Is interval from an initial biopsy a significant predictor of prostate cancer at repeat biopsies?

BACKGROUND: Currently, there are no clear criteria for indicating repeat biopsies in patients with negative results at an initial biopsy of the prostate. The aim of the present study is to determine the clinical and pathological parameters which predict prostate cancer at repeat biopsies with special attention to the interval between biopsies in addition to prostate specific antigen (PSA) and its derivatives. METHODS: We reviewed 100 patients who underwent an initial biopsy that proved negative for prostate cancer and required repeat biopsies between November 1996 and November 2003. Clinical parameters such as age, PSA and its derivatives, interval between biopsies, number of cores taken and initial biopsy histology were analyzed. RESULTS: In total, 31 patients (31.0%) were found to have prostate cancer, 18 (25.7%) of 70 patients by the second biopsy and 13 (46.4%) of 28 patients by the third biopsy. Two patients underwent the fourth biopsy, which revealed no prostate cancer. The patients with a positive biopsy had a significantly longer interval between the biopsies than the patients with a negative biopsy (P=0.0036). Furthermore, in both univariate and multivariate logistic regression analysis, only the interval between the biopsies proved to be an independent predictor of positive results at repeat biopsies (P=0.0094 and 0.0019). CONCLUSIONS: Only the biopsy interval was a significant predictor of prostate cancer at repeat biopsies in both univariate and multivariate analysis.     

Homozygous α-thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases

Summary. Forty-six hydropic infants with homozygous α-thalassaemia born during a period of 10 years have been reviewed. The incidence was 1: 1550 total births, and accounted for 81% of all non-immune hydrops. The male to female ratio was 1: 1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta. postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.     

Antidiabetic and haematological effect of aqueous extract of stem bark of Afzelia africana (Smith) on streptozotocin-induced diabetic Wistar rats

Objective

To investigate the antidiabetic properties of aqueous extract of stem bark of Afzelia africana (A. africana) and its beneficial effect on haematological parameters in streptozotocin induced diabetic rats.

Methods

A total of 30 rats including 24 diabetic and 6 normal rats were used for this study. Diabetes was induced in male Wistar rats by intraperitoneal injection of streptozotocin. After being confirmed diabetic, animals were orally treated with distilled water or extracts at 100 or 200 mg/kg body weight daily for 10 days. The haematological parameters including red blood and white blood cells and their functional indices were evaluated in diabetic treated groups compared with the controls.

Results

The extract significantly reduced the blood glucose levels while the best result was obtained at 200 mg/kg body weight. The feed and water intake in diabetic rats were significantly reduced while weight loss was minimized at both dosages. Similarly, the levels of red blood, white blood cells and their functional indices were significantly improved after extract administration at both doses.

Conclusions

It can be concluded that the aqueous extract of bark of A. africana possesses antihyperglycemic properties. In addition, the extract can prevent various complications of diabetes and improve some haematological parameters. Further experimental investigation is needed to exploit its relevant therapeutic effect to substantiate its ethnomedicinal usage.     

Upper gastrointestinal endoscopy findings in Mbale Regional Referral Hospital,Eastern Uganda: a 10-year retrospective analysis

BackgroundEndoscopy is required for formal diagnosis of many upper gastrointestinal (UGI) conditions including oesophageal cancer (OC). There is a paucity of data on endoscopy findings in East Africa as access to testing is challenging for patients. We describe the findings of 10 years of UGI endoscopy in Mbale Regional Referral Hospital (MRRH).MethodRecords of patients that underwent UGI endoscopy in MRRH, November 2009 – March 2019 were retrospectively analysed. Indication, macroscopic findings, histology and patient demographics were retrieved. Sub-group analyses were performed on those with a histological diagnosis of oesophageal cancer.Results833 eligible patients received single UGI procedures during the study period. Mean age was 54.8 years, range 16-93 years and 56.9% of patients were male. The main indication was dysphagia (42%) and the most common findings OC (34%) and gastritis (28%). 151 patients had histologically proven OC with a median age of 60 years and a 2:1 male to female ratio. 145/151 (96%) of samples tested revealed squamous cell carcinoma (SCC).ConclusionThose undergoing endoscopy in MRRH are most commonly male patients presenting in their 5th decade with dysphagia. There is a high proportion of significant findings including gastritis, peptic ulcer disease, and oesophageal cancer.     

Upregulation of hyaluronan and its binding receptors in an experimental model of chronic cyclosporine nephropathy

Aim: Hyaluronan (HA) is an important extracellular matrix (ECM) proteoglycan. The localization of HA and its binding receptors, CD44 and LYVE‐1, was evaluated in an experimental model of chronic cyclosporine A (CsA)‐induced nephropathy. Methods: Sprague–Dawley rats maintained on a low‐salt diet (0.05% sodium) received an s.c. injection of vehicle (1 mL/kg per day olive oil; VH groups) or CsA (15 mg/kg per day; CsA groups) for 1 or 4 weeks. Induction of chronic CsA nephropathy was evaluated according to renal function and pathology and expression of HA, CD44, LYVE‐1, ED‐1 and α‐smooth muscle actin (α‐SMA). Results: CsA treatment for 4 weeks caused renal dysfunction, which was accompanied by typical striped interstitial fibrosis. In the VH group, HA immunoreactivity was observed only in the inner medulla. However, the area of HA immunoreactivity increased with the duration of CsA treatment: CsA treatment for 1 week extended HA immunoreactivity to the outer medulla, and CsA treatment for 4 weeks caused a further extension of HA immunoreactivity to the cortex, which was vulnerable to CsA‐induced renal injury. HA binding receptor, CD44 and LYVE‐1 expression were also upregulated in the CsA groups, and were localized to the area of fibrosis and the peritubular capillaries of the cortex. In the CsA groups, ED‐1 and α‐SMA were predominantly expressed in fibrotic areas in which HA had accumulated. Conclusion: These findings suggest that upregulation of HA and its binding receptors are involved in interstitial fibrosis in chronic CsA‐induced renal injury.     

RNAi抑制PI3Kp85α蛋白活性对人乳腺癌细胞系MCF-7生长抑制的体外研究

目的:探讨敲低PI3Kp85α表达对人乳腺癌细胞系MCF-7细胞生长的影响和机制.方法:用靶向PI3Kp85α的siRNA转染人乳腺癌细胞系MCF-7,使用Real-time PCR法鉴定转染PI3Kp85α表达水平;MTT法评价PI3Kp85α siRNA对乳腺癌细胞系MCF-7生长的影响;流式细胞术检测转染后细胞周期分布和凋亡;采用免疫荧光染色及Western blot方法观察IA型PI3K/AKT通路主要成员的表达.结果:Real-timePCR结果显示PI3Kp85α siR-NA转染导致PI3Kp85α表达下调;MTT结果显示PI3Kp85α siRNA转染抑制肿瘤细胞生长;流式细胞术检测可见PI3Kp85α siRNA转染组细胞周期存在G_0/G_1期阻滞而且凋亡率显著高于对照组与空载体组(F=19.255,P=0.002).结论:应用PI3Kp85α siRNA转染人乳腺癌细胞系MCF-7细胞,可抑制其增殖和诱导细胞凋亡,因此PI3Kp85α可以作为人乳腺癌基因治疗的候选靶点.     

Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk

OBJECTIVE: Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia. METHODS: Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20-53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3-6 months and an evaluation of metastasis was performed every 6 months. RESULTS: At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma. CONCLUSION: Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.     

Significant relationship of time-dependent uroflowmetric parameters to lower urinary tract symptoms as measured by the International Prostate Symptom Score

AIMS: The aim of the present paper is to elucidate the possible involvement of time-dependent parameters as obtained by uroflowmetry in the manifestation of lower urinary tract symptoms (LUTS) in elderly patients. METHODS: Using simple and multiple regression analyses, the correlation of the International Prostate Symptom Score (IPSS) with objective parameters including age, postvoid residual, uroflowmetry and transrectal ultrasonic measurements of the prostate was analyzed in 206 male patients (average age of 68.0 +/- 7.4 years) who visited our outpatient clinic complaining of LUTS. RESULTS: In the 206 patients, the mean maximum flow rate was 12.2 mL/s (13.7 mL/s in mild, 11.9 mL/s in moderate, and 11.2 mL/s in severe IPSS total score) and average flow rate was 4.4 mL/s (5.4 mL/s in mild, 4.3 mL/s in moderate, and 3.5 mL/s in severe IPSS total score). Simple regression analyses demonstrated that age, voiding time, and average and maximum flow rates correlate significantly with symptom scores. In particular, relatively strong relationships were found between average flow rate and scores of intermittency, weak stream and total and voiding symptoms scores. Serum prostate specific antigen level, postvoid residual and prostatic ultrasonic measurements did not show a significant correlation with symptom scores. Multiple regression analyses revealed age and average flow rate to be independent determinants for symptom scores. These results suggest that the time-dependent function in micturition interferes in the manifestation of LUTS in elderly men who have borderline or pathologic maximum flow rate. When evaluating uro flowmetry in elderly male patients with LUTS, attention should be paid to time-dependent parameters such as voiding time and average flow rate.     

用放射吸收法(RA)测量指骨骨密度精确度和准确性的研究

目的 评价放射吸收法(RA)测量2、3、4指骨中节骨密度的精确度和准确性.方法 对19例尸体的双手,用铝制楔型标志物,分别进行了50 kV 400 mA和60 kV 300 mA两次X线照射,对每只手指的第二至第四节指骨的骨矿含量(BMC)和骨密度(BMD),以Au(指骨指数)为单位进行测量和分析.结果 对于BMC-AU来说,这种方法的精密度误差是1.0%,对于BMD-AU来说,精密度误差是0.6%.通过5 mm和6mm 酒精厚度所获得的X射线图可以观察到BMD-Au有2.0%到2.4%的降低,与对照组相比有明显的统计学差异(P<0.01).采用X射线吸收测定法得到的BMC-Au 和前臂的BMC有良好的相关性(r=0.887),并且在指骨的BMC-AU与骨灰重量之间也有较好的相关性(r=0.983).结论 放射吸收法(RA)测量外周骨骨密度具有较高的精确度和准确性.