Correlation of HOXD3 promoter hypermethylation with clinical and pathologic features in screening prostate biopsies.

BACKGROUND: Molecular markers that can discriminate indolent cancers from aggressive ones may improve the management of prostate cancer and minimize unnecessary treatment.Aberrant DNA methylation is a common epigenetic event in cancers and HOXD3 promoter hypermethylation (H3PH) has been found in prostate cancer. Our objective was to evaluate the relationship between H3PH and clinicopathologic features in screening prostate biopsies. METHODS: Ninety-two patients who underwent a prostate biopsy at our institution between October 2011 and May 2012 were included in this study. The core with the greatest percentage of the highest grade disease was analyzed for H3PH by methylation-specific PCR. Correlational analysis was used to analyze the relationship between H3PH and various clinical parameters. Chi-square analysis was used to compare H3PH status between benign and malignant disease. RESULTS: Of the 80 biopsies with HOXD3 methylation status assessable, 66 sets were confirmed to have cancer. In the 14 biopsies with benign disease there was minimal H3PH with the mean percentage of methylation reference (PMR) of 0.7%. In contrast, the HOXD3 promoter was hypermethylated in 16.7% of all cancers and in 50% of high risk tumors with an average PMR of 4.3% (P=0.008). H3PH was significantly correlated with age (P=0.013), Gleason score (P=0.031) and the maximum involvement of the biopsy core (P=0.035). CONCLUSIONS: H3PH is associated with clinicopathologic features. The data indicate that H3PH is more common in older higher risk patients. More research is needed to determine the role of this marker in optimizing management strategies in men with newly diagnosed prostate cancer.

Single-lung ventilation in a pediatric patient using a pediatric fibreoptically-directed wire-guided endobronchial blocker.

PURPOSE: The pediatric wire-guided endobronchial blocker is a new device for single-lung ventilation through small diameter endotracheal tubes. In this case report we will discuss the use of this blocker in a pediatric patient. CLINICAL FEATURES: We successfully placed the pediatric wire-guided endobronchial blocker in a 14-yr-old patient who underwent an aortic coarctation repair. The blocker is a 5-French 70 cm double-lumen catheter. One lumen contains an adjustable wire loop. The other lumen inflates a spherical low pressure, high volume balloon. Through a special bronchoscopy port, the blocker and bronchoscope were placed into a 7.0 cuffed endotracheal tube, the bronchoscope passed through the wire loop of the blocker and advanced towards the left mainstem bronchus. Then the blocker was advanced over the bronchoscope and positioned in the left mainstem bronchus. The balloon was slowly inflated under direct vision and the bronchoscope removed. During the case, single lung ventilation was achieved by inflating the balloon, thus collapsing the lung. At the end of the case, the lung was reinflated by deflating the balloon and the blocker was removed without difficulty. The patient tolerated the procedure well and had an uneventful postoperative course. CONCLUSION: Because of the endobronchial blocker's small diameter, this device can be used in a small endotracheal tube without sacrificing the inner diameter (ID) cross sectional area. Therefore, the patient is ventilated through a conventional endotracheal tube with a larger ID compared to the ID of a double-lumen endotracheal tube.