The novel nomogram of Gleason sum upgrade: Possible application for the eligible criteria of low dose rate brachytherapy

Objective: To examine the rate of Gleason sum upgrading (GSU) from a sum of 6 to a Gleason sum of ≥7 in patients undergoing radical prostatectomy (RP), who fulfilled the recommendations for low dose rate brachytherapy (Gleason sum 6, prostate‐specific antigen ≤10 ng/mL, clinical stage ≤T2a and prostate volume ≤50 mL), and to test the performance of an existing nomogram for prediction of GSU in this specific cohort of patients. Methods: The analysis focused on 414 patients, who fulfilled the European Society for Therapeutic Radiation and Oncology and American Brachytherapy Society criteria for low dose rate brachytherapy (LD‐BT) and underwent a 10‐core prostate biopsy followed by RP. The rate of GSU was tabulated and the ability of available clinical and pathological parameters for predicting GSU was tested. Finally, the performance of an existing GSU nomogram was explored. Results: The overall rate of GSU was 35.5%. When applied to LD‐BT candidates, the existing nomogram was 65.8% accurate versus 70.8% for the new nomogram. In decision curve analysis tests, the new nomogram fared substantially better than the assumption that no patient is upgraded and better than the existing nomogram. Conclusions: GSU represents an important issue in LD‐BT candidates. The new nomogram might improve patient selection for LD‐BT and cancer control outcome by excluding patients with an elevated probability of GSU.     

Clinical prognostic factors for ovarian metastasis in women with gastric cancer

BACKGROUND/AIMS: Krukenberg's tumor is considered to be a metastatic carcinoma to the ovary derived from a primary malignancy, usually from the gastrointestinal tract. This retrospective study tries to evaluate the clinicopathologic characteristics of ovarian metastasis in female gastric cancer and to define the prognostic factors. METHODOLOGY: Of 1,890 female patients with gastric cancers, 37 patients with metastatic ovarian carcinomas were analyzed. RESULTS: Patients with ovarian metastasis were younger in age, higher in primary tumor location, and far advanced in depth of invasion and lymph node metastases. Ovarian metastasis was largely related to the peritoneal seeding, which was statistically significant on survival time. A multivariate analysis of prognostic factors indicated that the presence of peritoneal seeding was the only significant independent factor. The young female patients with far advanced gastric cancer were vulnerable to recurrence of ovarian metastasis and were considered to undergo prophylactic oophorectomy with gastrectomy. The prognosis of ovarian metastasis is dismal, because this is frequently associated with the peritoneal disseminations. CONCLUSIONS: It is essential to treat the peritoneal disseminations in order to improve the survival rate of female gastric cancer patients with ovarian metastasis.     

Mechanism of asynchronous Ca2+ waves underlying agonist-induced contraction in the rat basilar artery

Background and purpose:

Uridine 5''-triphosphate (UTP) is a potent vasoconstrictor of cerebral arteries and induces Ca²⁺ waves in vascular smooth muscle cells (VSMCs). This study aimed to determine the mechanisms underlying UTP-induced Ca²⁺ waves in VSMCs of the rat basilar artery.

Experimental approach:

Isometric force and intracellular Ca²⁺ ([Ca²⁺]_i) were measured in endothelium-denuded rat basilar artery using wire myography and confocal microscopy respectively.

Key results:

Uridine 5''-triphosphate (0.1–1000 µmol·L⁻¹) concentration-dependently induced tonic contraction (pEC₅₀ = 4.34 ± 0.13), associated with sustained repetitive oscillations in [Ca²⁺]_i propagating along the length of the VSMCs as asynchronized Ca²⁺ waves. Inhibition of Ca²⁺ reuptake in sarcoplasmic reticulum (SR) by cyclopiazonic acid abolished the Ca²⁺ waves and resulted in a dramatic drop in tonic contraction. Nifedipine reduced the frequency of Ca²⁺ waves by 40% and tonic contraction by 52%, and the nifedipine-insensitive component was abolished by SKF-96365, an inhibitor of receptor- and store-operated channels, and KB-R7943, an inhibitor of reverse-mode Na⁺/Ca²⁺ exchange. Ongoing Ca²⁺ waves and tonic contraction were also abolished after blockade of inositol-1,4,5-triphosphate-sensitive receptors by 2-aminoethoxydiphenylborate, but not by high concentrations of ryanodine or tetracaine. However, depletion of ryanodine-sensitive SR Ca²⁺ stores prior to UTP stimulation prevented Ca²⁺ waves.

Conclusions and implications:

Uridine 5''-triphosphate-induced Ca²⁺ waves may underlie tonic contraction and appear to be produced by repetitive cycles of regenerative Ca²⁺ release from the SR through inositol-1,4,5-triphosphate-sensitive receptors. Maintenance of Ca²⁺ waves requires SR Ca²⁺ reuptake from Ca²⁺ entry across the plasma membrane via L-type Ca²⁺ channels, receptor- and store-operated channels, and reverse-mode Na⁺/Ca²⁺ exchange.     

Dynamic maps: a visual-analytic methodology for exploring spatio-temporal disease patterns

Background  

Epidemiologic studies are often confounded by the human and environmental interactions that are complex and dynamic spatio-temporal processes. Hence, it is difficult to discover nuances in the data and generate pertinent hypotheses. Dynamic mapping, a method to simultaneously visualize temporal and spatial information, was introduced to elucidate such complexities. A conceptual framework for dynamic mapping regarding principles and implementation methods was proposed.     

Association between anger and first-onset primary spontaneous pneumothorax

OBJECTIVE: Primary spontaneous pneumothorax (PSP) is a frequent and problematic disease, but its underlying causes and pathophysiology remain unclear. This study examined whether anger, which is related to many psychosomatic diseases, is a psychosocial factor associated with first-onset PSP. METHOD: We administered the State-Trait Anger Expression Inventory, Stress Response Inventory, Coping Scale, Beck Depression Inventory and Global Assessment of Recent Stress to 91 patients with first-onset PSP and to 77 patients with recent minor trauma as controls. RESULTS: The scores on anger-in, anger-out, state anger and trait anger were significantly higher in the PSP group than in the control group. Logistic regression analysis revealed that low body mass index and trait anger could be associated with PSP. CONCLUSION: We hypothesize that anger could play a role in the pathophysiology of PSP.     

Large Metastatic Lymph Node Size, Especially More Than 2 cm: Independent Predictor of Poor Prognosis in Node-Positive Gastric Carcinoma

The presence of metastatic lymph nodes (MLNs) is the most important prognostic factor for gastric carcinoma, with the number of MLNs thought to be predictive of the prognosis. However, there have been long-standing debates on how to classify node-positive patients into prognostic groups appropriately. Recent findings in patients with colon and esophageal cancer have suggested that MLN size, more than MLN number, is an important prognostic factor; but less is known about the impact of MLN size on the prognosis of patients with gastric carcinoma. We therefore assessed the prognostic impact of large MLNs, especially those ≥2 cm, in patients with gastric carcinoma. A total of 1190 patients who underwent curative resection for gastric carcinoma between 2001 and 2003 and had lymph node metastases were divided into two groups according to the size of the largest MLN: ≥2 cm (n = 51) vs. <2 cm (n = 1139). Clinicopathologic data, including tumor recurrence and survival, were reviewed retrospectively. The median follow-up for living patients was 47 months (range 30–80 months). Age, sex ratio, type of surgery, and histologic classification did not correlate with MLN size. The depth of invasion did correlate with MLN size (T1–2 vs. T3–4, p = 0.045) but not with the number of MLNs (N stage, p = 0.311). The two groups showed similar distribution of stage according to the UICC/AJCC TNM staging system. Disease-free survival (34% vs. 53%, p < 0.001) and overall survival (40% vs. 63%, p = 0.011) were significantly worse in the large MLN group. Univariate analysis with the log-rank test showed that MLN ≥2 cm, type of surgery, T stage, N stage, and histologic classification had a significant impact on overall survival. Multivariate analysis with the Cox proportional hazard model showed that MLN ≥2 cm was an independent prognostic factor (hazard ratio 1.76, p = 0.006), along with T stage and N stage. MLN ≥2 cm is an independent additional predictor of poor prognosis in patients with node-positive gastric carcinoma.     

胫股关节吻合性对人工膝关节聚乙烯磨损的影响

人工关节置换术是矫正关节畸形、解除关节疼痛、重建关节功能的主要手段。多年来 ,人工全髋、全膝皆以聚乙烯为关节形成表面 ,随着人工关节置换的广泛开展 ,聚乙烯磨损问题越来越引起人们的关注。聚乙烯磨损及其产生的碎屑和磨损颗粒所引发的生物学反应及导致的骨吸收、骨溶解 ,是造成假体松动、人工关节翻修的主要原因[1,2 ] 。与人工髋关节的球洞几何形态相比 ,人工膝关节的几何形态要不吻合的多 ,胫骨假体表面常承受较大的接触应力 ,较易产生磨损[2 ,3 ] ,理论上关节形成表面越吻合 ,聚乙烯磨损越少 ,不同的胫股关节吻合性 ,对假体磨损产…