Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer

Objectives

The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3?+?4 prostate cancer (PCa) on biopsy.

Methods

We retrospectively reviewed 304 patients with biopsy-proven GS 3?+?4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated.

Results

In predicting downgrading, T2-weighted imaging + DWI (AUC?=?0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC?=?0.72/0.73; p?DCE-MRI (AUC?=?0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p?=?0.48/p?>?0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC?=?0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC?=?0.73; p?Conclusion mpMRI improves the ability to identify a subgroup of patients with Gleason 3?+?4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading.

Key Points

? Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone. ? Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI. ? Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading. ? mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance.     

Identification, structural properties and chelating capacity of miltipolone as a broad-spectrum inhibitor to cancer cells

Miltipolone (1) was discovered as a good and broad-spectrum inhibitor against the growth of cancer cells from “Danshen” based on the activity-driven screening of TCMs. The structural features make 1 easily tautomerize between different forms and 1 is linked and stabilized by intermolecular O-H?O hydrogen bonds in the crystal structure. The interaction of 1 in ddH₂O solution with Co²⁺, Mn²⁺, Zn²⁺, Fe²⁺ or Fe³⁺ changed UV absorption values; the chelation of 1 with Fe²⁺ or Fe³⁺ also altered the characteristic UV absorption peaks. However, only did Fe²⁺ reverse 1’s inhibition against the growth of cancer cells; therefore, we concluded that 1 possibly acts as a Fe²⁺ chelator to conduct its inhibitory activity.     

Evaluation of pharmacokinetic and pharmacodynamic relationship for oral sustained-release atenolol pellets in rats

This study was designed to evaluate the in vitro release, pharmacokinetics (PK), pharmacodynamics (PD) and PK-PD relationships of atenolol sustained-release pellets (AT-SRPs), compared with those of atenolol immediate-release pellets (AT-IRPs). Blood sampling for AT plasma concentration was performed in normal rats and blood pressure-lowering effects were recorded continuously in hypertensive rats (HRs) before and at 1, 4, 8, 12, 16 and 24 h after drug administration. The parameters were calculated using DAS1.0 program and WinNonlin software. The release profile of SRPs was steadier and more sustained than that of IRPs. The mean Cmax and area under concentration-time curve from 0 to 24 h after administration (AUC0-24 h) of SRPs were significantly lower than that of IRPs (p<0.05), while area under concentration-time curve from 0 to infinity (AUC0-∞) was almost equivalent between the two formulations. The mean half life time (t1/2) of AT-SRPs was almost 2 times longer compared to that of AT-IRPs. The SRPs approximately achieved half of peak drug effect (Emax) of IRPs, while there were no significant differences in the area under effect-time curve from 0 to 24 h after administration (AUEC0-24 h) and the area under effect-time curve from 0 to infinity (AUEC0-∞). The value of the rate constant of equilibration between plasma and the effect-site (ke0) for SRPs was about 4 times higher than IRPs. The effect-concentration-time course for AT-SRPs was represented by the clockwise hysteresis loop, while the counter-clockwise hysteresis loop well showed that for AT-IRPs. The more favorable characteristics of SRPs would make it more appropriate as a potential dosage form for the treatment of hypertension.     

中西医结合治疗带状疱疹20例疗效观察

目的探讨中西医结合治疗老年带状疱疹的临床疗效。方法将20例患者分为两组,治疗组11例,以中药汤剂、中医针刺配合西药联合治疗,并设对照组9例单纯给予西药治疗及其他对症治疗。结果治疗组:1周内治愈8例,显效2例,总有效率为90.9%;对照组:1周内治愈6例,显效1例,总有效率为77.8%。两组比较,差异有统计学意义(P0.05)。结论中西医结合治疗比单用西药常规治疗效果好,可明显缩短病程,提高疗效,减轻病患痛苦,且无明显毒副作用,具有一定的临床推广意义。     

产科病房护理中断事件的干预性管理研究

目的探讨产科病房护理中断事件干预性管理的效果,降低护理中断事件的发生。方法观察16名护理人员高峰工作时段临床工作中护理中断事件的发生情况,并针对护理中断事件来源进行干预。比较干预前、后护理中断事件的发生次数、中断持续时间及中断的结局。结果干预后护理中断事件明显减少,中断时间较干预前显著缩短,因中断导致的消极型结局和不良护理事件显著减少(均P0.01)。结论护理中断事件干预性管理可以降低护理中断事件的发生,减少中断护理不良事件。     

百令胶囊对尿毒症腹膜透析患者腹透液中转化生长因子-β1、纤维连接蛋白表达的影响

目的研究百令胶囊对尿毒症腹膜透析患者腹透液中转化生长因子-β1（transforming growth factor-β1,TGF-β1）、纤维连接蛋白（fibronectin,FN）水平的影响。方法将腹膜透析患者60例随机分为对照组和试验组（各30例）,均应用1.5%腹膜透析液、6 000 mL/d,试验组加用百令胶囊5粒、3/d、口服,观察1、3、6个月后2组腹透液中TGF-β1、FN水平的变化。结果对照组TGF-β1、FN水平随透析时间延长逐渐升高;试验组TGF-β1、FN水平无明显变化,与对照组比较明显降低（P＜0.05）。结论百令胶囊可以降低腹透液中TGF-β1、FN水平,能起到抑制腹膜纤维化的作用。     

Sequential adjuvant chemotherapy after surgical resection of high‐risk urothelial carcinoma

BACKGROUND:

Despite definitive surgery, the survival of patients with high‐risk urothelial carcinoma (UC) is poor. Adjuvant cisplatin‐based chemotherapy may be beneficial, but it is restricted by the need for normal renal function (RF). Sequential administration of adjuvant chemotherapy facilitates drug delivery and improves survival in patients with breast cancer. The objective of this study was to evaluate the feasibility and survival impact of adjuvant, sequential chemotherapy in patients with high‐risk UC.

METHODS:

Fifty patients were treated on 2 simultaneous protocols between 1997 and 2004. The patients on Protocol A (normal RF) received doxorubicin and gemcitabine (AG) followed by paclitaxel and cisplatin. The patients on Protocol B (impaired RF) received AG followed by paclitaxel plus carboplatin. Overall survival (OS) and disease‐specific survival (DSS) were compared with a group of 203 contemporary control patients who had similar pathology and RF and who underwent surgery alone.

RESULTS:

The median follow‐up of protocol patients was 6.5 years (range, 0.9‐8.6 years), and 25 patients remained alive. The median follow‐up of the control group was 4.7 years (0.0‐9.2), and 68 patients remained alive. The median OS for patients on Protocol A was greater than that for controls who had good RF (4.6 years vs 2.5 years; P = .03). The median OS for patients on Protocol B was greater than that for controls who had impaired RF (3.4 years vs 2 years; P = .04). DSS for the protocol and matched control groups was similar (good RF: 4.6 years vs 3 years; P = .24; impaired RF: 3.4 years vs 3.3 years; P = .40).

CONCLUSIONS:

In this nonrandomized study, adjuvant, sequential chemotherapy for patients with high‐risk UC did not improve DSS over that observed with surgery alone. Cancer 2009. © 2009 American Cancer Society.     

Upregulation of Periostin expression in the pathogenesis of ameloblastoma

Ameloblastoma(AB) is an aggressive and slow-growing tumor with high recurrence rate, which arises from odontogenic epithelium. AB mostly shows osteolytic growth, but the specific pathogenesis is not yet clear. Periostin is a considered a prominent oncogene, which was mainly produced by osteoblasts and their precursors cells, it have been proved that Periostin play an important role in bone lysis. However, the precise role of Periostin in AB progression remains unknown. In this article, the surgical specimens from cases of AB were collected, and the Periostin expression was tested and the results were analyzed for possible correlations with clinical characteristics. In addition, the proliferation、cell cycle and migration of AM-1 cells were evaluated after transfection of siPeriostin. The results showed that Periostin levels were significantly higher in patients with AB than in controls. Moreover, Periostin levels in patients with AB were significantly associated with the number of disease. Furthermore, the results suggested that Periostin expression significantly promoted the proliferation and migration, in addition to cell cycle progression of AM-1 cells. The present study demonstrated that Periostin may be important in the pathogenesis and progression of AB and indicated its potential therapeutic value.     

OPERATIONS ON ANEURYSMS OF THE ANTERIOR COMMUNICATING ARTERY NOT VISUALIZED BY CEREBRAL ANGIOGRAPHY──REPORT OF FOUR CASES

ＯＰＥＲＡＴＩＯＮＳＯＮＡＮＥＵＲＹＳＭＳＯＦＴＨＥＡＮＴＥＲＩＯＲＣＯＭＭＵＮＩＣＡＴＩＮＧＡＲＴＥＲＹＮＯＴＶＩＳＵＡＬＩＺＥＤＢＹＣＥＲＥＢＲＡＬＡＮＧＩＯＧＲＡＰＨＹ──ＲＥＰＯＲＴＯＦＦＯＵＲＣＡＳＥＳ￥ＺｈａｎｇＪｕｎｔｉｎｇ（张俊延），...