RESUMEN
Methane is an end product of ruminal fermentation that is energetically wasteful and contributes to global climate change. Bromoethanesulfonate, animal-vegetable fat, and monensin were compared with a control treatment to suppress different functional groups of ruminal prokaryotes in the presence or absence of protozoa to evaluate changes in fermentation, digestibility, and microbial N outflow. Four dual-flow continuous culture fermenter systems were used in 4 periods in a 4 x 4 Latin square design split into 2 subperiods. In subperiod 1, a multistage filter system (50-microm smallest pore size) retained most protozoa. At the start of subperiod 2, conventional filters (300-microm pore size) were substituted to efflux protozoa via filtrate pumps over 3 d; after a further 7 d of adaptation, the fermenters were sampled for 3 d. Treatments were retained during both subperiods. Flow of total N and digestibilities of NDF and OM were 18, 16, and 9% higher, respectively, for the defaunated subperiod but were not different among treatments. Ammonia concentration was 33% higher in the faunated fermenters but was not affected by treatment. Defaunation increased the flow of nonammonia N and bacterial N from the fermenters. Protozoal counts were not different among treatments, but bromoethanesulfonate increased the generation time from 43.2 to 55.6 h. Methanogenesis was unaffected by defaunation but tended to be increased by unsaturated fat. Defaunation did not affect total volatile fatty acid production but decreased the acetate:propionate ratio; monensin increased production of isovalerate and valerate. Biohydrogenation of unsaturated fatty acids was impaired in the defaunated fermenters because effluent flows of oleic, linoleic, and linolenic acids were 60, 77, and 69% higher, and the ratio of vaccenic acid:unsaturated FA ratio was decreased by 34% in the effluent. This ratio was increased in both subperiods with the added fat diet, indicating an accumulation of intermediates of biohydrogenation. However, the flow of 18:2 conjugated linoleic acid was unaffected by defaunation or by treatments other than added fat. The flows of trans-10, trans-11, and total trans-18:1 fatty acids were not affected by monensin or faunation status.
Asunto(s)
Alcanosulfonatos/farmacología , Grasas Insaturadas en la Dieta/metabolismo , Eucariontes , Fermentación/efectos de los fármacos , Hidrocarburos Bromados/farmacología , Monensina/farmacología , Biosíntesis de Proteínas/efectos de los fármacos , Rumen , Amoníaco/análisis , Animales , Antiinfecciosos/farmacología , Antiprotozoarios/farmacología , Bacterias/efectos de los fármacos , Bacterias/metabolismo , Bovinos , Técnicas de Cultivo , Eucariontes/efectos de los fármacos , Eucariontes/metabolismo , Eucariontes/fisiología , Ácidos Grasos Volátiles/análisis , Femenino , Contenido Digestivo/química , Hidrogenación/efectos de los fármacos , Metano/metabolismo , Nitrógeno/análisis , Nitrógeno/metabolismo , Rumen/metabolismo , Rumen/parasitologíaRESUMEN
Methionine supplemented as 2-hydroxy-4-(methylthio)-butanoic acid (HMB) has been suggested to alter bacterial or protozoal populations in the rumen. Our objective was to determine if source of Met would change microbial populations in the rumen and to compare those results to samples from the omasum. The ruminal and omasal samples were collected from cows fed control (no Met), dl-Met, HMB, or the isopropyl ester of HMB (HMBi; estimated 50% rumen protection) in a replicated 4 x 4 Latin square design. In one square, changes in protozoal populations were determined using microscopic counts and denaturing gradient gel electrophoresis (DGGE), whereas changes in bacterial populations were determined using DGGE and ribosomal intergenic spacer length polymorphism (RIS-LP). Neither the protozoal counts nor the DGGE banding patterns derived from protozoa were different among the dietary treatments or for ruminal vs. omasal samples. As revealed by both DGGE and RIS-LP, bacterial populations clustered by treatments in ruminal and especially in omasal samples. Using cows from both Latin squares, the flow of protozoal cells from the rumen was quantified by multiplying protozoal cell count in omasal fluid by the omasal fluid flow (using CoEDTA as a liquid flow marker) or was estimated by rumen pool size of cells multiplied by either the ruminal dilution rate of CoEDTA (after termination of CoEDTA dosing) or the passage rate of Yb-marked particles. Compared with the omasal fluid flow measurement (16.4 h), protozoal generation time was approximated much more closely using the particulate than the fluid passage rate from the rumen (generation times of 15.7 and 7.5 h, respectively). There seems to be minimal selective retention of protozoal genera in the rumen in dairy cattle fed every 2 h. Data support the validity of the omasal sampling technique under our conditions.
Asunto(s)
Bacterias/crecimiento & desarrollo , Bovinos , Eucariontes/crecimiento & desarrollo , Metionina/administración & dosificación , Rumen/microbiología , Rumen/parasitología , Animales , Bacterias/genética , Bovinos/microbiología , Bovinos/parasitología , ADN Bacteriano/análisis , Dieta , Suplementos Dietéticos , Duodeno/microbiología , Duodeno/parasitología , Electroforesis , Femenino , Concentración de Iones de Hidrógeno , Lactobacillus/genética , Lactobacillus/crecimiento & desarrollo , Metionina/análogos & derivados , Omaso/microbiología , Omaso/parasitologíaRESUMEN
The esterification of 2-hydroxy-4-(methylthio)-butanoic acid (HMB) to isopropanol (HMBi) decreases the rate and extent of its ruminal breakdown. The modes of action of HMB and HMBi appear to be different. The quantification of the production response to HMBi has not been done. The objectives of this study were (1) to determine the lactation response to HMB, (2) to determine the lactation response to HMBi, and (3) to evaluate whether the response to HMBi is affected by HMB in the diet. Sixty-one Holstein cows (24 primiparous, 37 multiparous) were assigned to 1 of 4 dietary treatments 21 to 28 d after calving. The base diet consisted of [on a dry matter (DM) basis] 32.5% corn silage, 17.5% alfalfa hay, 10% whole cottonseed, and 40% of a pelleted concentrate made primarily of ground corn, soybean meal, and blood meal, and was fed for 16 wk as a control diet. To prepare the dietary treatments, the base diet was supplemented with 0.1% of diet DM with HMB (treatment 2), with 0.15% HMBi (treatment 3), or with 0.045% HMB and 0.15% HMBi (treatment 4). Results showed a significant increase in milk yield (2.9 kg/d), protein content (0.15%), protein yield (115 g/d), fat yield (165 g/d), and lactose yield (182 g/d) from HMBi. Supplementation of HMB had small and nonsignificant effects on milk yield and composition. There were no significant interaction effects of HMB with HMBi on any of the production traits measured in this experiment. Plasma free Met as a proportion of essential amino acids was increased by HMBi, but not by HMB. Dietary supplementation of HMBi increased gross N efficiency expressed as the proportion of ingested N secreted in milk. Consequently, HMBi significantly improved N efficiency.
Asunto(s)
2-Propanol/farmacología , Bovinos/fisiología , Dieta , Lactancia/efectos de los fármacos , Metionina/análogos & derivados , Leche/química , Aminoácidos/sangre , Animales , Composición Corporal , Peso Corporal , Aceite de Semillas de Algodón/química , Esterificación , Femenino , Medicago sativa/química , Metionina/administración & dosificación , Metionina/farmacología , Proteínas de la Leche/análisis , Nitrógeno/metabolismo , Ensilaje/análisis , Zea mays/químicaRESUMEN
Objectives were to quantify the ruminal effects and flows to the omasum of Met provided as 2-hydroxy-4-(methylthio)-butanoic acid (HMB), the isopropyl ester of HMB (HMBi), and DL-Met. Eight ruminally cannulated cows were used in a replicated 4 x 4 Latin square design. Treatments were 1) no Met (control), 2) HMB at 0.10% of DM, 3) HMBi at 0.13% of DM, and 4) DL-Met at 0.088% of DM. Diets were identical except for type of Met supplement and were based on corn silage and alfalfa hay at 30 and 13% of dietary DM, respectively. Samples of omasal fluid were used to determine the proportion of Met supplements passing out of the reticulorumen. Dry matter intake (20.1 kg/d) was restricted during the week of sampling to a maximum of 95% of ad libitum DMI determined during the first 2 wk of the period. Milk yields (37.7 +/- 0.8 kg/d) and fat concentration (3.42 +/- 0.15%) were not significantly different for control, HMB, HMBi, and DL-Met. Milk protein concentration (2.91, 2.95, 3.02, 2.96 +/- 0.07%, respectively) was significantly increased by the HMBi treatment. Rumen volatile fatty acids profile and NH3 concentrations were similar across treatments. Apparent ruminal digestibility of organic matter and neutral detergent fiber were higher for the three diets supplemented with Met sources than for the control diet. In situ rate of digestibility of CP from alfalfa hay, TMR, and corn silage was affected by Met sources. Passage rates of small particles (0.071/h) and fluid (0.167/h) were not affected by treatments. Protozoal counts in the rumen and omasum were not significantly affected by Met sources. Proportion of omasal N from bacterial N was not different (0.54 +/- 0.03), and bacterial N flow (305 +/- 24.4 g/d) was similar across treatments. The proportion of HMB that passed into the omasum was 5.3 +/- 1.5% of the amount consumed. Only a small amount (2.3%) of HMBi was found as HMB in the omasum. These results indicate that little HMB escapes ruminal degradation through passage to the omasum and that the site of HMBi absorption must be preomasal.
Asunto(s)
Bovinos/metabolismo , Lactancia , Metionina/análogos & derivados , Metionina/metabolismo , Rumen/metabolismo , Aminoácidos/sangre , Amoníaco/análisis , Animales , Dieta , Fibras de la Dieta/metabolismo , Digestión , Ácidos Grasos Volátiles/análisis , Femenino , Metionina/administración & dosificación , Nitrógeno/metabolismo , Omaso/metabolismo , Rumen/químicaRESUMEN
Holstein cows starting at wk 8 of lactation were used to evaluate lactation performance when wet brewers grains, whole linted cottonseed, or starch-coated whole linted cottonseed (Easiflo) were substituted for forage. The wet brewers grains were added to diets to decrease forage neutral detergent fiber from 21% incrementally down to 15% while simultaneously decreasing nonfiber carbohydrate concentration from 40.3% down to about 33.8%. The cottonseed treatments all had similar concentrations of forage neutral detergent fiber (15%) and nonfiber carbohydrates (33.1 and 36.0%). Dry matter intake and milk production were similar across treatments. Milk fat percentage was decreased for Easiflo versus whole linted cottonseeds, but no other responses were detected. The current National Research Council (NRC) energy model was evaluated using individual cow data that were averaged over the entire 16-wk treatment period. For treatment means, the output of energy averaged 99% of the net energy of lactation intake, indicating very good corroboration of the model to account for energy usage for a group of cows. However, the ability to predict energy usage for individual cows was less accurate based on the comparison of residuals of observed and predicted body weight change regressed against predicted body weight change, apparently because of compounding of random errors in this prediction, which was alleviated over a larger number of observations. These results also corroborate current NRC guidelines for minimum forage neutral detergent fiber concentrations for lactating cows past the calving transition period.
Asunto(s)
Fenómenos Fisiológicos Nutricionales de los Animales , Bovinos/fisiología , Aceite de Semillas de Algodón , Dieta , Grano Comestible , Lactancia , Alimentación Animal , Animales , Peso Corporal , Fibras de la Dieta/administración & dosificación , Metabolismo Energético , Femenino , Lípidos/análisis , Leche/químicaRESUMEN
The major pathologic manifestations of rheumatoid arthritis (RA) and osteoarthritis (OA) are joint inflammation and articular cartilage resorption by proinflammatory cytokine-stimulated matrix metalloproteinases (MMPs) and aggrecanases. The Chinese herbal remedy Tripterygium wilfordii Hook F (TWHF) is effective for treatment of various types of arthritis. However, mechanisms and targets of its actions are poorly understood. Anti-inflammatory activities of the extracts of this plant were previously attributed to inhibition of cyclooxygenase-2 mRNA and prostaglandin E(2) synthesis. Here, we show that in primary human femoral head osteoarthritic and normal bovine chondrocytes, TWHF partially or completely inhibited mRNA and protein expression of tumor necrosis factor-alpha, interleukin (IL)-1, and IL-17-inducible MMP-3 and MMP-13. This agent also inhibited cytokine-stimulated MMP-3 protein expression in human synovial fibroblasts. A dose range of 2.5 to 10 ng/ml of TWHF was effectively inhibitory for IL-1. Pretreatment for 30 min or 1 h (but not 2-10 h) after IL-1 treatment with TWHF inhibited MMP-3 RNA induction. The inhibitory doses had no adverse effect on the viability of chondrocytes. Mechanistic studies revealed no impact on the activation of extracellular signal-regulated kinase, p38, and c-Jun N-terminal kinase mitogen-activated protein kinases. Instead, TWHF partially inhibited DNA binding capacity of cytokine-stimulated activating protein-1 (AP-1) and nuclear factor-kappaB (NF-kappaB) transcription factors. Therefore, besides its anti-inflammatory activity, this agent may also be effective in blocking cartilage matrix resorption by MMPs by impairing AP-1 and NF-kappaB binding activities. Thus, TWHF extract contains novel inhibitors of MMP expression that may be of therapeutic potential in arthritis and other conditions associated with increased MMPs.
Asunto(s)
Condrocitos/efectos de los fármacos , Citocinas/farmacología , Medicamentos Herbarios Chinos/química , Regulación de la Expresión Génica/efectos de los fármacos , Metaloproteinasa 3 de la Matriz/biosíntesis , FN-kappa B/antagonistas & inhibidores , Factor de Transcripción AP-1/antagonistas & inhibidores , Animales , Cartílago Articular/citología , Cartílago Articular/efectos de los fármacos , Bovinos , Células Cultivadas , Condrocitos/enzimología , Colagenasas/biosíntesis , Colagenasas/genética , ADN/efectos de los fármacos , ADN/metabolismo , Interacciones Farmacológicas , Humanos , Metaloproteinasa 13 de la Matriz , Metaloproteinasa 3 de la Matriz/genética , Extractos Vegetales/farmacología , TripterygiumRESUMEN
To assess effects of smooth muscle energy state and intracellular pH (pH(i)) on pulmonary arterial tone during hypoxia, we measured ATP, phosphocreatine, P(i), and pH(i) by (31)P-NMR spectroscopy and isometric tension in phenylephrine-contracted rings of porcine proximal intrapulmonary arteries. Hypoxia caused early transient contraction followed by relaxation and late sustained contraction. Energy state and pH(i) decreased during relaxation and recovered toward control values during late contraction. Femoral arterial rings had higher energy state and lower pH(i) under baseline conditions and did not exhibit late contraction or recovery of energy state and pH(i) during hypoxia. In pulmonary arteries, glucose-free conditions abolished late hypoxic contraction and recovery of energy state and pH(i), but endothelial denudation abolished only late hypoxic contraction. NaCN had little effect at 0. 1 and 1.0 mM but caused marked vasorelaxation and decreases in energy state and pH(i) at 10 mM. These results suggest that 1) regulation of tone, energy state, and pH(i) differed markedly in pulmonary and femoral arterial smooth muscle, 2) hypoxic relaxation was mediated by decreased energy state or pH(i) due to hypoxic inhibition of oxidative phosphorylation, 3) recovery of energy state and pH(i) in hypoxic pulmonary arteries was due to accelerated glycolysis mediated by mechanisms intrinsic to smooth muscle, and 4) late hypoxic contraction in pulmonary arteries was mediated by endothelial factors that required hypoxic recovery of energy state and pH(i) for transduction in smooth muscle or extracellular glucose for production and release by endothelium.
Asunto(s)
Metabolismo Energético , Arteria Femoral/fisiopatología , Hidrógeno/metabolismo , Hipoxia/fisiopatología , Arteria Pulmonar/fisiopatología , Vasoconstricción , Sistema Vasomotor/fisiopatología , Adenosina Trifosfato/metabolismo , Animales , Endotelio Vascular/fisiopatología , Arteria Femoral/metabolismo , Glucólisis , Concentración de Iones de Hidrógeno , Hipoxia/metabolismo , Músculo Liso Vascular/fisiopatología , Fosforilación Oxidativa , Fosfocreatina/metabolismo , Fósforo/metabolismo , Arteria Pulmonar/metabolismo , Porcinos , VasodilataciónRESUMEN
To determine the effects of hypoxia on energy state and intracellular pH (pHi) in resting pulmonary and systemic arterial smooth muscles, we used 31P nuclear magnetic resonance spectroscopy and colorimetric and enzymatic assays to measure pHi; intracellular concentrations of ATP, phosphocreatine, creatine, and Pi; and phosphorylation potential in superfused tissue segments from porcine proximal intrapulmonary and superficial femoral arteries. Under baseline conditions (PO2 467 +/- 12.1 mmHg), energy state and total creatine (phosphocreatine + creatine) concentration were lower and pHi was higher in pulmonary arteries. During hypoxia (PO2 23 +/- 2.4 mmHg), energy state deteriorated more in femoral arteries than in pulmonary arteries. pHi fell in both tissues but was always more alkaline in pulmonary arteries. Reoxygenation reversed the changes induced by hypoxia. These results suggest that production and/or elimination of ATP and H+ was different in resting pulmonary and systemic arterial smooth muscles under baseline and hypoxic conditions. Because energy state and pHi affect a wide variety of cellular processes, including signal transduction, contractile protein interaction, and activities of ion pumps and channels, further investigation is indicated to determine whether these differences have functional significance.
Asunto(s)
Metabolismo Energético/fisiología , Arteria Femoral/metabolismo , Hidrógeno/metabolismo , Hipoxia/metabolismo , Músculo Liso Vascular/metabolismo , Arteria Pulmonar/metabolismo , Adenosina Trifosfato/metabolismo , Animales , Creatina/metabolismo , Concentración de Iones de Hidrógeno , Técnicas In Vitro , Membranas Intracelulares/metabolismo , Espectroscopía de Resonancia Magnética , Concentración Osmolar , Fosfocreatina/metabolismo , Fósforo/metabolismo , Fosforilación , PorcinosRESUMEN
BACKGROUND: This study was designed to evaluate the efficacy of iodine-125 interstitial radiation in the treatment of prostate carcinoma classified as T1 or T2. METHODS: One hundred twenty-six consecutive patients with adenocarcinoma of the prostate (T1, 23%; T2, 77%) were treated with iodine-125 radionuclides between January 1, 1988, and December 31, 1990. Four patients died of intercurrent illness within 1 year postimplant, leaving 122 men in the study. The prescribed minimum radiation dose was 160 gray. Median follow-up was 69.3 months. Prebiopsy prostate specific antigen (PSA) values (median, 5.0 ng/mL) were available for all patients. Posttherapy evaluation included clinical, biochemical (PSA), and pathologic (repeat needle biopsy) studies. No patient was surgically staged, and none received androgen deprivation therapy. Morbidity was graded according to the Radiation Therapy Oncology Group grading scale. Statistical appraisal was performed by the Kaplan-Meier method. PSA failure was defined in two ways: (1) PSA progression, i.e., 2 consecutive increases from a nadir value; and (2) failure to attain an arbitrary serum PSA value of 1.0 or 0.5 ng/mL at last follow-up. RESULTS: The overall 7-year survival was 77%; there were no deaths from prostate carcinoma in this cohort. The 7-year actuarial PSA progression free outcome was 89%, and the PSA < or = 1.0 ng/mL outcome was 87%. When PSA < or = 0.5 ng/mL was selected as an outcome end point, and PSA values in this series of radiation-treated patients were compared with PSA values proposed to indicate disease free survival after radical prostatectomy (PSA < or = 0.3-< or = 0.6 ng/mL), the 7-year actuarial disease free survival was 79%. Morbidity was minimal except in patients who had preimplant or postimplant transurethral prostate resection. CONCLUSIONS: Outpatient-based iodine-125 prostate brachytherapy for prostate carcinoma classified as T1 or T2 resulted in biochemical outcomes comparable to end points resulting from radical prostatectomy and external beam radiation.
Asunto(s)
Braquiterapia , Neoplasias de la Próstata/radioterapia , Adenocarcinoma/radioterapia , Biopsia con Aguja , Braquiterapia/efectos adversos , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Estadificación de Neoplasias , Antígeno Prostático Específico/metabolismo , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Dosificación Radioterapéutica , Análisis de SupervivenciaRESUMEN
BACKGROUND: Extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection occurred over the past decade. Illinois teen knowledge and attitudes about sun exposure/protection, sun-exposure/protection behavior, and information sources were determined by a summer telephone survey. METHODS: Telephone interviews with 658 teenagers between ages 11 and 19 included African-American, Asian, Hispanic, Native American, and white teenagers. RESULTS: Teens knew that too much sun was harmful as it caused skin cancer and sunburn. Sunburn was mentioned more often by those with skin types that burned easily and tanned poorly (I,II) (P < 0.001), was better known to girls than to boys (P < 0.001), and was recognized more by those with higher socioeconomic status (P < 0.001) but was not associated with age. Widely held sun exposure attitudes were socializing with friends and feeling better when outdoors. On weekdays, boys averaged 5.3 hr (SD, 1.65 hr) outside compared with 3.9 hr (SD, 0.75 hr) for girls (P < 0.001). Teenage boys were more likely to obtain occupational sun exposure, and girls sunbathed. Subjects with skin types I and II reported an average of 3.3 sunburns in the past year. During unprotected sun exposure, extensive numbers of teens with moderate-risk skin type experienced at least 1 sunburn per year. Indoor tanning use was more prevalent among older girls and those with skin types I and II. Sunscreen use was associated with water recreational activities (swimming, water sports, and going to the beach) by girls slightly more than by boys (P < 0.001). Hat-wearing was more common among boys than among girls. CONCLUSIONS: Teen knowledge that excessive sun exposure causes skin cancer and sunburns and that wearing sunscreens and hats were sun-protective methods did not enable sun protection that prevented burning. This is particularly troublesome because severe sunburns in youth are associated with an increased risk of melanoma. Existing teen sunscreen use could be broadened by educating teens to use adequate quantities of sunscreen prior to daily sun exposure to prevent painful burns. Messages to teens that emphasize the short-term consequence of painful sunburns because of inadequate protection during outdoor occupational and non-water-related recreational exposure would increase the relevance of the message and may enable behavioral change. Parents and physicians need to be included in messages that are directed to teens and to become part of their education. Parents could ensure an adequate sunscreen supply for daily use by the family, encourage teens not to deliberately tan, and serve as role models for the use of protective clothing.
Asunto(s)
Conducta del Adolescente , Conocimientos, Actitudes y Práctica en Salud , Cuidados de la Piel/psicología , Neoplasias Cutáneas/prevención & control , Luz Solar/efectos adversos , Adolescente , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Niño , Estudios Transversales , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/prevención & control , Exposición a Riesgos Ambientales/estadística & datos numéricos , Femenino , Educación en Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Helioterapia/efectos adversos , Helioterapia/psicología , Helioterapia/estadística & datos numéricos , Humanos , Illinois/epidemiología , Masculino , Ropa de Protección/estadística & datos numéricos , Muestreo , Distribución por Sexo , Cuidados de la Piel/estadística & datos numéricos , Pigmentación de la Piel , Quemadura Solar/epidemiología , Quemadura Solar/prevención & control , Protectores SolaresRESUMEN
The goal of radiation therapy is to deliver a high dose to the tumor while preserving normal surrounding tissue. For early-stage prostate cancer, the ultimate conformal irradiation is to place radioactive sources directly into the gland either as permanent or temporary seeds. Permanent seed implantation is capable of delivering two times the radiobiologically equivalent dose of external beam irradiation to the prostate and tumor. In the past, the results of prostate brachytherapy were likely poor owing to the technical difficulty in accurately placing the radioactive seeds uniformly throughout the prostate. The use of low-dose-rate I-125 to treat high-grade cancers probably also contributed to the poorer results as compared with external beam irradiation. Over the last 10 years, however, technologic advances in transrectal ultrasonography, computer dosimetry, and template-based transperineal techniques have dramatically improved the accuracy and consistency of the brachytherapist to place radioactive sources directly into the prostate gland. Transperineal ultrasound or CT directed seed implantation has replaced the older retropubic method. Brachytherapists are now able to accurately map out the gland prior to the implant and carefully evaluate preoperatively seed placement. The availability of such radioactive sources as iodine-125, palladium-103, and iridium-192 has also given the brachytherapist isotopes that can be more carefully matched to the biology and stage of the tumor. More sensitive definitions of failure have prompted radiation oncologists and urologists to carefully evaluate the efficacy of external beam irradiation and surgery. Accurate comparison of the efficacy of brachytherapy to surgery and to external beam radiation requires a randomized study. Comparisons of retrospective studies are fraught with the problems of the heterogeneous nature of early-stage prostate cancer. Imbalances in stage, grade, initial PSA extraprostatic disease, and nodal status of patient groups make comparisons difficult. Most of the long-term data for permanent seed implantation are the result of work at a single institution. These results will need to be repeated at other institutions treating patients in a similar manner. Because techniques vary from institution to institution, permanent implant results will need to be carefully evaluated for technique as well as stratified for pretreatment variables. Pretreatment PSA and grade appear to be more sensitive variables than stage in predicting failure after radiation. As more patients are diagnosed with very early and nonpalpable disease, future studies will need to stratify patients based on these pretreatment factors. Patients with early-stage disease but identified as high risk for extraprostatic disease will require more intensive regimens. The treatment outcomes based on biopsy results are inconclusive. A lack of consensus on the definition of a truly positive biopsy remains forthcoming. The value of a positive prostate biopsy as an outcome predictor for clinical failure is still unclear. The use of prostate nuclear cell antigen staining may help clarify the issue. Comparison of treatment outcome based on absolute PSA is also difficult. The Seattle series suggest that brachytherapy by permanent seed implantation is as efficacious as external beam irradiation for early-stage disease in patients with a low PSA (< 10 ng/mL). As the PSA value rises above 10 ng/mL, the probability of failure after external beam rises substantially. Results from the Seattle series suggest an advantage to seed implant alone or the judicious application of seed implant boost to external beam radiation for these patients with more advanced cancer. The most sensitive measurement of therapeutic outcome is progression-free survival. Few studies to date have evaluated progression-free survival.
Asunto(s)
Neoplasias de la Próstata/radioterapia , Biopsia , Braquiterapia/economía , Braquiterapia/métodos , Análisis Costo-Beneficio , Relación Dosis-Respuesta en la Radiación , Humanos , Masculino , Estadificación de Neoplasias , Cuidados Posoperatorios/métodos , Neoplasias de la Próstata/economía , Neoplasias de la Próstata/patología , Resultado del TratamientoRESUMEN
Changes in phosphate energy metabolism with time in a rat flap model were followed noninvasively with in vivo 31P-NMR. The influence of age on high-energy phosphate metabolites in perfused and ischemic ends of 3 x 10 cm dorsal flaps was noted from 30 minutes to 7 days after closure in 6-, 12-, and 24-month-old (n = 4, 7, and 8, respectively) male Fischer 344 rats. Phosphocreatine to inorganic phosphate ratios showed younger animals exhibiting significant returns to preinjury energy status in 2- and 3-mm ischemic layers. This behavior, 24 to 72 hours after closure, coincides with neovascularization of the flap tissue. By contrast, 12- and 24-month-old animals experienced statistically significantly lesser high-energy rebound, developing greater necrosis in the ischemic regions. Early intracellular pH lowering, indicative of lactate production, was somewhat greater in the flaps of younger animals. The in vivo 31P-NMR methods thus provide metabolic insights into flap behavior correlating with physiologic influences of aging.
Asunto(s)
Envejecimiento/fisiología , Metabolismo Energético/fisiología , Piel/metabolismo , Colgajos Quirúrgicos/fisiología , Animales , Espectroscopía de Resonancia Magnética , Masculino , Necrosis , Fósforo , Ratas , Ratas Endogámicas F344 , Piel/patología , Colgajos Quirúrgicos/patologíaRESUMEN
Phosphorus-31 nuclear magnetic resonance techniques using shallow penetrating coils have been used to noninvasively monitor severity and metabolic changes over time in skin wounds in rats. Ratios of phosphocreatine (PCr) to inorganic phosphate (Pi) indicate energy status in both thermal wounds and surgical flaps. In partial and full-thickness scald wounds, reductions in PCr/Pi ratios correlated with burn depth and improved over time postinjury, suggesting wound revascularization. No decrease in intracellular pH was noted in these wounds; the phosphate shifts may be primarily the result of tissue degradation followed by restoration of the microvasculature. Distal regions of caudally based dorsal 3 x 10 cm full-thickness skin flaps reveal progressively lower PCr/Pi ratios to 3-6 hours after elevation as well as drops in pH up to 0.5 units, presumably as a result of anaerobic glycolysis in these tissues. After 24 hours, the intracellular pH returned to normal (7.1-7.2) and the PCr/Pi ratios approached 70%-90% of the well-perfused proximal regions within 3-7 days. These results indicate the establishment of a microvasculature from the underlying bed as the distal regions survive as free grafts. The data demonstrate the potential usefulness of the technique in noninvasive measurement of the biochemical response to injury and wound healing in living organisms.
Asunto(s)
Quemaduras/metabolismo , Piel/metabolismo , Colgajos Quirúrgicos , Animales , Concentración de Iones de Hidrógeno , Espectroscopía de Resonancia Magnética , Masculino , Fósforo , Ratas , Ratas Endogámicas Lew , Ratas Sprague-Dawley , Piel/lesionesRESUMEN
Clinically, there is strong rationale for developing a method which will provide a scientific basis for comparing the efficacy of one hyperthermia treatment with another. In order to accomplish this goal, methods must first be developed which will allow the clinician to know the three-dimensional temperature distribution in heated tissue. In this paper, examples of how this goal can be achieved are presented. Techniques for compensating for various modifiers of hyperthermia effectiveness are proposed. The limitations and advantages of these approaches are described and directions for future research are discussed.