Diagnosis of cystocele – the correlation between clinical and radiological evaluation

In patients with genital prolapse involving several compartments simultaneously, radiologic investigation can be used to complement the clinical assessment. Contrast medium in the urinary bladder enables visualization of the bladder base at cystodefecoperitoneography (CDP). The aim of the present study was to evaluate the correlation between clinical examination using the Pelvic Organ Prolapse Quantification system (POP-Q) and CDP. Thirty-three women underwent clinical assessment and CDP. Statistical analysis using Pearsons correlation coefficient (r) demonstrated a wide variability between the current definition of cystocele at CDP and POP-Q (r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome (r=0.63). The present study demonstrates a moderate correlation between clinical and radiologic findings in patients with anterior vaginal wall prolapse. It does not support the use of bladder contrast at radiologic investigation in the routine preoperative assessment of patients with genital prolapse.Abbreviations CDP Cystodefecoperitoneography Editorial Comment: The authors attempt to correlate the visceral position of the bladder on fluoroscopy to the anterior vaginal wall measurements on POP-Q examination. Consistent with other published reports, they show only moderate statistical correlations. Clinically, the correlations are probably not useful. Thirty-eight percent of women with radiographic cystoceles had no clinically significant prolapse (stage III or IV). Based on their findings the authors conclude that the routine use of radiologic investigation might not be warranted in the preoperative assessment of women with pelvic organ prolapse. This must be interpreted with caution when generalizing their data to all women with prolapse. Only 17% of the women in this study had had prior pelvic surgery. The authors also do not address how cystodefecoperitoneography results affected the diagnosis of enterocele or rectocele. Other authors have shown a significant increase in enterocele diagnosis using cystodefecoperitoneography.     

ATM polymorphisms as risk factors for prostate cancer development

The risk of prostate cancer is known to be elevated in carriers of germline mutations in BRCA2, and possibly also in carriers of BRCA1 and CHEK2 mutations. These genes are components of the ATM-dependent DNA damage signalling pathways. To evaluate the hypothesis that variants in ATM itself might be associated with prostate cancer risk, we genotyped five ATM variants in DNA from 637 prostate cancer patients and 445 controls with no family history of cancer. No significant differences in the frequency of the variant alleles at 5557G>A (D1853N), 5558A>T (D1853V), ivs38-8t>c and ivs38-15g>c were found between the cases and controls. The 3161G (P1054R) variant allele was, however, significantly associated with an increased risk of developing prostate cancer (any G vs CC OR 2.13, 95% CI 1.17-3.87, P=0.016). A lymphoblastoid cell line carrying both the 3161G and the 2572C (858L) variant in the homozygote state shows a cell cycle progression profile after exposure to ionising radiation that is significantly different to that seen in cell lines carrying a wild-type ATM gene. These results provide evidence that the presence of common variants in the ATM gene, may confer an altered cellular phenotype, and that the ATM 3161C>G variant might be associated with prostate cancer risk.     

A gene expression signature associated with metastatic outcome in human leiomyosarcomas

Metastasis is a major factor associated with poor prognosis in cancer, but little is known of its molecular mechanisms. Although the clinical behavior of soft tissue sarcomas is highly variable, few reliable determinants of outcome have been identified. New markers that predict clinical outcome, in particular the ability of primary tumors to develop metastatic tumors, are urgently needed. Here, we have chosen leiomyosarcoma as a model for examining the relationship between gene expression profile and the development of metastasis in soft tissue sarcomas. Using cDNA microarray, we have identified a gene expression signature associated with metastasis in sarcoma that allowed prediction of the future development of metastases of primary tumors (Kaplan-Meier analysis P = 0.001). Our finding may aid the tailoring of therapy for individual sarcoma patients, where the aggressiveness of treatment is affected by the predicted outcome of disease.     

MMR vaccine uptake rates: a data validation study

As part of our investigation into the decrease in the measles, mumps and rubella (MMR) vaccine uptake rates, we validated MMR vaccination records of all children born between 01/09/1998 and 31/08/1999 in our area (North Cheshire, South Cheshire, and Wirral). A significant number of children had received their MMR vaccine but were not recorded as such by the Child Health Computer System (CHCS). Reported COVER (cover of vaccination evaluated rapidly) data uptake (combined) for North Cheshire, South Cheshire, and Wirral Health Authorities for the period covered by the data validation study was 90.5%, the corrected uptake following the validation was 92.6%, 2.1% higher than the reported coverage. If the coverage data were to continue to form part of the NHS indicators of PCT performance, action by all PCTs to improve accuracy of immunisation data would be highly desirable. Electronic transfer of information from practices to the CHCS and between CHCSs, i.e. across boundaries, could improve data accuracy.     

Preliminary evidence for in vivo tumour initiation by oral administration of extracts of the blue-green alga cylindrospermopsis raciborskii containing the toxin cylindrospermopsin

New reports indicate that the toxic alkaloid cylindrospermopsin occurs in cyanobacteria in Israel, Florida, South America, and Australia in drinking water sources. This toxin is now recognised as a potential threat to human health. Furthermore, we have recently demonstrated the mutagenicity of cylindrospermopsin in vitro in a human lymphoblastoid cell-line. Therefore it is essential to determine whether cylindrospermopsin is also carcinogenic in vivo. In this preliminary study, 53 mice were treated up to three times orally with Cylindrospermopsis raciborskii extract containing cylindrospermopsin, while 27 control mice were treated with saline. A proportion of each group were then given O-tetradecanoylphorbol 13-acetate (10 microg/mouse, twice weekly in liquid food) for the duration of the experiment; the remainder were given a control diet. After 30 weeks, the mice were euthanased and the major organs were examined histologically. Five tumours were found in 53 cylindrospermopsin-treated mice while none were found in the 27 controls. Although the number of animals used was too low to provide statistical significance (p=0.16), the calculated relative risk (RR=6.2; 95% CI: 0.33-117) indicates a potential biological and public health significance requiring further investigation. Estimates are given of the size of experiment required to provide statistical proof of cylindrospermopsin carcinogenicity.     

Cell-free protein synthesis inhibition assay for the cyanobacterial toxin cylindrospermopsin

The cyanobacterial toxin cylindrospermopsin (CYN) is known to be a potent inhibitor of protein synthesis. This paper describes the use of a rabbit reticulocyte lysate translation system as a protein synthesis inhibition assay for CYN. A dose response curve for protein synthesis inhibition by CYN was constructed and was modeled to a sigmoidal dose response curve with variable slope (R2 = 0.98). In this assay, CYN has an IC50 of 120 nM [95% confidence limits (Cl) = 111-130 nM] with a detection limit in the region of 50 nM in the assay solution. Application of the assay allows quantification of toxin samples within the range 0.5-3.0 microM (200-1200 micrograms/L) CYN. To assess the usefulness of this assay, a range of toxic and nontoxic Cylindrospermopsis raciborskii extracts, including both laboratory strains and environmental samples, were assayed by protein synthesis inhibition. These CYN quantifications were then compared to quantifications obtained by high performance liquid chromatography (HPLC) and HPLC-tandem mass spectrometry (HPLCMS-MS). The results demonstrate that the protein synthesis inhibition assay correlates well with both HPLCMS-MS (r2 = 0.99) and HPLC (r2 = 0.97) quantifications. We conclude that this is an accurate and rapid assay for the measurement of cylindrospermopsin in cyanobacterial extracts.