Testosterone and benign prostatic hyperplasia

The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.     

Primary cardiac tumours: eighteen years of surgical experience on 21 patients

BACKGROUND: The literature on primary cardiac tumours is relatively limited because of their rare occurrence. OBJECTIVE: To report the authors' experience with primary cardiac tumours at McGill University teaching hospitals, Montreal, Quebec. In addition, four exceedingly rare primary cardiac tumours are presented--three valve myxomas and the seventh reported case of a primary synovial sarcoma. METHODS: Twenty-one patients resected for primary cardiac tumours were retrospectively reviewed in terms of their clinical presentation, surgical treatment, histopathological findings and outcome. Postoperative success was defined by disease-free survival after resection. A survival analysis was performed using the Kaplan-Meier life-table method. RESULTS: The mean age at the time of resection was 45.5 years (range birth to 74 years). The most common clinical presentation in adults was dyspnea (38%) or central nervous system/embolic phenomena (24%), and in the pediatric group, it was hypoxia (50%). All but one of the tumours were visualized using transthoracic echocardiography. Coronary angiography was performed in 11 patients, with a diagnosis of coronary artery disease in five patients (45%), all of whom underwent coronary artery bypass grafting. The surgical approach was uniatrial in 10 patients (48%)--seven (33%) via the left atrium and three (14%) via the right atrium. Eight patients (38%) required a biatrial approach; the remaining three patients (14%) with ventricular tumours required a ventricular approach. Of the 21 cases, 17 were adults and four were pediatric cases. There were 16 myxomas (76%), two rhabdomyomas (10%), one fibroma (5%), one angiosarcoma (5%) and one synovial sarcoma (5%). In adults, myxoma was the most common primary cardiac tumour (88%), whereas rhabdomyoma occurred most frequently in the pediatric population (50%). Three valve myxomas, two involving the mitral valve and one involving the tricuspid valve, were encountered; all underwent conservative leaflet resection and valve repair. The probability of disease-free survival for all patients was 80.7% (95% CI 63.6 to 97.7) at one year, and 75.6% (95% CI 57.0 to 94.3) at both five and 10 years after resection. For adult benign tumours, the probability of disease-free survival was 93% (95% CI 79.4 to 100.0) at one, five and 10 years. There was a total of five deaths. CONCLUSIONS: The results suggest that complete surgical resection of primary cardiac tumours prolongs symptom-free survival and is associated with a low recurrence rate. Benign primary cardiac tumours have an excellent prognosis in the adult population compared with in the pediatric population (93% versus 50% survival, respectively, in the present cohort). Furthermore, conservative leaflet resection with valve repair of valve myxomas, rather than radical excision and valve replacement, should be strongly considered. Early identification and diagnosis of primary cardiac tumours are necessary for expeditious surgical resection if a cure is desired, especially when encountering malignant primary cardiac sarcomas.     

SOCS-1, -2, -3: selective targets and functions downstream of the prolactin receptor

We have cloned a full-length cDNA coding for activin betaA subunit from a goldfish brain and pituitary cDNA library, which represents the first for activin betaA in fish. Sequence analysis of goldfish activin betaA shows that this peptide is highly conserved across vertebrates. The mature region of goldfish activin betaA shares 81% amino acid identity with that of humans. Messenger RNA of goldfish activin betaA is expressed in a variety of tissues including ovary, testis, brain and liver, suggesting a wide range of physiological roles for activin A in the goldfish. The identity of the cloned goldfish activin betaA was confirmed by expressing the protein in the Chinese hamster ovary (CHO) cells followed by detection of the specific activin activity in the culture medium using erythroid differentiation factor (EDF) assay with F5-5 cells. Stable CHO cell lines producing high level of recombinant goldfish activin A were established and characterized.     

Metastatic shoulder liposarcoma to the right ventricle: CT findings

Metastatic cardiac liposarcoma is rare. A right ventricular liposarcoma metastasis is described in a 46-year-old man, who was admitted with significant shortness of breath and fatigue, and in whom a large lobulated low attenuation mass occupying most of the right ventricular cavity, with extension through the right ventricular apex and a small-to-moderate pericardial effusion was detected by electrocardiogram-gated cardiac computed tomography. The patient had an antecedent history of a left upper arm liposarcoma treated with surgical resection, chemotherapy, and postoperative radiotherapy 3 years earlier. Surgical resection was performed with the majority of the neoplasm removed though; the right ventricular apex and epicardial extension of tumor could not be fully resected. The histopathologic analysis revealed a liposarcoma, similar to the one resected in the left arm 3 years earlier. Electrocardiogram-gated cardiac computed tomography was able to visualize the metastatic tumor within the heart, accurately evaluate cardiac function and allow for prompt surgical treatment that produced relief of symptoms, and assess for further metastatic disease within the thorax.     

中国包虫病流行区居民包虫病防治知识知晓率——Meta分析

目的 综合评估中国包虫病流行区居民包虫病防治核心知识知晓率现状,为开展包虫病防诊治工作提供参考依据。方法 检索中国各大核心知识库和文献库,收集近十年来我国公开发表的有关包虫病防治核心知识知晓情况的调查研究文献,用STROBE声明对文献质量进行了评估,使用Revman5.3软件对核心知晓率进行了Meta分析,并按地区、对象、文献质量进行了亚组分析,采用随机效应模型合并了各样本知晓率及95%CI。结果 共纳入11篇文献进行研究,中国包虫病流行区包虫病防治核心知识知晓率为51%(95%CI:37%~65%),各亚组之间无统计学差异,其原因可能是对于包虫病核心知识知晓率调查研究尚无统一、标准、规范的知晓率量表,且作为研究对象主体的农牧民属于低文化群体。结论 中国包虫病流行区居民包虫病防治核心知识知晓率总体偏低。     

Effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures

IntroductionExperimental studies have revealed that nicotine upregulates the expression of receptors of advanced glycation end products and retards fibroblastic cell migration in the gingiva of smokers compared with nonsmokers, thereby inducing a proinflammatory effect. The aim of this study was to review the effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures.MethodsTo address the focused question, “What is the effect of cigarette smoking on clinical outcomes after periodontal surgical interventions?”, databases were searched from 1968 to May 2010 using various combinations of the following key words: inflammation, mucoperiosteal flap, periodontal surgery, smoking and tobacco. The inclusion criteria included all levels of available evidence. Articles published only in the English language were evaluated, and unpublished data were not sought.ResultsTwenty-four clinical studies were included. The duration of smoking habit ranged from at least 5 years to 27.8 years. Sixteen studies showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.ConclusionCigarette smoking has a negative effect on periodontal wound healing after surgical interventions.     

In situ cell cycle kinetics in bone marrow biopsies following sequential infusions of IUdR/BrdU in patients with hematopoietic malignancies.

Examination of the proliferative characteristics of myeloblasts was undertaken in situ in bone marrow (BM) biopsies of patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) following sequential infusions of iodo- (IUdR) and bromodeoxyuridine (BrdU). The ability to identify S-phase cells which have incorporated both or either one of the labels in vivo by using two monoclonal antibodies in vitro permitted the measurement of labeling index (LI) and durations of S-phase (Ts) and the total cell cycle (Tc) both from the BM aspirates and biopsies. While the LI is 2-3 times higher in biopsies, Ts and Tc are fairly comparable in the two samples in 8/10 cases (p = 0.02 and 0.003 respectively). Advantages associated with the determination of cell cycle parameters in BM biopsies have been discussed at length.     

Patient satisfaction with eletriptan in the acute treatment of migraine in primary care

OBJECTIVE: The efficacy of triptans for acute migraine has been well established in clinical trials but not in primary care, where they are most commonly prescribed. The aim of this open-label study was to evaluate the effectiveness of eletriptan 40 mg in primary care, using a patient-weighted satisfaction scale. METHODS: Eligible patients met International Headache Society criteria for migraine, with 1-6 attacks per month. Patients completed questionnaires at screening and following a single eletriptan-treated attack. Treatment satisfaction was evaluated using a six-item Medication Satisfaction Questionnaire (MSQ). MSQ item scores were weighted, based on the important score ratings, to yield individualised satisfaction scores. The primary end-point was the difference in weighted satisfaction scores between the patient's previous treatment and eletriptan 40 mg. Secondary end-points assessed quality of life (QOL), functioning and efficacy of treatment. RESULTS: Of 590 patients screened, 437 completed the study. Degree (95.2%), time (88.8%) and duration (83.8%) of headache pain relief were rated as most important by patients. The mean (+/-SD) total satisfaction score on the MSQ was higher for eletriptan than previous therapy (2.2 +/- 3.0 vs. 0.6 +/- 2.4; p < 0.001). The high level of satisfaction with eletriptan vs. previous treatment reflects the improvements in QOL and functioning observed, and the high headache and pain-free response rates. CONCLUSIONS: Patient-weighted satisfaction with eletriptan 40 mg was higher than with previous treatment for all items. The use of patient-weighted importance ratings of satisfaction is a promising approach for establishing effectiveness of treatment in primary care.