Genetic association study of the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms and the risk to develop erectile dysfunction in a German ED population.

Erectile dysfunction (ED) is often associated with cardiovascular disorders such as hypertension, coronary heart disease, hypercholesterolaemia and diabetes mellitus. The genotypes in the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms have been identified as genetic risk factors for cardiovascular disorders. The association between the genotypes in these polymorphisms and the risk to develop ED was analysed. In 455 German ED patients and 111 age-matched healthy controls genotyping in the candidate polymorphisms was performed after DNA extraction from whole blood. Association studies between the genotype distribution in the control group in comparison with the ED-group and age of onset of the disease as well as erectile response to intracorporal prostaglandin injection in dependence of candidate polymorphism genotype were performed using the SPSS-Software(R). Genotype distribution of the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms was similar in the ED population and the healthy control group. The age of onset of the disease as well as the erectile response to intracorporal prostaglandin injection was independent of the genotypes in the three candidate polymorphisms. In contrast to the previous studies in this analysis, the risk to develop ED is not influenced by the genotypes in the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms.

Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study.

BACKGROUND: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. OBJECTIVE: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). DESIGN, SETTING, AND PARTICIPANTS: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. INTERVENTION: The SOC cohort (n=1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n=263) received either salvage lymph node dissection (n=166) or stereotactic body radiotherapy (n=97) at PSA progression to a positron emission tomography-detected nodal recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. RESULTS AND LIMITATIONS: At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p=0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p=0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. CONCLUSIONS: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. PATIENT SUMMARY: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes.

[Urotechnology: a new interdisciplinary platform for promoting and managing of technical innovations in urology]. / Urotechnologie : Neue Plattform zur Förderung und zum Innovationsmanagement der medizintechnischen Forschung in der Urologie.

The innovative power in medical engineering and technology development requires a close cooperation between universities and non-university research institutions and a collaboration with industrial partners. German knowledge in the fields of video and micro-optics, microsystem technology and of informational technology and software applications seem to be highly competitive at international level. Germany's previous leadership in the development of technical equipment will be challenged by today's requirements and difficulties in medical engineering. Research and expenses demands for the development of novel medical instruments, products and applications will increase continuously. Transparency and coordinated collaboration between universities and industrial partners will contribute to a substantial improvement in surgical therapy. Medical technology of the future, including urotechnology, requires professional structures and coordination and will have to be based on evidence.

Impaired cytokine production in whole blood cell cultures of patients with urological carcinomas.

The production of the cytokines interferon gamma (IFN gamma), interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor alpha (TNF alpha) was investigated in the mitogen-stimulated whole blood cell culture media from 51 patients with urinary bladder carcinomas, 52 patients with renal carcinomas, 31 patients with prostatic carcinomas and 360 healthy controls. The cytokines were measured 4 days after induction by a sensitive enzymo-immunological assay. In the blood cell culture supernatants of the patients with urinary bladder carcinomas significant lower levels of IFN gamma (P < or = 0.001), IL-2 (P < or = 0.01) and TNF alpha (P < or = 0.05) were found as compared to the controls. Blood cells of patients with renal carcinomas had lower production of IFN gamma (P < or = 0.01), IL-2 (P < or = 0.001) and IL-1 alpha (P < or = 0.01), whereas the values of the total group of patients with prostatic carcinomas were not significantly different from those of the controls. Lymphocyte and monocyte counts were almost identical in the control and all tumor patient groups. When the patients with renal carcinomas and prostatic carcinomas were analyzed according to their different clinical stages we could show a gradual depression of the IFN-gamma levels, which was related to tumor burden.

Quantitative and qualitative analysis of dynamic cavernosographies in erectile dysfunction due to venous leakage.

Of 521 patients with erectile dysfunction in whom a multidisciplinary approach was used, 145 (27.8%) showed venous leakage as (concomitant) etiology of the impotence in dynamic cavernosography. The rate of the maintenance flow corresponded well with the response to a standardized intracavernosal injection of vasoactive drugs (p less than 0.05) in patients with venous leakage. The maintenance flow increased with the age in secondary impotent men. It was not statistically different in patients with or without concomitant arterial insufficiency (p = 0.19). Fifty-one of 145 patients (32.2%) presented a pathologic cavernosal drainage via a single venous system; 94/145 (64.8%) showed a combined venous leakage. The type of leakage corresponded neither to the maintenance flow nor to the response to intracavernosal injections. Our findings show that standardized intracavernosal testing and Doppler have a high predictive value for the status of the venous occlusive system. Exact evaluation of the type of leakage can be made by bidimensional cavernosography only.

Calcitonin gene-related peptide: possibly neurotransmitter contributes to penile erection in monkeys.

The distribution of calcitonin gene-related peptide (CGRP) immunoreactivity in the cavernous tissue and the erectile response to intracavernous injection of CGRP was investigated in 7 monkeys. Intracavernous CGRP increased cavernous arterial flow and induced cavernous smooth muscle relaxation and venous outflow occlusion. Intracavernous injection of CGRP antibody did not significantly change the erectile response to cavernous nerve stimulation. Histologic staining for CGRP immunoreactivity showed nerve fiber-like staining within the cavernous arterial wall and the cavernous smooth muscles. These data suggest that CGRP may contribute to penile erection in monkeys.

Construction and in vivo evaluation of an anti-PSA x anti-CD3 bispecific antibody for the immunotherapy of prostate cancer.

BACKGROUND: Cross-linking of tumor antigens with the T-cell associated CD3 antigen can be effectively achieved by bispecific monoclonal antibodies and lead to an increase in antigen-specific cytotoxicity in T cells. Because of the high organ specificity of the prostate specific antigen (PSA), a bispecific antibody (BiAb) directed against this antigen and CD3 may be a tool for a highly specific immune therapy of prostate cancer. METHODS: For generating BiAb, the quadroma technique was used. Binding properties both to CD3 and PSA were shown by flow cytometry with the CD3 expressing Jurkat cell line and fluorescein-labeled PSA. Specific tumor cell lysis was tested with the PSA expressing prostate carcinoma cell line LNCaP as target and interleukin-2 activated human peripheral blood lymphocytes as effector cells in a chromium-51-release assay. For in vivo evaluation of the BiAb, a nude mouse model was used. The mice were inoculated with LNCaP prostate carcinoma cells. Animals with growing tumors were treated with 100 micrograms BiAb and 5 x 10(6) effector cells. RESULTS: Three stable quadromas producing anti-CD3 x anti-PSA BiAb were established. From the culture supernatant of one quadroma, BiAb was separated by affinity chromatography and tested in vitro and in vivo for its ability to target effector T lymphocytes against appropriate tumor cells. In vitro, a specific lysis of PSA expressing prostate carcinoma cells was demonstrated. In vivo, a significant reduction in tumor growth (p < 0.05) could be shown in nude mice treated with BiAb and effector cells as compared to a group treated only with effector cells and an untreated control group. CONCLUSION: In the present study, an anti-CD3 x anti-PSA-BiAb was demonstrated to be effective against prostate carcinoma cells in vitro and in vivo. Therefore this BiAb may be a tool for the immunotherapy of prostate cancer.

Correlation of clinical and immunological parameters of metastatic renal cell carcinoma patients undergoing therapy with interleukin 2, interferon-alpha and retinoic acid.

IFN-gamma production in whole blood cell cultures (WBCC), and TNF-receptor p75 (TNF-R-75) plasma levels were measured as two independent immunological parameters in a group of 67 untreated renal cell carcinoma (RCC) patients at different clinical stages, and 40 age matched healthy controls. In the blood cell cultures of the tumor patients the levels of IFN-gamma were significantly lower compared to the controls and the values decreased with increasing tumor mass. In contrast, TNF-R-75 plasma levels were significantly higher in the tumor patients and increased with tumor stage. Additionally serial assessments of these parameters were studied in another group of 15 patients with advanced RCC during treatment with IL-2, IFN-alpha and retinoic acid according to three different protocols in order to search for any correlation between the biological marker values and the clinical response to treatment. During each 5 day cycle of high dose IL-2/IFN-alpha combination therapy (protocol 1) IFN-gamma-levels in the WBCC were markedly decreased, whereas the plasma levels of TNF-R-75 were increased. During low dose, long-term continuous IFN-alpha/IL-2 administration (protocol 2) in two patients a clear increase of the ex vivo leukocyte IFN-gamma production was seen for the first 5 and 6 months of treatment, respectively, which could be correlated to stable disease for this time. When progression was diagnosed, IFN-gamma levels in the WBCC decreased. In the WBCC of the other four patients with progressive IFN-gamma levels were rather low throughout (< 10 ng/ml) and no clear changes were measured. During low does IFN-alpha and 13-cis-retinoic acid therapy in repetitive weekly cycles (protocol 3) two patients had stable disease for 6 and 14 months respectively. In the WBCC cultures of these patients IFN-gamma production was higher during stable than during progressive disease. The other two patients with tumor progression had a very low leukocyte IFN-gamma production and high plasma levels of TNF-R-75. It is concluded that IFN-gamma levels in WBCC and TNF-R-75 plasma levels may be useful parameters for the immunological monitoring of therapies with biological response modifiers. Low IFN-gamma values and high TNF-R-75 levels may be predictive of tumor progression and bad prognosis.

Percutaneous lithotripsy of renal calculi.

Percutaneous nephrostomy and stone removal was performed 240 times in 84 patients during a five-year period. Surgery was necessary in only two cases; hemorrhage requiring blood transfusion occurred in four. Perforation of the renal pelvis in five patients healed without sequelae. Final control of the nephrostomy was achieved in almost all cases. Indications and technical points regarding percutaneous lithotripsy are discussed.

[Limitations of reproductive medicine from an andrological/urological point of view]. / Grenzen der Reproduktionsmedizin aus andrologisch-urologischer Sicht.

Since the first child was born after in-vitro fertilization in 1978, different techniques of ovarian stimulation, oocyte retrieval and embryo culture have improved significantly. The development of microinjection techniques was a mile stone in reproductive medicine. Even in cases of severe impairment of semen quality, using the Intracytoplasmic Sperm Injection (ICSI), pregnancy rates of approximately 20 % per treatment cycle can be achieved. However for using artificial reproductive techniques (ART) the female age is a major limiting factor as well as the development of premature ovarian failure (POF). Crucial for the male is the question whether or not sperm cells can be retrieved. Today an interdisciplinary approach is recommended to take care of the afflicted couple in order to address the complex problem of infertility. There is evidence that children born after microinjection techniques bare a higher risk for chromosomal aberrations compared to the normal population. However rates of major malformations seem to be identical in both groups. An evaluation of the potential risks and efforts and an extensive counseling of the infertile couple has to be taken before initiating invasive ART.

[Diagnosis of a venous fistula as a cause of erection disorders. Experimental principles and practical conclusions]. / Die Diagnose des venösen Lecks als Ursache von Erektionsstörungen. Experimentelle Grundlagen und praktische Schlussfolgerungen.

An experimental study was done in ten dogs and eight monkeys to evaluate the accuracy of dynamic and pharmacologic cavernosometry and cavernosography in the diagnosis of venogenic impotence. Our findings show that erection induced by saline perfusion comes about because the penile venous outflow capacity is exceeded. Thus, the cavernous occlusive mechanisms are not activated. Cavernosography in induced erection always demonstrated the entire cavernous venous system. However, cavernosometry after pharmacologic cavernous smooth muscle relaxation provides useful diagnostic information. Similarly, cavernosography after pharmacologic cavernous smooth muscle relaxation proved to be useful for the identification of abnormally draining veins.

[Open multicenter study of the differential diagnosis of erectile dysfunction with a papaverine-phentolamine combination (BY023)]. / Offene Multizenterstudie zur Differentialdiagnostik der erektilen Dysfunktion mit einer Papaverin-Phentolamin-Kombination (BY023).

We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).

[UroLift®: an operative non-ablative procedure for treatment of benign prostatic syndrome]. / UroLift® : Ein operatives, nicht ablatives Verfahren zur Therapie des benignen Prostatasyndroms.

The implantation of a tissue retractor (UroLift®, Neotract, Pleasanton, CA) allows for the first time as a non-ablative operative technique, moderate deobstruction without removal or destruction of prostate tissue. The achievable treatment results are at least comparable to drug therapy with respect to alleviation of suffering and symptoms (primary treatment aim) and superior with respect deobstruction. The advantage of this method compared to all other conservative and operative therapy procedures is preservation of sexual function. An evaluation of this method is currently being carried out and compared to TURP in prospective, randomized studies (BPH6 study) and the results are expected in 2015.

[The Freiburg Index of Patient Satisfaction: introduction and validation of a new questionnaire]. / Der Freiburger Index für Patientenzufriedenheit. Vorstellung eines neuen Instruments und seiner psychometrischen Eigenschaften.

BACKGROUND: In the era of evidence-based medicine health-related quality of life measurements are recognized as valuable indicative factors. Because there was no generally applicable questionnaire addressing patient satisfaction after interventional or surgical procedures, the Freiburg Index of Patient Satisfaction was developed and psychometrically evaluated. METHODS: A preliminary version was evaluated and optimized through structured interviews with 20 patients (qualitative pre-study). The final questionnaire was then applied to 257 urological patients and a comprehensive statistical analysis including validation to a matching questionnaire (ZUF-8, Kriz 2008) was performed. RESULTS: All psychometric qualities scored well. The examined sample showed no missing values and no ceiling effect as otherwise found frequently: the most positive answer categories accounted for 43.6 % of cases. Reliability (Cronbach's Alpha = 0.84, discriminatory power = 0.50) was high. Furthermore the results of a factor analysis proofed unidimensionality of the questionnaire. Validity was shown by a close correlation between FIPS and ZUF-8 scores (r = 0.747, p < .001). CONCLUSION: The Freiburg Index of Patient Satisfaction is a generally applicable questionnaire to evaluate treatment satisfaction after interventional or surgical procedures. The questionnaire can be used to objectify results and increase comparability of clinical studies and quality in health care.

[Empathic leadership: shaping positive change]. / Empathische Führung: Veränderung positiv gestalten.

This paper explains the concept of empathic leadership in the setting of fundamental organisational changes. It deals with the question of how you can establish a culture of leadership, which motivates employees positively and enthuses them for the upcoming changes. It discusses the basics of empathic leadership and considers the question of how handling of emotions influences change processes and how different management styles can be used supportively during changes. With the help of a practical example the different phases of change are presented from a management point of view. Thereby the theory of different levels of employee motivation is explained inter alia. The article shows that empathic leadership also has a lasting economic effect. This can be seen particularly in the power of motivation for change, in addition to recruitment and long-term employee retention.

[Testosterone and psyche]. / Testosteron und Psyche.

Testosterone, like other steroid hormones, crosses the blood-brain barrier, and the androgen receptor is present in most parts of the human brain. Therefore, testosterone has many effects on the psyche, mainly in men but also in women. Most often discussed is its influence on sexuality, especially on desire and sexual fantasies, spontaneous nighttime erections, sexual activity, and the number of orgasms and ejaculations. Mood and energy are also testosterone related. Testosterone deficiency in male patients can lead to depressive disorders. In the past, elevated testosterone levels were seen as responsible for strongly aggressive behaviour. Some cognitive functions (spatial and mathematical sense, verbal skills) are, at least to a certain point, testosterone related. Due to the extremely complex functioning of the human brain, a scientifically exact statement regarding the true relationship between testosterone and human behaviour is not possible. On the one hand, the cause is definitively multifactorial, but on the other, testosterone is metabolised in the brain, and the metabolites act by themselves. Furthermore, a bidirectional relationship exists between hormones and human behaviour: Human behaviour is influenced by hormones, and human behaviour also has a direct influence on the levels of many hormones in the human body. Finally, much data in this field are derived from animal studies; studies on humans cannot be conducted because of ethical reasons or scientific and technical problems.

A bispecific diabody directed against prostate-specific membrane antigen and CD3 induces T-cell mediated lysis of prostate cancer cells.

BACKGROUND: Although cancer of the prostate is one of the most commonly diagnosed cancers in men, no curative treatment currently exists after its progression beyond resectable boundaries. Therefore, new agents for targeted treatment strategies are needed. Cross-linking of tumor antigens with T-cell associated antigens by bispecific monoclonal antibodies have been shown to increase antigen-specific cytotoxicity in T-cells. Since the prostate-specific membrane antigen (PSMA) represents an excellent tumor target, immunotherapy with bispecific diabodies could be a promising novel treatment option for prostate cancer. METHODS: A heterodimeric diabody specific for human PSMA and the T-cell antigen CD3 was constructed from the DNA of anti-CD3 and anti-PSMA single chain Fv fragments (scFv). It was expressed in E. coli using a vector containing a bicistronic operon for co-secretion of the hybrid scFv V(H)CD3-V(L)PSMA and V(H)PSMA-V(L)CD3. The resulting PSMAxCD3 diabody was purified from the periplasmic extract by immobilized metal affinity chromatography (IMAC). The binding properties were tested on PSMA-expressing prostate cancer cells and PSMA-negative cell lines as well as on Jurkat cells by flow cytometry. For in vitro functional analysis, a cell viability test (WST) was used. For in vivo evaluation the diabody was applied together with human peripheral blood lymphocytes (PBL) in a C4-2 xenograft-SCID mouse model. RESULTS: By Blue Native gel electrophoresis, it could be shown that the PSMAxCD3 diabody is mainly a tetramer. Specific binding both to CD3-expressing Jurkat cells and PSMA-expressing C4-2 cells was shown by flow cytometry. In vitro, the diabody proved to be a potent agent for retargeting PBL to lyze C4-2 prostate cancer cells. Treatment of SCID mice inoculated with C4-2 tumor xenografts with the diabody and PBL efficiently inhibited tumor growth. CONCLUSIONS: The PSMAxCD3 diabody bears the potential for facilitating immunotherapy of prostate cancer and for the elimination of minimal residual disease.

A recombinant PSMA-specific single-chain immunotoxin has potent and selective toxicity against prostate cancer cells.

Prostate cancer is the most commonly diagnosed form of cancer and the second leading cancer-related death among men in the Western civilization. Since no effective therapy exists for this tumor after progression beyond resectable boundaries, there is an urgent need for new treatment strategies. Prostate specific membrane antigen (PSMA) represents an excellent target on prostate cancer cells, and therefore specific immunotherapy may be a novel therapeutic option for the management of this tumor. We constructed a fully recombinant immunotoxin (A5-PE40) from a single-chain antibody fragment (scFv) against cell-adherent PSMA and a truncated form of Pseudomonas exotoxin A (PE40) lacking its natural binding domain Ia. The scFv A5 was obtained from a mAb elicited with native PSMA by phage display technology and direct selection on cells carrying the antigen. The bacterially expressed and purified immunotoxin A5-PE40 specifically binds to PSMA-positive prostate cancer cells and induces a 50% reduction of viability (IC50) at a concentration of 20 pM, while PSMA-negative cells remain unaffected. Due to its high and specific toxicity this recombinant immunotoxin is a promising candidate for therapeutic applications in patients with prostate cancer.