[Research progress in psychological factors in the diagnosis and treatment of temporomandibular joint disorders].

Temporomandibular disorders (TMD) is one of the most common diseases in the orofacial region. The occurrence, development and outcome of TMD are affected by many factors. Among various risk factors, the psychological factors, especially anxiety, depression and somatic symptoms, are getting more and more attention in the etiology, diagnosis and treatment of TMD. Psychological factors are associated with the occurrence of TMD, and the accurate diagnostic criteria is conducive to the assessment of the patient's psychological state. If necessary, an appropriate psychological treatment according to a patient's psychological status can effectively improve the effect of clinical treatment. This article, based on domestic and international literatures, reviews the research progress of the correlation between the psychological factors and the etiology, diagnosis and treatment of TMD, in order to provide new ideas for clinicians to diagnose and treat TMD.

[Effect of red blood cell transfusion on the oxygenation of mesenteric tissue in premature infants].

Objective: To investigate the effect of red blood cell transfusion on the oxygenation of mesenteric tissue in premature infants. Methods: In this prospective cohort study, preterm infants with gestational age <37 weeks who were treated with red blood cell transfusions were enrolled from June 2017 to March 2018 in Department of Neonatology, Children's Hospital of Fudan University. The infants were categorized into feeding intolerance group and feeding tolerance group according to the feeding intolerance standard. Near-infrared spectroscopy was applied to continuously monitor intestinal oxygen saturation from 2 h before red blood cell transfusion to 48 h after red blood cell transfusion. Intergroup differences of basic conditions were analyzed with t test, Mann-Whitney U test and χ(2) test. Mixed linear model was used to compare intragroup and intergroup differences in intestinal oxygen saturation over time. Results: A total of 73 cases with gestational age <37 weeks were enrolled, of whom 41 were males and 32 were females, with mean gestational age of (30±4)weeks and mean birth weight of (1 543±688)g; there were 33 cases in feeding intolerance group and 42 cases in feeding tolerance group. The average intestinal oxygen saturations at 2 h before blood transfusion, during blood transfusion, 2, 6, 12, 24, and 48 h after transfusion were 0.50±0.07, 0.52±0.07, 0.52±0.08, 0.51±0.08, 0.51±0.07, 0.51±0.08, and 0.51±0.07 respectively in feeding intolerance group and were 0.51±0.04, 0.55±0.04, 0.57±0.05, 0.57±0.04, 0.56±0.04, 0.56±0.04, and 0.56±0.05 respectively in feeding tolerance group. Compared with 2 h before transfusion, intestinal oxygen saturation were increased during transfusion in both group (feeding intolerance group t=4.992, P=0.000; feeding tolerance group t=9.615, P=0.000), however this effect lasted until 48 h after transfusion in feeding tolerance group (t=5.519, 12.409, 10.033, 9.133, 7.983, all P=0.000). Additionally, the increasement of intestinal oxygen saturation over time were lower in feeding intolerance group(F=8.876, P=0.000). Besides, the level of intestinal oxygen saturation was positively correlated with postmenstrual age (PMA)(F=4.863, P=0.031). In infants with PMA<30 weeks, particularly in feeding intolerance group, the level of intestinal oxygen saturation significantly decreased at 2 h after transfusion (t=23.063, P=0.002). Conclusions: Feeding status and PMA may play a role in development of transfusion-associated necrotizing enterocolitis. Red blood cell transfusion may increase the risk for mesenteric ischemia and is more likely to cause necrotizing enterocolitis in preterm infants with PMA <30 weeks as well as feeding intolerance. Clinical Trail: Children's Hospital of Fudan University, NCT02544100.

[Comparison of perioperative serum thrombomodulin levels in patients underwent off-pump coronary artery bypass grafting with and without cardiogenic shock].

Objective: To observe the perioperative changes of serum thrombomodulin in patients with and without cardiogenic shock undergoing off-pump coronary artery bypass grafting surgery. Methods: A total of 66 patients with coronary artery disease who underwent off-pump coronary artery bypass grafting surgery between June and December 2015 in our hospital were included in this study.The patients were divided into non-cardiogenic shock group (n=51) and shock group (n=15) according to the absence or presence of cardiogenic shock.The clinical data of the two groups were analyzed.Arterial blood samples were collected immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery.The levels of serum thrombomodulin were tested with enzyme-linked immunosorbent assay. Results: (1)The prevalence of diabetes was significantly higher (64.7%(33/51) vs. 20.0%(3/15), P<0.01), while prevalence of myocardial infarction was significantly lower (41.2%(21/51)vs. 100%(15/15), P<0.01) in non-cardiogenic shock group than in cardiogenic shock group.(2)The peak plasma creatinine level, troponin I level and creatine kinase MB level were significantly lower in the non-cardiogenic shock group than in the cardiogenic shock group ((88.5±36.7) µmol/L vs. (122.6±71.1) µmol/L, 1.3(0.2, 2.7) µg/L vs. 16.4(5.8, 23.4) µg/L and (18.8±4.7) µg/L vs.(49.3±15.9) µg/L, respectively, all P<0.05). (3)Mechanical ventilation time was significantly longer (11.5 (9.0, 18.0) hours vs. 20.0 (8.5, 82.5) hours, P=0.02), and frequency of intra-aortic balloon pump use (0 vs. 100%, P<0.01) was significantly higher in the cardiogenic shock group than in the non-cardiogenic shock group.(4) Prevalence of atrial fibrillation (5.9%(3/51) vs. 80.0%(12/15)) and myocardial infarction (19.6%(10/51)vs. 93.3%(14/15)) that occurred during and after surgery was significantly lower in the non-cardiogenic shock group than in the shock group(all P<0.01). (5)The serum thrombomodulin concentration was similar among various time point in the non-cardiogenic shock group: 3.30(2.68, 7.44), 4.09(2.95, 7.18), 4.35(2.68, 8.22), 3.50(2.95, 8.00), 3.41(2.60, 5.97), 3.30(2.65, 5.42)and 3.94(2.82, 5.60) µg/L, taken immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery respectively, and was 2.44(1.97, 2.67), 2.21(1.93, 2.83), 2.64(2.29, 2.67), 2.84(2.26, 2.94), 3.35(2.43, 4.05), 2.76(2.73, 2.97) and 3.81(2.96, 5.96)µg/L respectively, in the cardiac shock group (all P>0.05). The serum thrombomodulin levels at 4 and 8 hours after surgery were higher in the non-cardiogenic shock group than cardiogenic shock group(all P<0.05). Conclusion: Compared with the non-cardiogenic shock group, the peak serum thrombomodulin level appears later and recovers slower in cardiogenic shock patients who underwent off-pump coronary artery bypass grafting surgery.

Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope.

BACKGROUND: Outbreaks of urinary tract infections (UTIs) due to contaminated ureteroscopes have been rarely reported. AIM: To report such an outbreak at a regional teaching hospital in southern Taiwan. METHODS: From October to December 2010, ertapenem-resistant Enterobacter cloacae were identified from urine cultures of 15 patients who had undergone ureteroscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods. Polymerase chain reaction and sequencing were used to analyse ß-lactamase genes. FINDINGS: A total of 70 specimens were obtained during the first surveillance operation. One ertapenem-resistant E. cloacae was isolated from a ureteroscope. Although the disinfection protocols for ureteroscopes were revised and implemented, seven additional UTI cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the ureteroscope shared a common pattern with minor variance. Most isolates were resistant to gentamicin, levofloxacin, ceftriaxone, ceftazidime, and ertapenem. All isolates were susceptible to amikacin, imipenem, and meropenem. SHV-12 and IMP-8 genes were simultaneously identified in 16 of the 18 isolates. CONCLUSION: The outbreak of ertapenem-resistant E. cloacae was caused by a contaminated ureteroscope and was terminated by the implementation of a revised disinfection protocol for ureteroscopes.

Kinase expression and chromosomal rearrangements in papillary thyroid cancer tissues: investigations at the molecular and microscopic levels.

Structural chromosome aberrations are known hallmarks of many solid tumors. In the papillary form of thyroid cancer (PTC), for example, activation of the receptor tyrosine kinase (RTK) genes, ret or the neurotrophic tyrosine kinase receptor type I (NTRK1) by intra- or interchromosomal rearrangements have been suggested as a cause of the disease. The 1986 accident at the nuclear power plant in Chernobyl, Ukraine, led to the uncontrolled release of high levels of radioisotopes. Ten years later, the incidence of childhood papillary thyroid cancer (chPTC) near Chernobyl had risen by two orders of magnitude. Tumors removed from some of these patients showed aberrant expression of the ret RTK gene due to a ret/PTC1 or ret/PTC3 rearrangement involving chromosome 10. However, many cultured chPTC cells show a normal G-banded karyotype and no ret rearrangement. We hypothesize that the "ret-negative" tumors inappropriately express a different oncogene or have lost function of a tumor suppressor as a result of chromosomal rearrangements, and decided to apply molecular and cytogenetic methods to search for potentially oncogenic chromosomal rearrangements in Chernobyl chPTC cases. Knowledge of the kind of genetic alterations may facilitate the early detection and staging of chPTC as well as provide guidance for therapeutic intervention.

Molecular cytogenetic characterization of chromosome 9-derived material in a human thyroid cancer cell line.

The incidence of papillary thyroid carcinoma (PTC) increases significantly after exposure of the head and neck region to ionizing radiation, yet we know neither the steps involved in malignant transformation of thyroid epithelium nor the specific carcinogenic mode of action of radiation. Such increased tumor frequency became most evident in children after the 1986 nuclear accident in Chernobyl, Ukraine. In the eight years following the accident, the average incidence of childhood PTCs (chPTC) increased 70-fold in Belarus, 200-fold in Gomel, 10-fold in the Ukraine and 50-fold in Tschnigov, Kiev, Rovno, Shitomyr and Tscherkassy compared to the rate of about 1 tumor incidence per 106 children per year prior to 1986 (Likhtarev et al., 1995; Sobolev et al., 1997; Jacob et al., 1998). To study the etiology of radiation-induced thyroid cancer, we formed an international consortium to investigate chromosomal changes and altered gene expression in cases of post-Chernobyl chPTC. Our approach is based on karyotyping of primary cultures established from chPTC specimens, establishment of cell lines and studies of genotype-phenotype relationships through high resolution chromosome analysis, DNA/cDNA micro-array studies, and mouse xenografts that test for tumorigenicity. Here, we report the application of fluorescence in situ hybridization (FISH)-based techniques for the molecular cytogenetic characterization of a highly tumorigenic chPTC cell line, S48TK, and its subclones. Using chromosome 9 rearrangements as an example, we describe a new approach termed 'BAC-FISH' to rapidly delineate chromosomal breakpoints, an important step towards a better understanding of the formation of translocations and their functional consequences.

In vitro susceptibility testing of amorolfine in pathogenic fungi isolated from dermatomycosis patients in China.

The antifungal susceptibility of isolates from Chinese dermatomycosis patients to amorolfine was investigated following National Committee for Clinical Laboratory Standards (NCCLS) protocols. In total, 383 isolates were tested, including 132 strains from tinea pedis, 148 strains from tinea corporis/cruris, and 103 strains from onychomycosis. The minimum inhibitory concentration (MIC) of amorolfine against dermatophytes ranged from 0.01 to 0.08 microg ml(-1). The MIC(50) and MIC(90) of amorolfine for Trichophyton rubrum were both equal to 0.04 micro ml(-1); for T. mentagrophytes these MICs were 0.04 microg ml(-1) and 0.08 microg ml(-1) respectively; and for Epidermophyton floccosum they were 0.02 microg ml(-1) and 0.04 microg ml(-1) respectively. The MIC range of amorolfine against Candida parapsilosis was 0.5-16 microg ml(-1). MIC(50) and MIC(90) for C. parapsilosis were 0.5 and 2 microg ml(-1). MIC ranges of amorolfine against Scopulariopsis spp. and Acremonium spp. were 0.5-4 and 2-8 microg ml(-1), respectively. Candida albicans, Fusarium solani and Aspergillus flavus required relatively higher concentrations of amorolfine to inhibit their growth (MIC 0.125-64 microg ml(-1), MIC(50) and MIC(90) were 4 and 64 microg ml(-1)). The results demonstrated that amorolfine is the only topical agent that has such a potent antifungal activity and a broad spectrum against a wide range of pathogenic fungi.

In vitro anti-inflammatory effects of quercetin 3-O-methyl ether and other constituents from Rhamnus species.

The anti-inflammatory activities of the isolated flavonoids, quercetin 3-O-methyl ether (1), kaempferol (2), and quercetin (3), of Rhamnus nakaharai, and anthraquinone, frangulin B (4), of Rhamnus formosana, were assessed in vitro by determining their inhibitory effects on the chemical mediators released from mast cells, neutrophils, macrophages, and microglial cells. Compounds 1 - 3 strongly inhibited the release of beta-glucuronidase and lysozyme from rat neutrophils stimulated with formyl-Met-Leu-Phe/cytochalasin B (fMLP/CB). Compound 1 strongly inhibited superoxide anion formation in fMLP/CB or phorbol 12-myristate 13-acetate (PMA)-stimulated rat neutrophils. Compound 1 exhibited potent inhibitory effect on tumor-necrosis factor-alpha ( TNF-alpha) formation in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells while 1 and 4 showed potent inhibitory effects on TNF-alpha formation in LPS/IFN-gamma (interferon-gamma)-stimulated murine microglial cell lines N9.

Obesity and renal cell cancer--a quantitative review.

Obesity has been associated with an increased risk of renal cell cancer among women, while the evidence for men is considered weaker. We conducted a quantitative summary analysis to evaluate the existing evidence that obesity increases the risk of renal cell cancer both among men and women. We identified all studies examining body weight in relation to kidney cancer, available in MEDLINE from 1966 to 1998. The quantitative summary analysis was limited to studies assessing obesity as body mass index (BMI, kg m(-2)), or equivalent. The risk estimates and the confidence intervals were extracted from the individual studies, and a mixed effect weighted regression model was used. We identified 22 unique studies on each sex, and the quantitative analysis included 14 studies on men and women, respectively. The summary relative risk estimate was 1.07 (95% CI 1.05-1.09) per unit of increase in BMI (corresponding to 3 kg body weight increase for a subject of average height). We found no evidence of effect modification by sex. Our quantitative summary shows that increased BMI is equally strongly associated with an increased risk of renal cell cancer among men and women.

DNA microarray reveals changes in gene expression of shear stressed human umbilical vein endothelial cells.

Using DNA microarray screening (GeneFilter 211, Research Genetics, Huntsville, AL) of mRNA from primary human umbilical vein endothelial cells (HUVEC), we identified 52 genes with significantly altered expression under shear stress [25 dynes/cm(2) for 6 or 24 h (1 dyne = 10 microN), compared with matched stationary controls]; including several genes not heretofore recognized to be shear stress responsive. We examined mRNA expression of nine genes by Northern blot analysis, which confirmed the results obtained on DNA microarrays. Thirty-two genes were up-regulated (by more than 2-fold), the most enhanced being cytochromes P450 1A1 and 1B1, zinc finger protein EZF/GKLF, glucocorticoid-induced leucine zipper protein, argininosuccinate synthase, and human prostaglandin transporter. Most dramatically decreased (by more than 2-fold) were connective tissue growth factor, endothelin-1, monocyte chemotactic protein-1, and spermidine/spermine N1-acetyltransferase. The changes observed suggest several potential mechanisms for increased NO production under shear stress in endothelial cells.

[Relationship between TT virus infection and hepatocellular carcinoma].

OBJECTIVE: To clarify the relationship between TT virus (TTV) infection and the development of hepatocellular carcinoma (HCC). METHODS: TTV was examined in sera of 112 patients with HCC and 95 patients with chronic liver disease (CLD) without HCC. 30 patients without liver disease were examined as control. TTV DNA was detected by the second generation of TTV PCR primers (NG059, NG061 and NG063) after extraction of DNA from 50 microliters serum. The relationship between TTV infection and clinical features of each group patients was analyzed. RESULTS: TTV DNA was detected in 17.86% (20/112) of HCC patients, and this prevalence in HCC patients was not significantly higher than that of TTV DNA in CLD patients (15.78%, 15/95). There were no significant differences in age, gender, tumor factors (size, TNM classification and markers) and other hepatitis virus markers between TTV-positive and TTV-negative in HCC and CLD patients, except history of blood transfusion [(80.00% vs 35.87% (P < 0.05) in HCC patients and 73.33% vs 27.50% (P < 0.05) in CLD patients)] and ALT [(93 +/- 27) IU/L vs (68 +/- 31) IU/L (P < 0.05) in HCC patients]. It seemed that TTV did not do any harm to the liver function of patients who infected with HBV or HCV, except for elevating ALT level in such a kind of HCC patients. CONCLUSION: Although TTV could do harm to the liver function of HCC patients, it does not contribute to the development of HCC from CLD.

A new acylated flavonol glycoside and antioxidant effects of Hedyotis diffusa.

A study on the bioactive principles of Hedyotis diffusa Willd., led to the isolation of a new acyl flavonol di-glycoside which was characterized as kaempferol 3-O[2"-O-(E-6'"-O-feruloyl)-beta-D-glucopyranosyl]-beta-D-galactop yranoside by spectral and chemical methods from the methanolic extract. In addition, three known flavonol glycosides and six known iridoid glycosides were also obtained. The above-mentioned glycosides were tested for antioxidant effects on xanthine oxidase inhibition, xanthine-xanthine oxidase cytochrome c and TBA-MDA systems.

Acute toxicity of excess mercury on the photosynthetic performance of cyanobacterium, S. platensis--assessment by chlorophyll fluorescence analysis.

Measurement of chlorophyll fluorescence has been shown to be a rapid, non-invasive, and reliable method to assess photosynthetic performance in a changing environment. In this study, acute toxicity of excess Hg on the photosynthetic performance of the cyanobacterium S. platensis, was investigated by use of chlorophyll fluorescence analysis after cells were exposed to excess Hg (up to 20 microM) for 2 h. The results determined from the fast fluorescence kinetics showed that Hg induced a significant increase in the proportion of the Q(B)-non-reducing PSII reaction centers. The fluorescence parameters measured under the steady state of photosynthesis demonstrated that the increase of Hg concentration led to a decrease in the maximal efficiency of PSII photochemistry, the efficiency of excitation energy capture by the open PSII reaction centers, and the quantum yield of PSII electron transport. Mercury also resulted in a decrease in the coefficients of photochemical and non-photochemical quenching. Mercury may have an acute toxicity on cyanobacteria by inhibiting the quantum yield of photosynthesis sensitively and rapidly. Such changes occurred before any other visible damages that may be evaluated by other conventional measurements. Our results also demonstrated that chlorophyll fluorescence analysis can be used as a useful physiological tool to assess early stages of change in photosynthetic performance of algae in response to heavy metal pollution.

Prediction of biochemical relapse for stage pT3 prostate cancer following radical prostatectomy.

BACKGROUND: Approximately 30% to 50% of clinically localized prostate cancers are found to be locally advanced after radical prostatectomy. Without adjuvant therapy, more than 30% of stage pT3 patients will have biochemical failure in a median follow-up of three years. Whether adjuvant therapy should be given remains controversial. Identification of prognostic indicators may be helpful to select patients at risk of biochemical failure for postoperative adjuvant therapy. METHODS: The medical records of 22 pT3 prostate cancer patients were analyzed retrospectively. Postoperative management included surveillance (7 patients), adjuvant hormone therapy (7) and radiotherapy (8). Patients were monitored every three months using serum prostate-specific antigen (PSA). Biochemical failure was defined as an elevation in PSA of more than 0.2 ng/ml. The clinical outcome was correlated with tumor grading, pathologic staging, preoperative PSA level, and p53 and bcl-2 status. RESULTS: Five patients (23%) experienced biochemical relapse within a median follow-up time of 52 months (range, 10-71 months). A Gleason score of 8 or more (p = 0.001) and seminal vesicle involvement (p = 0.014) were significant prognostic indicators in the univariate analysis. Patients with low preoperative PSA levels (< 20 ng/ml) had a significantly higher failure rate (p = 0.031). However, most of these patients (56%) had tumors with Gleason scores of 8 or more. Neither p53 gene mutation nor bcl-2 overexpression predicted PSA failure. Postoperative adjuvant therapy did not appear to reduce the risk of disease recurrence. In multivariate analysis, the Gleason score was the only significant factor predicting biochemical failure (p = 0.017). CONCLUSIONS: Patients with poorly differentiated tumors and/or seminal vesicle invasiveness are at higher risk of biochemical failure after radical prostatectomy. Our limited experience did not support the routine application of adjuvant therapy for this subgroup of patients. A larger sample size with a longer follow-up period is necessary to reach a definitive conclusion.

Duration of gestation and prostate cancer risk in offspring.

This large population-based nested case-control study investigated the importance of perinatal characteristics as risk factors for prostate cancer in later life in a cohort of men who were born between 1889 and 1941 in Stockholm, Sweden. Eight hundred and thirty-four prostate cancer cases over 18 years of age and of singleton birth were identified from the cohort between 1958 and 1994. For each case, singleton males born live to the first four mothers admitted after the case's mother were selected as potential controls; 1880 eligible controls were included in the study. For each study subject, we obtained data on mother's parity, pre-eclampsia or eclampsia before delivery, age at delivery, and socioeconomic status, as well as child's birth length and weight, placental weight, and gestational age. Odds ratio (OR) estimates and 95% confidence intervals (CIs) were derived from logistic regression analyses. We found no statistically significant differences between cases and controls with respect to maternal age, socioeconomic status, or parity. Birth weight, birth length, and placental weight were also not significantly related to prostate cancer risk. Pregnancy toxemia (OR = 0.33; 95% CI, 0.07-1.45) and longer gestation age were associated with a reduced risk of prostate cancer; the OR estimate was 0.94 (95% CI, 0.89-0.99) for each 1-week prolongation of the duration of gestation. Our results suggest that birth size indicators are not important risk factors for prostate cancer in later life. In addition, our data on gestation age indicate that the late in utero environment may be as important as the early in utero environment in the modulation of prostate cancer risk in offspring.

Tea consumption: fluid intake and bladder cancer risk in Southern Taiwan.

OBJECTIVES: To determine whether tea consumption and intake of other beverages increases bladder cancer risk. METHODS: A case-control study was conducted in Kaohsiung, Taiwan between August 1996 and June 1997. Index patients studied were consecutive patients with histologically confirmed, newly diagnosed bladder cancer in two major hospitals. For each patient, 4 controls were selected from patients with non-neoplastic and nonurologic diseases undergoing surgical operations in the same hospital and individually matched by sex, age, and date of admission. Using a structured questionnaire, a trained interviewer interviewed 40 patients and 160 controls. Conditional logistic regression analysis adjusting for ethnicity, family history, and smoking status and matching variables were used to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: Tea consumption overall was associated with increased bladder cancer risk (OR 3.29, 95% CI 1.34 to 8.05). Compared with non-tea drinkers, the odds ratios of bladder cancer for oolong tea drinkers was 3.00 (95% CI 1.20 to 7.47); for non-oolong tea drinkers (black and/or other green tea), it was 14.86 (95% CI 2.13 to 103.83). The risk was greater among those who began to drink tea before age 40 (OR 9.50, 95% CI 2.39 to 37.75) and those who had been drinking tea for more than 30 years (OR 17.75, 95% CI 3.00 to 105.17). Coffee, tap water, and alcohol consumption were associated with a slightly increased risk, and both soy juice and rice juice consumption were associated with reduced risk; none of these odds ratio estimates were statistically significant, however. CONCLUSIONS: Our results suggest that tea consumption is associated with an increased risk of bladder cancer.

Management of stage pTxN+ adenocarcinoma of the prostate: influence of radical prostatectomy on progression-free interval.

BACKGROUND: Whether stage pN+ prostate cancer patients will benefit from radical prostatectomy remains a controversial issue. We assess the impact of radical prostatectomy on a progression-free interval for patients with stage pN+ prostate cancer. METHODS: From October 1990 to June 1997, 25 patients were diagnosed with stage pTxN+ adenocarcinoma of the prostate in our institute. Ten of these patients were treated with radical retropubic prostatectomy (RRP) due to false-negative frozen sections at staging pelvic lymphadenectomy. In 15 patients, radical surgery was discontinued because of grossly enlarged lymph nodes and/or positive frozen section results during staging pelvic lymph node dissection (PLND). All patients received immediate androgen ablation therapy with or without radiotherapy. Serum prostate-specific antigen (PSA) was regularly monitored in all patients. RESULTS: During a median follow-up period of 33 months (range, 15-89 months), eight patients (53%) in the PLND group and two (20%) in the RRP group experienced disease progression as defined by significant elevation of serum PSA concentrations. The median progression-free intervals were 46 and 51 months, respectively. Both univariate and multivariate analyses failed to show statistically significant differences in the progression-free survival between the RRP and PLND groups. CONCLUSIONS: Based on our limited experience, surgical removal of the primary tumor may have only a marginal effect in terms of the progression-free interval for prostatic cancer patients with metastasized pelvic lymph nodes (p = 0.124, log-rank test). The follow-up period was not long enough to evaluate the difference in cancer-specific survival.

Changes and implications of blood flow velocity of the vertebral artery during rotation and extension of the head.

OBJECTIVE: To study the effects of extension and extension-rotation of the head on the blood flow velocity of the vertebral artery experimentally and clinically. DESIGN: Randomized experimental clinical study. SETTING: Institute of Clinical Anatomy and Biomechanics and the Department of Ultrasound, NanFang Hospital of the First Military Medical University, Guangzhou, China. SUBJECTS: The fresh spines from T1-2 to the occipital bone were obtained from persons who died of acute brain death (n = 10). For the transcranial Doppler measurement, 27 asymptomatic subjects with routine physical examination results and 23 students from the above-mentioned university took part in the test. INTERVENTIONS: The instillation experiment in the cadavers was made. Clinical measurements of blood flow velocity in the vertebral artery in the subjects and students were taken and recorded. MAIN OUTCOME MEASURES: Changes in the drop of the vertebral artery were measured by the instillation test in the experimental sample. The blood flow velocity was measured with transcranial Doppler sonography during extension and extension-rotation of the head. RESULTS: During one-sided rotation of the head with extension of the head, measurements in the contralateral vertebral artery and the bilateral vertebral arteries were both reduced in the instillation experiment. The blood flow velocity in the bilateral vertebral arteries decreased during extension and extension-rotation of the head in the subjects and the students. The pulsatility index in the right vertebral arteries increased more than that in the left in extreme extension and that in the bilateral vertebral arteries in neutral position. CONCLUSIONS: Extreme rotation and extension are dangerous to patients who have abnormal vertebral arteries when extreme rotatory and extension manipulations are applied. Doctors should be very careful when rotating the patient's head to the right side.

Isolation of a human-brain sodium-channel gene encoding two isoforms of the subtype III alpha-subunit.

Voltage-gated sodium channels are members of a multigene family of transmembrane proteins that are important determinants of electrical excitability in cell membranes. These proteins are typically composed of a large alpha-subunit and one or two beta-subunits. The primary structure of alpha-subunits is highly conserved among different subtypes and different species. Based on the conserved sequences and application of the rapid amplification of cDNA ends (RACE) reaction, we have isolated three overlapping clones from human brain. These sequences share highest homology (89%) to the rat brain subtype III gene and cover a 4.2-kb expanse of the transcript. The 5'-most clone has a translation start site located in the same region as other mammalian brain sodium channel genes. A 92-nucleotide insert was found in domain I at a location previously demarcated by published splice sites in rat brain sodium channels IIN/IIA and IIIN/IIIA. It is most likely that this transcript represents the two isoforms (neonatal and adult) of the human brain sodium channel gene, SCN3A (GenBank accession numbers AF035685 and AF035686). As is the case for rat brain sodium channels IIN/IIA and IIIN/IIIA, these isoforms are generated through an alternative splicing mechanism. The conservation of the exon structure suggests that alternative RNA splicing is a common feature for sodium channel mRNA processing and may play an important role in modulating the channel function.

Multifocal retroperitoneal malignant fibrous histiocytoma: a case report.

This report concerns a 67-year-old male with malignant fibrous histiocytoma arising from the psoas muscle and perirenal soft tissue. The tumor was considered a mesenchymal neoplasm. These are generally clinically and radiologically indistinguishable from other retroperitoneal tumors. This patient received en bloc resection of the retroperitoneal tumor and radical nephrectomy without adjuvant therapy. He underwent excision of a retroperitoneal cystic mass complicated with lymph leakage one year postoperatively. Discharged in a stable condition after one week of total parenteral nutrition, the patient remains disease-free 16 months postoperatively.