Response of proopiomelanocortin and gonado- or lactotroph systems to in-vitro fertilisation procedures stress

Objective

To analyse for the first time the response of the corticotroph-type and the melanotroph-type pituitary proopiomelanocortin (POMC) system with regard to in-vitro fertilisation (IVF) treatment using self-developed highly specific non-cross-reacting radioimmunoassay.

Study design

Setting: University hospital. Patients: A total of 28 patients undergoing IVF oocyte retrieval. Cross sectional exploratory study, one factorial design with repeated measurements on one factor, non-parametric tests. Blood was collected before anaesthesia (t_A) (n = 28) and immediately after oocyte retrieval (t_B) (n = 28). Main outcome measure(s): β-endorphin immunoreactive material (IRM), acetyl-N-β-endorphin IRM, β-lipotropin IRM, ACTH, cortisol, estradiol, progesterone, prolactin, luteinizing hormone, and follicle-stimulating hormone. For determination of authentic β-endorphin [β-endorphin (1–31)] a highly specific two-site fluid phase immunoprecipitation radioimmunoassay was developed, which did not cross-react with any β-endorphin derivative or any other opioid peptide tested.

Results

No response of acetyl-N-β-endorphin IRM and of authentic β-endorphin (1–31) was observed to oocyte retrieval in contrast to a significant increase of corticotroph-type proopiomelanocortin derivatives. A significant rise in prolactin plasma concentration indicates a pronounced lactotroph response to oocyte retrieval stress. No significant correlation between POMC derivates and prolactin and between POMC derivatives and gonadotropins or sexual steroids except for ACTH and progesterone and for β-endorphin IRM and estradiol was observed.

Conclusion

IVF treatment stress led to significant corticotroph-type POMC and lactotroph responses, but not to responses of authentic β-endorphin or melanotroph-type POMC in women undergoing oocyte retrieval.     

Ischias und Bandscheibenvorfall

Ohne Zusammenfassung     

A Positron Emission Tomograph based on LSO-APD modules with a sampling ADC read-out system for a students’ advanced laboratory course

A one-day laboratory course on positron emission tomography (PET) for the education of physics students and PhD students in medical physics has been set up. In the course, the physical background and the principles of a PET scanner are introduced. Course attendees set the system in operation, calibrate it using a ²²Na point source and reconstruct different source geometries filled with ¹⁸F. The PET scanner features an individual channel read-out of 96 lutetium oxyorthosilicate (LSO) scintillator crystals coupled to avalanche photodiodes (APD). The analog data of each APD are digitized by fast sampling analog to digital converters (SADC) and processed within field programmable gate arrays (FPGA) to extract amplitudes and time stamps. All SADCs are continuously sampling with a precise rate of 80 MHz, which is synchronous for the whole system. The data is transmitted via USB to a Linux PC, where further processing and the image reconstruction are performed. The course attendees get an insight into detector techniques, modern read-out electronics, data acquisition and PET image reconstruction. In addition, a short introduction to some common software applications used in particle and high energy physics is part of the course.     

Differentiating normal hyaline cartilage from post-surgical repair tissue using fast gradient echo imaging in delayed gadolinium-enhanced MRI (dGEMRIC) at 3 Tesla

The purpose was to evaluate the relative glycosaminoglycan (GAG) content of repair tissue in patients after microfracturing (MFX) and matrix-associated autologous chondrocyte transplantation (MACT) of the knee joint with a dGEMRIC technique based on a newly developed short 3D-GRE sequence with two flip angle excitation pulses. Twenty patients treated with MFX or MACT (ten in each group) were enrolled. For comparability, patients from each group were matched by age (MFX: 37.1 ± 16.3 years; MACT: 37.4 ± 8.2 years) and postoperative interval (MFX: 33.0 ± 17.3 months; MACT: 32.0 ± 17.2 months). The Δ relaxation rate (ΔR1) for repair tissue and normal hyaline cartilage and the relative ΔR1 were calculated, and mean values were compared between both groups using an analysis of variance. The mean ΔR1 for MFX was 1.07 ± 0.34 versus 0.32 ± 0.20 at the intact control site, and for MACT, 1.90 ± 0.49 compared to 0.87 ± 0.44, which resulted in a relative ΔR1 of 3.39 for MFX and 2.18 for MACT. The difference between the cartilage repair groups was statistically significant. The new dGEMRIC technique based on dual flip angle excitation pulses showed higher GAG content in patients after MACT compared to MFX at the same postoperative interval and allowed reducing the data acquisition time to 4 min.     

Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes

Background

Recommendations for intraoperative and postoperative breast sentinel lymph node (SLN) processing differ widely. Micrometastases and isolated tumor cells (ITC) have recently been proposed as prognostically and therapeutically relevant. We compared 3 SLN protocols with regard to intraoperative and postoperative diagnosis.

Materials and Methods

SLN in cohort I (270 patients) were intraoperatively assessed by stereomicroscopy. Intraoperative frozen section (IFS) was used only in stereomicroscopically suspicious SLN. In cohort II (197 patients), all SLN were examined with only 1 IFS. Final SLN workup in cohorts I and II consisted of complete step sectioning with immunohistochemistry. In cohort III (268 patients) 2 or more IFS were performed followed by 3 step sections and immunohistochemistry.

Results

pN1 stages were significantly higher in cohorts I and II (33.3% and 34.0% respectively) than in cohort III (24.6%). Intraoperative false negativity for the detection of metastases (pN1) ranged from 54.4% (cohort I) and 35.8% (cohort II) to 21.2% (cohort III). In contrast, ITC were detected significantly more frequently in cohort I (9.3%) and cohort II (14.7%) than in cohort III (1.9%).

Conclusions

Higher rates of SLN metastases and ITC in cohort I/II compared to cohort III suggest that IFS may result in tissue loss thus increasing the risk of missing metastases. Sparse IFS but complete postoperative SLN workup with step sectioning and immunohistochemistry provides more accurate information regarding minimal disease in SLN, but often results in delayed axillary lymph node dissection. This is important for preoperative patient information and recommendations in SLN processing protocols.     

Experimental blunt chest trauma impairs fracture healing in rats

In poly‐traumatic patients a blunt chest trauma is an important trigger of the posttraumatic systemic inflammatory response. There is clinical evidence that fracture healing is delayed in such patients, however, experimental data are lacking. Therefore, we investigated the influence of a thoracic trauma on fracture healing in a rat model. Male Wistar rats received either a blunt chest trauma combined with a femur osteotomy or an isolated osteotomy. A more rigid or a more flexible external fixator was used for fracture stabilization to analyze whether the thoracic trauma influences regular healing and mechanically induced delayed bone healing differently. The blunt chest trauma induced a significant increase of IL‐6 serum levels after 6 and 24 h, suggesting the induction of a systemic inflammation, whereas the isolated fracture had no effect. Under a more rigid fixation the thoracic trauma considerably impaired fracture healing after 35 days, reflected by a significantly reduced flexural rigidity (three‐point‐bending test), as well as a significantly diminished callus volume, moment of inertia, and relative bone surface (µCT analysis). In confirming the clinical evidence, this study reports for the first time that a blunt chest trauma considerably impaired bone healing, possibly via the interaction of the induced systemic inflammation with local inflammatory processes. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:734–739, 2011     

Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer: a possible implication of androgens in male homosexual arousal

Study Type – Symptom prevalence (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? A recent published paper regarding sexual and cognitive duality presents that androgens act synergic with female sexual pheromones while estrogens would act synergic with male sexual pheromones in normal potent men. The same authors found in this study that bicalutamide disfavours sexual function predominantly in homosexual rather than heterosexual men suffering with prostate cancer. The results of this study are interpreted alone in this article, the similarities and differences with results corresponding to younger and normal potent men following to be discussed recently in a review regarding psychosexual dualism.

OBJECTIVE

? Not only has a precise characterization of libido and sexual arousal in men as a central neural process been lacking, but the interactive role of gonadal hormones and sexual orientation in such processes has never been investigated. We investigate the relationships among sexual hormones, sexual arousal, and sexual orientation in men by comparing the self‐reported sexual response of heterosexual and homosexual men with locally advanced prostate neoplasm, receiving the non‐steroidal anti‐androgen bicalutamide as monotherapy.

PATIENTS AND METHODS

? 29 Romanian men participated in this study: 17 heterosexual and 12 homosexual. Patients were undergoing treatment for prostate cancer consisting of a standard daily dose of 50 mg bicalutamide, a fast acting non‐steroidal anti‐androgen with action comparable to other anti‐androgen drugs but with reportedly fewer sexual side effects. ? Patients retrospectively provided information regarding their sexual functioning measured by the IIEF prior to commencing bicalutamide treatment. ? Then, about five weeks later, patients were asked to prospectively provide information regarding their current sexual functioning while undergoing bicalutamide treatment.

RESULTS

? Overall IIEF scores as well as the Erectile Function, Orgasmic Function, Sexual Desire, and Overall Satisfaction subscales showed group, treatment, and group by treatment effects. ? The Intercourse Satisfaction subscale showed group and group by treatment effects. ? On most subscales, homosexual men showed lower functioning than heterosexual men, primarily in response to treatment with bicalutamide.

CONCLUSIONS

? Treatment with an anti‐androgen in a clinical population of men undergoing therapy for prostate cancer affected homosexual men more than heterosexual men, although not all heterosexual men were unaffected. ? These results are discussed in the context of dual sexual natures, a concept recently developed in the sexual literature. ? Furthermore, these findings reiterate the importance of incorporating such variables as sexual orientation into studies investigating medical treatments on sexual response.     

Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy

BACKGROUND: To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy. OBJECTIVE: To identify independent predictors for satisfaction and regret after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. MEASUREMENTS: Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis. RESULTS AND LIMITATIONS: A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03-0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41-0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90-10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60-4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30-3.12) were independently associated with satisfaction (p相似文献