and Gondogeneia antarctica, followed by Bovallia gigantea, Orchomenella cf. ultima, Paradexamine fissicauda, Prostebbingia brevicornis, Pariphimedia integricauda, and Jassa wandeli.     

Major chemical compositions,possible sources,and mass closure analysis of PM2.5 in Jinan,China

The fine particulate matter samples for 24 h were carried out at the Environment Monitoring Station (EMS) and Shandong Jianzhu University (SJU) sites during 2010 in Jinan City, China. Eight water-soluble ion species were analyzed by ion chromatography, while organic carbon (OC) and elemental carbon (EC) were determined with the IMPROVE thermal optical reflectance method, and 20 inorganic elements were measured by inductively coupled plasma-atomic emission spectrometer and inductively coupled plasma-mass spectroscopy. The annual average mass concentration of PM_2.5 was 168.85 μg m^?3 at EMS and 148.67 μg m^?3 at SJU. The coefficient of divergence was 0.14, 0.19, 0.23, and 0.23 in spring, summer, fall, and winter, respectively, indicating that there was no obvious spatial difference at the two sampling sites. The highest PM_2.5, OC, and OC/EC ratio were in winter because of the enhanced emissions from coal combustion for heating and poor atmospheric dispersion. By the method of enrichment factors, the 20 inorganic elements were divided into three types owing to their sources. Al, Si, and Ti were mainly contributed by crustal sources. Na, Mg, P, K, Ca, V, Cr, Mn, Fe, Co, Ni, Ba, and Sr were from both natural emissions and anthropogenic sources. Cu, Zn, Pb, and Sn mainly originated from anthropogenic sources such as vehicular exhaust and industrial emission. Chemical mass closure calculation estimated that SO₄ ^2? was the largest contributor and explained 29.66 % of PM_2.5 mass at EMS, while 31.64 % was at SJU. The organic matter, crustal matter, and NO₃ ^–, respectively, accounted for 15.12, 12.87, and 13.77 % to PM_2.5 at EMS, while it accounted for 13.46, 13.96, and 14.93 % at SJU, respectively. By the positive matrix factorization analysis, the coal combustion and biomass burning, secondary sulfate, soil dust, secondary nitrate, and vehicle emissions were identified as the major emission sources.     

Comparison of CTP, MELD, and MELD-Na scores for predicting short term mortality in patients with liver cirrhosis]

BACKGROUND/AIMS: MELD-Na (model for end-stage liver disease with incorporation of serum sodium) was suggested to provide better survival prediction than MELD alone for patients with end stage liver disease. However, there is no data verifying the usefulness of MELD-Na for predicting short term mortality of cirrhotic patients in Korea. This study was aimed to determine whether MELD-Na would be more accurate in predicting short term mortality than other scoring systems such as Child-Turcotte-Pugh (CTP) or MELD. METHODS: Data from 355 patients admitted due to liver cirrhosis were retrospectively reviewed. The cumulative survival rates were obtained. Prediction of mortality rate for three months and one year were analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: One hundred patients (28%) died during the study period. All of the three systems showed significant differences in the cumulative survival rate according to the scores on admission (p0.001). The AUC of CTP, MELD, and MELD-Na in predicting three-months mortality were 0.828, 0.845, and 0.862 (p0.05), and the AUC of each score system for death within one year were 0.792, 0.800, and 0.831, respectively (p0.05). The AUC of MELD-Na in predicting short term death were the highest, although it was not statistically significant. Multivariate analysis showed that only MELD-Na was significantly related to three-month mortality (p=0.012). CONCLUSIONS: MELD-Na is more appropriate in predicting short term mortality, but larger scale studies are needed to confirm the superiority of MELD-Na to MELD and CTP in patients with liver cirrhosis.     

Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: Results from the Korea National Health and Nutrition Examination Survey, 1998–2012

Background

Mortality from coronary heart disease in Korea has increased continuously, but there are few comprehensive national data on trend in the prevalence of risk factors for cardiovascular disease in this population. We examined the trends in the prevalence of major risk factors for cardiovascular disease, including smoking, obesity, hypertension, diabetes, and hypercholesterolemia, from 1998 through 2012 in a representative Korean population.

Methods

Using data from the Korea National Health and Nutrition Examination Survey I (1998) to V (2010–2012), we selected the adults aged ≥ 30 yr who participated in both a health examination and health interview survey.

Results

From 1998 to 2012, significant decrease in the prevalence of hypertension was observed in both men (32.5 to 31.5%) and women (26.9 to 24.3%). Smoking rates decreased only in men (65.1 to 47.0%), whereas the prevalence of diabetes did not change over time. Conversely, the prevalence of hypercholesterolemia significantly increased from 7.2% to 12.6% for men and from 8.4% to 14.9% for women, whereas the rates of awareness and treatment for hypercholesterolemia were relatively lower than that of hypertension and diabetes. During the period, prevalence of obesity significantly increased from 26.8% to 38.1% only in men.

Conclusions

The increased prevalence of hypercholesterolemia and obesity may have contributed to the increasing trend in the mortality from coronary heart disease in Korea. Further population-based surveillance of blood cholesterol levels and obesity needs to be performed, and national strategies for improvement of these factors should be established in Korea.     

Clinical features and treatment outcomes of limited-stage mantle cell lymphoma: Consortium for Improving Survival of Lymphoma report

Annals of Hematology - Limited-stage (Ann Arbor stage I or II) mantle cell lymphoma (MCL) is an extremely rare disease. Thus, there is little data on the clinical features and treatment outcomes of...     

Involvement of Transglutaminase-2 in α-MSH-Induced Melanogenesis in SK-MEL-2 Human Melanoma Cells

Skin hyperpigmentation is one of the most common skin disorders caused by abnormal melanogenesis. The mechanism and key factors at play are not fully understood. Previous reports have indicated that cystamine (CTM) inhibits melanin synthesis, though its molecular mechanism in melanogenesis remains unclear. In the present study, we investigated the effect of CTM on melanin production using ELISA reader and the expression of proteins involved in melanogenesis by Western blotting, and examined the involvement of transglutaminase-2 (Tgase-2) in SK-MEL-2 human melanoma cells by gene silencing. In the results, CTM dose-dependently suppressed melanin production and dendrite extension in α-MSH-induced melanogenesis of SK-MEL-2 human melanoma cells. CTM also suppressed α-MSH-induced chemotactic migration as well as the expressions of melanogenesis factors TRP-1, TRP-2 and MITF in α-MSH-treated SK-MEL-2 cells. Meanwhile, gene silencing of Tgase-2 suppressed dendrite extension and the expressions of TRP-1 and TRP-2 in α-MSH-treated SK-MEL-2 cells. Overall, these findings suggested that CTM suppresses α-MSH-induced melanogenesis via Tgase-2 inhibition and that therefore, Tgase-2 might be a new target in hyperpigmentation disorder therapy.