Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.     

Mouse models of asthma: a comparison between C57BL/6 and BALB/c strains regarding bronchial responsiveness, inflammation, and cytokine production

Objective

Animal models of asthma mimic major features of human disease. Since the genetic background of experimental animals might affect hyperresponsiveness and inflammation, we studied its potential influence and the mechanisms leading to differences in strains.

Methods

We applied a mouse model of allergic asthma to BALB/c and C57BL/6 mice.

Results

BALB/c mice displayed greater levels of airway reactivity to methacholine than C57BL/6 mice. Moreover, BALB/c mice exhibited higher numbers of mast cells in lung tissue when compared to C57BL/6. On the contrary, eosinophil and neutrophil counts in bronchoalveolar lavage fluid (BALF) as well as peribronchial eosinophilia were greater in C57BL/6. IL (Interleukin)-4, IL-5, IL-13, and CCL11 levels measured in whole-lung extracts were higher in BALB/c, while, in sharp contrast, CCL11 and CCL5 levels were higher in BALF of C57BL/6 mice.

Conclusions

We observed phenotypic differences between C57BL/6 and BALB/c mice in an asthma model with different distributions of pro-inflammatory cytokines and inflammatory cells.     

Challenges and Opportunities in Hormone-Resistant Prostate Cancer

ContextThe lack of options available for the treatment of hormone-resistant prostate cancer (HRPC) presents a significant challenge to clinicians. In the TAX 327 trial, treatment with docetaxel plus prednisone was demonstrated to improve survival compared with mitoxantrone plus prednisone but was associated with a higher incidence of adverse events, notably haematologic toxicities. Indeed, there is debate about the use of this cytotoxic regimen, particularly for patients with metastatic disease who are asymptomatic or only mildly symptomatic for pain.ObjectiveThere is a need to develop less toxic regimens suitable for such patients and to develop treatment options which offer better efficacy than the currently available agents.Evidence acquisitionA nonsystematic review of the literature was performed in 2008. Databases browsed included PubMed, abstracts from congresses, and PR Newswire.Evidence synthesisA number of studies have been conducted or are underway to investigate the use of docetaxel in combination with a number of new agents, including high-dose calcitriol and the antiangiogenesis agents bevacizumab and aflibercept. Other treatments administered as monotherapy include abiraterone, denosumab, and satraplatin and the cancer vaccines G-VAX and Provenge.One promising novel approach is antagonism of the endothelin A (ET_A) receptor, which plays a key role in tumour progression in HRPC. Atrasentan is an endothelin receptor antagonist with selectivity for the ET_A receptor and in a phase 2 study was associated with a significantly increased time to progression versus placebo. The atrasentan phase 3 study failed to meet its primary end point, although this may have been related to limitations inherent in the trial design. ZD4054 is a specific ET_A receptor antagonist that has shown a promising improvement in overall survival versus placebo in a phase 2 study and was generally well tolerated.ConclusionsThe ENdoTHelin A USE (ENTHUSE) programme, consisting of three large, multicentre phase 3 trials, is now ongoing to study ZD4054 as a monotherapy or in combination with docetaxel in patients with M0 and M1 HRPC.     

Depressive coping is a predictor for emotional distress and poor quality of life in a German-Austrian sample of cardioverter-defibrillator implant recipients at 3 months and 1 year after implantation

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has been proven to prolong the lives of patients with life-threatening ventricular arrhythmia. However, implant recipients must cope with numerous challenges. We studied the effects of specific coping strategies and the adaptability of coping in ICD implant recipients. METHOD: This prospective study investigated the subjective well-being and objective disease course in 180 patients with life-threatening cardiac arrhythmias, who were recruited while awaiting implantation of a cardioverter defibrillator. Patients completed well-validated self-assessment questionnaires before implantation (T0), as well as 3 months (T1) and 1 year (T2) after implantation. In addition, cardiological findings were documented. RESULTS: Depressive coping (range Beta, -0.36 to -0.58) was found to be a stable highly-significant predictor for low emotional well-being and quality of life. Active problem-oriented coping showed small positive influence (range Beta, 0.10 to 0.19). Employing a broad range of coping strategies was predictive of less emotional distress and better quality of life. CONCLUSIONS: Depressive coping is a risk factor for emotional distress and poor quality of life after ICD implantation. Patients with this tendency should be identified early and offered supportive psychotherapy.     

The association of depression and anxiety with medical symptom burden in patients with chronic medical illness

BACKGROUND: Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. METHODS: MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. RESULTS: Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. CONCLUSIONS: Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.     

The interaction of psychosocial adversity and biological risk in childhood aggression

Childhood aggression has both biological and environmental underpinnings. However, the manner in which these factors interact to influence various types of aggression remains an important area of study. The current study examined the degree to which biological risk and psychosocial adversity, both alone and in combination, are associated with childhood aggression. Linear regression procedures were used to assess the extent to which biological risk status (low vs. high serotonergic responsivity, as measured by prolactin response to fenfluramine), magnitude of psychosocial risk, and the interaction of these factors predicted parent and teacher ratings of aggression and delinquency. After accounting for the independent contribution of biological and psychosocial risk, the interaction of biological and psychosocial risk was significantly associated with parent-rated aggression and marginally related to parent-rated delinquency. In contrast, no such interaction was observed for teacher-rated aggression. Findings suggest that individuals at biological risk for aggression may be particularly vulnerable to the impact of psychosocial adversity.