Entwicklung antiangiogener Kombinationstherapien zur Behandlung des Nierenzellkarzinoms

Ohne Zusammenfassung     

Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie

OBJECTIVE: We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography. RESULTS: In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography. CONCLUSIONS: TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.     

Growth plate fractures of the distal tibia: is CT imaging necessary?

Purpose  

Comparison of conventional radiographs (CR) of distal tibial growth plate fractures [Salter–Harris (SH) fracture types I–V/triplane fractures I–III] with computed tomography (CT) as the reference standard and assessment of diagnostic benefit of CT imaging in the affected patients.     

Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study.

OBJECTIVES. Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. METHODS. Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders. RESULTS. Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community. CONCLUSIONS. Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and longterm care.     

Depression and suicidal behaviors in medicare primary care patients under age 65

OBJECTIVE: To examine suicidal behavior and depression prevalence among a group of Medicare patients under age 65 with functional impairment and recent significant health care services use. DESIGN: An observational study of baseline characteristics of participants in a randomized controlled trial. SETTING: A Medicare demonstration (N=1,605) that enrolled primary care patients in 8 counties in New York, 6 counties in West Virginia, and 5 counties in Ohio. PATIENTS/PARTICIPANTS: All demonstration participants under age 65 (n=164). Participants were required to have impairment in at least 2 activities of daily living or 3 instrumental activities of daily living, and to have had recent significant health care use. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Paykel questionnaire for suicidal ideation and attempts, the Mini-international Neuropsychiatric Interview Major Depressive Episode module, and the 15-item Geriatric Depression Scale were administered at baseline; 14.8% of the patients indicated suicidal ideation during the past year, 4.9% reported a suicide attempt during that time, 25.9% indicated at least 1 lifetime suicide attempt, 34.6% had a major depressive episode in the last month, and 58.3% had clinically significant depressive symptoms during the previous week. CONCLUSIONS: These levels of suicidal ideation and behaviors and of depression are far higher than those found in studies of nonelderly American adults, and may indicate the need for routine screening in this population.     

MiR‐34a deficiency accelerates medulloblastoma formation in vivo

Previous studies have evaluated the role of miRNAs in cancer initiation and progression. MiR‐34a was found to be downregulated in several tumors, including medulloblastomas. Here we employed targeted transgenesis to analyze the function of miR‐34a in vivo. We generated mice with a constitutive deletion of the miR‐34a gene. These mice were devoid of mir‐34a expression in all analyzed tissues, but were viable and fertile. A comprehensive standardized phenotypic analysis including more than 300 single parameters revealed no apparent phenotype. Analysis of miR‐34a expression in human medulloblastomas and medulloblastoma cell lines revealed significantly lower levels than in normal human cerebellum. Re‐expression of miR‐34a in human medulloblastoma cells reduced cell viability and proliferation, induced apoptosis and downregulated the miR‐34a target genes, MYCN and SIRT1. Activation of the Shh pathway by targeting SmoA1 transgene overexpression causes medulloblastoma in mice, which is dependent on the presence and upregulation of Mycn. Analysis of miR‐34a in medulloblastomas derived from ND2:SmoA1(tg) mice revealed significant suppression of miR‐34a compared to normal cerebellum. Tumor incidence was significantly increased and tumor formation was significantly accelerated in mice transgenic for SmoA1 and lacking miR‐34a. Interestingly, Mycn and Sirt1 were strongly expressed in medulloblastomas derived from these mice. We here demonstrate that miR‐34a is dispensable for normal development, but that its loss accelerates medulloblastomagenesis. Strategies aiming to re‐express miR‐34a in tumors could, therefore, represent an efficient therapeutic option.     

Direct and indirect effects of stress on bulimic symptoms and BMI: the mediating role of irrational food beliefs

Objective

To test the possible mediating role of irrational food beliefs (IFBs) in the connection between stress and bulimic symptoms and BMI in a subclinical population.

Methods

Participants were college students (N = 356) administered measures of daily hassles, IFBs, and bulimic symptoms. Simple mediation analyses using bootstrapping methods were performed to examine the potential direct effects of stress, and indirect effects of stress through IFBs, on bulimic symptoms and BMI.

Results

Daily hassles exerted a direct effect on bulimic symptoms, but not on BMI. Indirect effects of daily hassles, through IFBs, on both bulimic symptoms and BMI were observed. The pattern of results was not altered when gender was included in the models as a covariate.

Conclusions

The findings support a cognitive mediation model of the effects of stress on eating disorder symptoms and body mass through irrational food beliefs in both men and women.