Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study

Only 54% of prostate cancer cases in Korea are localized compared with 82% of cases in the US. Furthermore, half of Korean patients are upgraded after radical prostatectomy (41.6%–50.6%). We investigated the risk factors for upgrading and/or upstaging of low-risk prostate cancer after radical prostatectomy. We retrospectively reviewed the medical records of 1159 patients who underwent radical prostatectomy at five hospitals in Honam Province. Preoperative data on standard clinicopathological parameters were collected. The radical prostatectomy specimens were graded and staged and we defined a “worsening prognosis” as a Gleason score ≥ 7 or upstaging to ≥ pT3. Multivariate logistic regression models were used to assess factors associated with postoperative pathological upstaging. Among the 1159 patients, 324 were classified into the clinically low-risk group, and 154 (47.5%) patients were either upgraded or upstaged. The multivariable analysis revealed that the preoperative serum prostate-specific antigen level (odds ratio [OR], 1.131; 95% confidence interval [CI], 1.007–1.271; P= 0.037), percent positive biopsy core (OR: 1.018; 95% CI: 1.002–1.035; P= 0.032), and small prostate volume (≤30 ml) (OR: 2.280; 95% CI: 1.351–3.848; P= 0.002) were predictive of a worsening prognosis. Overall, 47.5% of patients with low-risk disease were upstaged postoperatively. The current risk stratification criteria may be too relaxed for our study cohort.     

大鼠慢性前列腺炎模型中TRPA1及相关炎症因子的表达

目的:探讨模拟慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)动物模型疼痛产生的分子机制。方法:取SD大鼠36只,随机分为实验组和对照组,每组18只。实验组向前列腺双腹侧叶注射50μl 3%无菌λ-角叉菜胶制作大鼠无菌性前列腺炎症性疼痛模型,对照组注射等量无菌生理盐水。两组分别于造模后1周、2周和4周3个时间节点,每个节点6只大鼠,解剖获取大鼠前列腺组织、L6~S1段背根神经节(DRG)及脊髓,采用免疫组化联合Western印迹法检测神经生长因子(NGF)、瞬时受体电位通道蛋白A1(TRPA1)及降钙素基因相关肽(CGRP)在不同组织内的表达情况。结果:慢性前列腺炎症性疼痛大鼠前列腺组织中NGF、CGRP、TRPA1蛋白的表达均高于对照组(P<0.05),且随造模时间的延长各蛋白表达逐渐减弱,组间比较差异有统计学意义(P<0.05)。在大鼠L6~S1段DRG及脊髓内,造模后1周,实验组NGF、CGRP及TRPA1表达与对照组比较差异无统计学意义(P>0.05),造模后2周及4周,各蛋白表达呈持续高水平状态,与造模后1周大鼠比较差异无统计意义(P>0.05),但各实验组大鼠与对照组蛋白表达比较差异均有统计学意义(P<0.05),两时间点上两组蛋白表达比较差异无统计学意义(P>0.05)。结论:前列腺内注射λ-角叉菜胶方法制作的大鼠前列腺炎症性疼痛模型,可在分子水平模拟CP/CPPS的产生机制;TRPA1在CP/CPPS患者疼痛产生上可能发挥中继通道的作用。     

Comparison of fondaparinux sodium and low molecular weight heparin in the treatment of hypercoagulability secondary to traumatic infection

Purpose: To compare the effects and side-effects of fondaparinux sodium and low molecular weight heparin in patients with hypercoagulability accompanied with traumatic infection. Methods: Thirty-six patients with post-traumatic infections in our hospital intensive care center were diagnosed with hypercoagulability from February 2012 to February 2013. These patients were randomly divided into 2 groups. In group F (18 patients), the patients were treated with fondaparinux sodium, 2.5 mg, 1/d for 11 d. In group L (18 patients), the patients were treated with low molecular weight heparin, 4100 U, 1/12 h for 11 d. The incidence of deep vein thrombosis, bleeding events and multiple organ dysfunction syndrome (MODS) and mortality of two groups after anticoagulation therapy were analyzed. Fibrinogen, D-dimer level and activity of antithrombin III were measured by the coagulation analyzer. Results: The incidence of deep vein thrombosis, MODS incidence and mortality were not significantly different between the two groups. The rate of bleeding evens in group F was lower than group L (p < 0.05). Antithrombin III got an upward trend after anticoagulant therapy, in which it was higher in group F than in group L on the 5th d and 11th d (p<0.05). Fibrinogen levels were gradually increased, and there was no significant difference between two groups (p>0.05). D-dimer was significantly decreased after anticoagulant therapy for 5 d (p<0.01), and there were significant differences between two groups on the 5th d and 7th d (p < 0.05). It showed no significant difference on the 11th d (p>0.05). Conclusion: Fondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection. Compared with low molecular weight heparin, fondaparinux sodium may reduce the risk of bleeding events in patients with hypercoagulability accompanied by traumatic infection.     

Recipient Myd88 Deficiency Promotes Spontaneous Resolution of Kidney Allograft Rejection

The myeloid differentiation protein 88 (MyD88) adapter protein is an important mediator of kidney allograft rejection, yet the precise role of MyD88 signaling in directing the host immune response toward the development of kidney allograft rejection remains unclear. Using a stringent mouse model of allogeneic kidney transplantation, we demonstrated that acute allograft rejection occurred equally in MyD88-sufficient (wild-type [WT]) and MyD88^−/− recipients. However, MyD88 deficiency resulted in spontaneous diminution of graft infiltrating effector cells, including CD11b⁻Gr-1⁺ cells and activated CD8 T cells, as well as subsequent restoration of near-normal renal graft function, leading to long-term kidney allograft acceptance. Compared with T cells from WT recipients, T cells from MyD88^−/− recipients failed to mount a robust recall response upon donor antigen restimulation in mixed lymphocyte cultures ex vivo. Notably, exogenous IL-6 restored the proliferation rate of T cells, particularly CD8 T cells, from MyD88^−/− recipients to the proliferation rate of cells from WT recipients. Furthermore, MyD88^−/− T cells exhibited diminished expression of chemokine receptors, specifically CCR4 and CXCR3, and the impaired ability to accumulate in the kidney allografts despite an otherwise MyD88-sufficient environment. These results provide a mechanism linking the lack of intrinsic MyD88 signaling in T cells to the effective control of the rejection response that results in spontaneous resolution of acute rejection and long-term graft protection.     

甲状腺术中喉返神经的损伤和预防

喉返神经损伤是甲状腺术后严重的并发症之一,单侧损伤引起声音嘶哑、双侧损伤则导致呼吸困难,甚至发生危及生命的声门梗阻.分析甲状腺损伤的原因:喉返神经与甲状腺下动脉紧密复杂的关系、喉返神经存在分支及分支的变异、喉不返神经、以及甲状腺Zuckerkandl结节的存在等解剖因素造成其易损伤;喉返神经本身的脆弱性造成其易损;未能合理使用能量手术器械造成神经的热损伤.预防喉返神经损伤可从以下方面努力:在甲状腺术中解剖显露喉返神经,使其“可视化”;术中精细化解剖喉返神经,解剖程度适中;掌握能量器械的性能,安全使用能量器械以减少神经的热损伤;合理使用术中神经监测,使用连续性神经监测,有助于降低喉返神经损伤的风险.     

The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

BackgroundWear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.MethodsTwenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.ResultsThe median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.ConclusionsThe survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.