Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.     

All is Not Lost: Utilizing Continuous Remote ILR Monitoring to Diagnose Syncope

A 63‐year‐old man with frequent unexplained syncope was implanted with a second generation remotely monitored implantable loop recorder for continuous electrocardiogram (ECG) monitoring. He had a subsequent syncopal episode and despite accidental destruction of his patient activator, vital ECG data from the event were transmitted wirelessly, enabling a cardiac arrhythmia to be excluded. This case highlights the benefit of remote monitoring in syncope assessment, as well as a transmission system that ensures prompt analysis of the ECG data and therefore rapid optimal patient management. (PACE 2010; 33:763–765)     

Initial induction of immunity, followed by suppression of responses to parasite antigens during Trypanosoma cruzi infection of mice

Infection of a relatively resistant strain of mice (C57BL/6J) with the protozoan parasite Trypanosoma cruzi results in both the induction of parasite-specific T-helper cells and nonspecific suppressor cells. A time course study of the activation of help and suppression revealed that parasite-specific T-helper cell activity increases very early in infection (less than 12 days) at a time when suppression of non-parasite-specific responses and suppressor cell activity is increasing. Between 12 and 14 days of infection, the T-helper cell response to T. cruzi, as measured by the antibody response to hapten-T. cruzi in vitro, is suddenly and dramatically regulated. As reported previously, plastic and G-10 adherent cells appear to be responsible for the regulation of antibody responses to heterologous antigen during T. cruzi infection. These adherent suppressor cells are also responsible for the suppression of antibody responses to hapten-T. cruzi following the first 2 weeks of infection. Suppressor cells continue to regulate the parasite-specific response well into chronic infection even though the response to hapten-T. cruzi appears to return to normal levels. These results are the first to directly implicate nonspecific suppressor cells in the regulation of anti-T. cruzi humoral immune responses.     

The relative contribution of antibody production and CD8+ T cell function to immune control of Trypanosoma cruzi

The life cycle of the protozoan parasite Trypanosoma cruzi in mammalian hosts includes both non-dividing trypomastigote forms which circulate in the blood and replicating intracellular amastigotes which reside within the cytoplasm of a variety of host cells. In this study we have used mice with induced mutations in genes responsible for either antibody production or cytolytic T lymphocyte (CTL) function to examine the relative contributions of these effector mechanisms to control of T. cruzi. Mice deficient in the production of antibodies exhibited a delay in the rise in acute phase parasitaemia and an extended time to death relative to mice lacking CD8⁺ T cells. Nevertheless, B cell deficient mice eventually succumbed to the infection. Prior infection with an avirulent strain of T. cruzi failed to protect either CD8⁺ T cell-deficient mice or B cell deficient mice from challenge infection with virulent parasites. In contrast, mice with disruptions in the genes controlling perforin- or granzyme B-mediated cytolytic pathways had parasitaemia and mortality rates similar to wild-type mice and were protected from secondary infection by prior exposure to avirulent parasites. These results 1) confirm that antibody production, although secondary in importance to cellular responses, is nevertheless absolutely required and 2) perforin- or granzyme B-mediated lytic pathways are not required for control of T. cruzi infection.     

On the Ca2+-permeability of neurons and glia

Fractions enriched in pinched-off nerve terminals and astrocytic glial cells were used to analyse the permeability of Ca⁺⁺of the two membranes. Three experimental models were used to illustrate a principle difference of the excitatory versus the non-excitatory cell membrane, with respect to Ca-permeability. The effect of an increased [Ca⁺⁺] on ⁸⁶Rb⁺and ³H-GABA transport was measured in medium containing low and high [K⁺]. The possibility of GABA stimulation of release of preaccumulated ⁴⁵Ca⁺⁺with low and high [K⁺] was compared in neurons and glia. Finally, the effect of depolarizing [K⁺] on the transmembranal Ca⁺⁺-gradient was measured by comparing the efficacy of the Ca-ionophore A23187 to depolarize or to inhibit the ³H-GABA uptake at these different [K⁺]. The data essentially confirms the picture of a potential dependent Ca⁺⁺-permeability in the neuron, while the permeability of the glial cells seems a “true” constant. It might be relevant to suggest the astrocyte a role as a “Ca-buffer” with possibilities to control extracellular Ca⁺⁺in cases of hyperactivity, this in analogy with what has been suggested for K⁺.