The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation.

OBJECTIVES: The objective of this study was to evaluate the impact of luteinizing hormone (LH), estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) administration on outcomes of in vitro fertilization (IVF) in controlled ovarian hyperstimulation (COH). STUDY DESIGN: In this retrospective study, 129 infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments were included; these cycles were stratified according to LH levels of ≥ 1.12 IU/L or < 1.12 U/L and according to E2 levels of ≥ 1,005.89 pmol/L or < 1,005.89 pmol/L. The main outcome measure was the clinical pregnancy rate. RESULTS: The clinical pregnancy rate was significantly higher in the group with LH ≥ 1.12 IU/L than in the group with LH < 1.12 U/L (43.28% vs. 30.65%, p < 0.05). The clinical pregnancy rate was also higher in the group with E2 ≥ 1,005.89 pmol/L than in the group with average E2 < 1,005.89 pmol/L (42.86% vs. 30.51%, p < 0.05). Among the LH, E2, and P levels on the day of HCG administration, LH level was the most important predictor of outcomes of IVF in COH. The present data showed an adverse effect of low serum LH level (LH < 1.12 IU/L) on the day of HCG administration on clinical pregnancy rate. E2 level can also predict the outcomes of IVF in COH. CONCLUSIONS: Low serum LH level (LH < 1.12 IU/L) and low serum E2 level (average E2 < 1,005.89 pmol/L) on the day of HCG administration led to low clinical pregnancy rates, while the P level on the day of HCG administration may have had little effect on clinical pregnancy.

Targeted diagnosis of bladder and ureteral carcinoma using radiolabelled BDI-1.

The aim of this study is to investigate the possibility of radioimmunoimaging (RII) by radiolabelled anti-bladder carcinoma monoclonal antibody BDI-1 applied to diagnosis of bladder cancer and ureteral cancer. BDI-1 was labelled with 131I and 99mTc. The immunoreactivity, pharmacokinetics and biodistribution in mice were studied. RII was performed in 46 patients. The results showed that 131I, 99mTc-BDI-1 have satisfactory immunoreactivity and excellent tumor-locating properties. The blood clearance half-life T1/2alpha and T1/2beta were 35 h in the first phase and 151 h in the second phase, respectively. Thirty-nine patients were studied by an intravesical administration method; the sensitivity was 90.5%. Seven patients were studied by an intravenous administration method. The RII results of three cases with primary or recurrent bladder cancer and three cases with ureteral cancer were confirmed histologically. RII was negative in one patient with suspected lung metastasis that was shown on radiography. The investigation revealed that RII can be used as an auxiliary method for the detection of bladder cancer and may be valuable for the diagnosis of ureteral cancer.

Clinical comparison of selective and non-selective alpha 1A-adrenoceptor antagonists for bladder outlet obstruction associated with benign prostatic hyperplasia: studies on tamsulosin and terazosin in Chinese patients. The Chinese Tamsulosin Study Group.

To examine the clinical usefulness of selective and non-selective alpha 1-adrenoceptor antagonists, we compared a selective (tamsulosin) and non-selective (terazosin) alpha 1-adrenoceptor antagonists in the treatment of Chinese patients with benign prostatic hyperplasia (BPH). The study was a single-blind, randomized, multicenter design to compare a fixed dose of tamsulosin (0.2 mg) or terazosin (2 mg) given once daily after breakfast for four weeks. A total of 212 patients were enrolled with 201 patients included in the analysis. The primary variables assessed were changes in total International Prostatic Symptom Score (IPSS), maximum urinary flow rate (Qmax), and average urinary flow rate (AFR) four weeks after dosing. Adverse events were recorded through the treatment period. Both tamsulosin and terazosin produced significant improvements in total IPSS (total score of 11.8 +/- 4.5; decrease in 45.1% and total score of 13.3 +/- 5.3; decrease in 39.0%, respectively) (p < 0.001), Qmax (13.2 +/- 4.1 mL/s, 37.5% increase and 13.6 +/- 3.6 mL/s, 30.8% increase, respectively) (p < 0.001) and AFR (7.7 +/- 3.3 mL/s, 37.5% increase and 7.8 +/- 3.1 mL/s, 25.8% increase, respectively) (p < 0.001) at endpoint. Tamsulosin was superior to terazosin in improvement of total IPSS (p < 0.05) and AFR (p < 0.05). The incidence of adverse events by administration of tamsulosin was less than that by terazosin (13 and 50, respectively; p < 0.01). Among the adverse event, incidence of dizziness (p < 0.001) and hypotension (p < 0.01) by administration of terazosin were significantly greater than that by tamsulosin. Both systolic and diastolic blood pressure of sitting position decreased significantly in patients treated with terazosin (p < 0.01). These results suggest that tamsulosin, a selective alpha 1A-adrenoceptor antagonist, was superior to terazosin, a non-selective alpha 1-adrenoceptor antagonist, in efficacy and adverse events in patients with symptomatic BPH.

Case-control study of diet and prostate cancer in China.

INTRODUCTION: A higher incidence of prostate cancer is observed in the Western world than in Asian countries. Although it is relatively rare in China, an increased incidence has been reported in recent years. Studies in high-risk populations have suggested that dietary fat may play a role in enhancing the risk of developing prostate cancer. However, limited epidemiologic study has never examined the role of diet in low risk populations. METHODS: A case-control study was conducted in 12 cities in China to evaluate the relationship between dietary factors and prostate cancer risk. We conducted personal interviews with 133 histopathologically confirmed prostate cancer cases diagnosed between 1989 to 1992 and 265 neighborhood controls of similar age. RESULTS: Cases were more likely than controls to consume food with high fat and from animal sources (p < 0.01). The daily fat intake and the percentage of energy from fat were statistically significantly higher among cases than among controls (p < 0.01). The adjusted odds ratio for total fat between lowest quartiles and highest quartiles was OR = 3.6 (95 percent C.I. 1.8-7.2); for saturated fat, OR = 2.9 (95 percent C.I. 1.5-5.7); and for unsaturated fat, OR = 3.3 (95 percent C.I. 1.7-6.3). DISCUSSION: The data suggest that dietary fat, both saturated and unsaturated, are associated with an increased risk for prostate cancer in a low risk population.

Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score.

BACKGROUND: The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia. METHODS: The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia. RESULTS: The percentages of Asian men considered to be symptomatic (symptom index > or = 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively. CONCLUSIONS: Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.

A multicentre prospective study of prostatic volume in asymptomatic men in various continents.

Objective: To compare prostatic volumes in asymptomatic Asian men with similar controls in Europe. Patients and methods: Six centres (Beijing, Hong Kong, Jinan, Lisbon, Palermo and Stirling) independently selected asymptomatic men aged 55 y or more for assessment of prostatic volume using transrectal ultrasound (total=320 men) between 1992 and 1993. Results: Prostatic volumes in asymptomatic men were greater in Beijing than Hong Kong, Stirling and Palermo (P<0.05) and were smaller in Stirling than Beijing and Jinan (P<0.05). Conclusions: These results suggest that men from Stirling are less likely to have large prostates, but there is no evidence that men from any of the six cities are more likely to have small prostates. This small series may suggest that benign prostatic hyperplasia (BPH) is as common in China as in European cities. The differences may be due to some cities (Beijing, Jinan and Lisbon) having a greater proportion of high values, perhaps suggesting looser selection criteria. This may indicate an abandonment of traditional Asian foods with their presumptive beneficial effect in favour of a Western dietary style.

Construction and expression of single-chain Fv antibody against human bladder carcinoma.

We designed two sets of oligonucleotide primers to amplify the immunoglobulin heavy- and light-chain variable-region genes from genomic DNA by polymerase chain reaction (PCR). The genomic DNA was extracted from hybridoma BDI-1 cells, which secreted a monoclonal antibody (mAb) against human bladder carcinoma. The primers contained special restriction sites that allowed the variable-region genes to be easily cloned for sequencing and expression. The recombinants were sequenced by Sanger's method. It was proved that the full lengths of the VH and VK genes were 366 and 324 bp, respectively. Compared with other published sequences, the VH gene was a member of mouse heavy-chain VH subgroup II and originated from the rearrangement of VH, Dsp2.2 and JH4. The VK gene was VK subgroup IV and from VK and JK4. The VH and VK genes was inserted expression vector pWAI80. By inducement, the ScFv antibodies were expressed and secreted from Escherichia coli. Binding activities against the bladder carcinoma cells were detected. We suggest that ScFv antibody recognized the antigen specifically.

Introduction of wild-type p53 gene downregulates the expression of H-ras gene and suppresses the growth of bladder cancer cells.

Retroviral vectors were used to introduce the wild-type p53 gene into human bladder cancer cell lines BIU-87 and EJ, which express endogenous wt-p53 gene and have a mutation in H-ras gene. The expression of the exogenous wt-p53 gene in cells suppresses the growth of the bladder cancer cells in standard culture and in soft agar and blocks the cell cycle progression in G1. The BIU-87 and EJ cells developed tumors with average volumes of 6.53 cm3 and 6.61 cm3 in nude mice in 9 weeks after inoculation, while the cells transduced with wt-p53 gene failed to form tumors. The expression of H-ras gene in bladder cancer cells was reduced at mRNA level. These results suggest that the overexpression of the wt-p53 gene suppresses the expression of mutant H-ras gene and inhibits the tumor cell growth in vivo and in vitro.

Preliminary study of the frequency of benign prostatic hyperplasia and prostatic cancer in China.

OBJECTIVES: This study determined the frequency of benign prostatic hyperplasia (BPH) and cancer of the prostate (CaP) in China. METHODS: Prostate specimens from 321 unselected autopsies were collected from 1989 to 1992. Slices were cut vertically every 0.5 cm from apex to base. Five to 12 slices were obtained from each prostate. Specimens were stained with hematoxylin-eosin and Masson trichrome. Sixty surgical specimens obtained from cystoprostatectomies with intact prostate were included to determine the frequency of latent CaP. RESULTS: The frequency of BPH, by age, was as follows: 41 to 50 years, 13.2%; 51 to 60 years, 20%; 61 to 70 years, 50%; 71 to 80 years, 57.1%; 81 to 90 years, 83.3%. The frequency of latent CaP, by age, was as follows: 41 to 50 years, 2.2%; 51 to 60 years, 9.3%; 61 to 70 years, 5.9%; 70 years or older, 25%. Incidental CaP was found in 4.9% (33 of 676) of BPH surgical specimens. The incidence of and mortality from CaP in Beijing were 2.41 per 100,000 men and 1.19 per 100,000 men, respectively, between 1985 and 1987. CONCLUSIONS: BPH was rare in China in the early years of this century, but it has become a common disease in recent decades. The histologic frequency of BPH in China was similar to that in Western countries, but the histologic frequency of latent CaP was less than half that in Western countries. The incidence of and mortality from CaP in China are about 20 times less than those in Western countries. Histologic CaP in a Chinese man is not as likely to evolve into clinical CaP as in a Western man.

[Abnormalities of anti-oncogene p53 in renal cell carcinoma].

Mutant forms of p53 gene are found in numerous human malignancies. Studies of the p53 mRNA showed different levels of expression in many tumours. But the relationship between the p53 gene and the renal cell carcinoma is less elucidated than the other. In this report we examined p53 gene at mRNA level by Northern blot on the tissues from 21 patients with renal cell carcinoma. Abnormalities of the p53 were found in 12(57%) tumors, in which seven had elevated level of p53 mRNA, and five lacked p53 mRNA. p53 gene alteration occurred in a high percentage in high-grade and advanced tumors. These results suggest that inactivation of p53 gene is common in renal cell carcinoma and may be involved in the progression of this malignancy.

Vasectomy and prostate cancer risk in China.

Vasectomy has been reported to be associated with an increased risk of prostate cancer in western countries. A hospital-based case-control study was conducted in 12 cities in China to evaluate the relationship between vasectomy and prostate cancer risk in China, a low-risk country with rising incidence and increasing use of vasectomy. Interviews were conducted with 138 histologically confirmed prostate cancer cases diagnosed during 1989-1992 and 638 controls (158 hospital cancer, 158 hospital noncancer, and 322 neighborhood controls) of similar ages. Vasectomy at least 10 years prior to interview was reported by 10% of the cases versus 3% of the controls. Odds ratios for prostate cancer associated with vasectomy were 2.0 (95% confidence interval, 0.7-6.1), 3.3 (95% confidence interval, 1.0-11.3), and 6.7 (95% confidence interval, 2.1-21.6), respectively, when hospital cancer, hospital noncancer, and neighborhood controls were used for comparison. Although detection bias is of concern, the data suggest that in China, men with a history of vasectomy may experience an increased risk of prostate cancer.

PIP: This paper reports the findings of a hospital-based case-control study that was conducted at major teaching hospitals in 12 cities in China. China reports the lowest incidence in prostate cancer of over 100 registries reporting cancer incidence. This investigation evaluated the relationship between vasectomy and prostate cancer and attempted to identify any etiological factor. A total of 138 study patients (index cases) were identified. Controls used in this study included a cancer control and a noncancer control from the same hospital, and 2 neighborhood controls. Chances of having prostate cancer were statistically determined by logistic regression analysis with age group adjustments made. The analysis reviewed 138 cases and 638 controls. Results indicate that, regardless of the variable control used for comparison, an increased risk of prostate cancer was associated with having had a vasectomy. Statistical odds ratio was 2.0 for hospital cancer controls (95% confidence interval [CI]; 0.7-6.1); 3.3 for hospital noncancer controls (95% CI; 1.0-11.3); and 6.7 for neighborhood controls (95% CI; 2.1-21.6). The authors conclude that, as reported for men in Western countries, Chinese men who have had a vasectomy are at significantly increased risk for developing prostate cancer compared to men who never have had a vasectomy. They report a near 2-fold increase in risk (vasectomy vs. non-vasectomy) in developing the disease. Conclusions about cause and effect are premature, but these findings warrant further investigation of several issues. These include: changes in the endocrine system due to vasectomy; systematic and local immunity changes after vasectomy; and other possible biochemical factors that enhance/inhibit cancer growth in the prostate gland.

Radioimmunoimaging diagnosis of human bladder carcinoma.

The monoclonal antibody (BDI-1) against human bladder carcinoma has been shown to have selective reactivity for bladder cancer. A total of 19 bladder cancer patients were studied by radioimmunoimaging (RII) and a clear immunoscintigraphy was observed in all. Blood samples collected at 1, 2, 3, days after instillation were shown to be almost free from radioactivity. It is suggested that BDI-1, as a target carrier, might also be for instillation target treatment of superficial bladder cancer.

[The incidences of benign prostatic hyperplasia and prostatic cancer in China].

Step-sections of 321 prostatic specimens from unselected autopsies were examined in order to understand the incidences of benign prostatic hyperplasia (BPH) and prostatic cancer (CaP) in China. The results showed that the incidence of BPH in patients of 51-60, 61-70, 71-80, and 81-90 years old was 20%, 50%, 57.1% and 33.3% respectively. The incidence of latent CaP in the above-mentioned age series, including 60 prostatic specimens from cystoprostatectomies was 9.3%, 5.7%, 26.9% and 16.7% respectively. The Incidence of CaP in BPH surgical specimens was 33/676 (4.9%). The histological incidences of BPH and CaP in China were similar to or half of that of western world. But the epidemiological incidence of CaP in China was only 1/20-1/30. Further investigation about this condition is necessary.

The prostate in eunuchs.

In 1960, there were 26 eunuchs from the palace of the Qing Dynasty still living in Beijing. The authors took that unique opportunity of carrying out a general physical examination, including palpation of the prostate, for every one of them. Their average age then was 72 years (59-83 years). They became eunuchs at the age of 10-26 years. The prostate was impalpable in 26 (81%) and 1-2 cm in width rectally in five, with a flat surface. At the time of the examination they had been eunuchs on the average for 54 years (41-65 years). This is probably the largest series of human beings followed for such a long period of time to confirm that testicular hormone is essential for the development and preservation of the prostate. The type of operation, the traditional way of carrying out the operation and the usual complications are presented.

Cellular origin of renal cell carcinoma--an immunohistological study on monoclonal antibodies.

It has been recognized in recent years that renal cell carcinoma possesses a proximal convoluted tubules origin. In an attempt of further intensive evaluation we assayed 51 renal cell carcinomas and 38 additional normal kidney specimens with 4 kidney segment-specific antibodies (Uro-2/S4, Uro-5/T16, Uro-10/T43, Anti Tamm-Horsfall Protein) directed against the nephrotic cells by indirect immunohistological techniques. Consistently stable staining was developed in the tests. The results showed that the majority of renal clear cell carcinomas expressed nephrogenous properties of proximal convoluted tubules but in part also of distal tubules and collecting ducts. Granular cell carcinoma mostly demonstrated histogenic appearance of distal convoluted tubules.

[Clinical significance of random mucosal biopsies in patients with bladder cancer: analysis of 117 cases].

The results of multiple random biopsies from apparently non-tumor bearing mucosa were analyzed in 117 cases with bladder cancer. Of the 687 evaluable specimens, 26.5% showed abnormalities including hyperplasia (12.4%), atypical hyperplasia (5.8%), flat carcinoma in situ (6.0%) and even occult carcinoma (2.3%). The frequency of mucosal lesions increased with advancing histologic grade of visible tumors. The frequency of occult cancerous or precancerous lesions in cases with visible tumors was significantly higher than that of cases with invisible tumors. Undoubtedly the existing of occult cancerous or precancerous lesions is one of the important factors of high recurrence rate after local resection of the bladder tumors. Patients with occult cancerous or precancerous lesions should be given intensive follow-up and intravesical prophylactic therapy.

Vicissitude of management of ureteral stones.

Following the use of rigid ureteroscopic lithotripsy (URS) in 1984 and extracorporeal shock wave lithotripsy (ESWL) in 1987, the treatment for ureteral stones has undergone significant changes. Our experience showed that the successful rate of URS for 132 patients was 89.4% and for the upper third was rather low, percutaneous antegrade URS should be considered. 376 patients treated with ESWL in prone position with a successful rate of 96.8%. The applicability of open surgery was reduced to 17.8% in 1987 and 14.5% in 1988.