Optimal treatment for castration-resistant prostate cancer

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Kinetics of cerebral blood flow in the moderate and heavy exercise intensity domains estimated using the transcranial Doppler method

Purpose: The purpose of this study was to investigate the kinetics of cerebral blood flow (CBF) in conjunction with cardiopulmonary response during constant-work rate cycling exercise of moderate and heavy intensities. Methods: Seven subjects (6 males and 1 female; age, 25.4 ± 7.7 yr; height, 171.9 ± 4.3 cm; body mass, 67.7 ± 11.4 kg) participated in the present study. The subjects completed incremental cycle ergometer test to assess VO2peak, the gas exchange threshold (GET), and the respiratory compensation threshold (RCT). Secondary, the subjects performed two sets of constant workload of exercise bouts (10 min) by cycle ergometer corresponding to the level of 10% below GET (moderate intensity) and RCT (heavy intensity). Respiratory gas analysis and the middle cerebral blood flow mean velocity (MCA Vmean) were measured simultaneously using the transcranial Doppler (TCD) method. PaCO2 was estimated (ePaCO2) using PETCO2 and VT. We assumed that MCA Vmean could be used as an index of the global CBF. Results: VO2 and ePaCO2 remained stable after the onset at moderate intensity whereas VO2 increased throughout the trail and ePaCO2 decreased after the onset at heavy intensity. The percentage change from baseline for MCA Vmean (ΔMCA Vmean) increased within 2 min to a peak value within 2 min by 32.8 ± 9.1% and 31.8 ± 11.8% at moderate and heavy intensity, respectively. In the heavy-intensity exercise ΔMCA Vmean decreased further below the response to moderate exercise as time progressed prior to the recovery phase (trials × time: F = 3.84, P < 0.05). Conclusion: The different kinetics of MCA Vmean between moderate and heavy-intensity exercise was identified during a constant work rate cycling exercise. We found that in heavy-intensity trials, the relationship between ePaCO2 and MCA Vmean was different to that at moderate intensity during the recovery phase

Cerebrovascular response to CO2 during moderate-intensity exercise measured by performing transcranial Doppler Ultrasonography

Previous studies demonstrated that cerebral blood flow (CBF) changes during dynamic exercise and a physiological basis for this observation may be explained by the tight control of CBF by arterial carbon dioxide tension (PaCO?). This study examined whether the steady state of the middle cerebral artery blood flow velocity (MCAVmean) and PaCO?could be observed during constant work rate cycling exercise and to investigate the cerebrovascular reactivity (CVR) to CO?. Seven young volunteers performed a 10-min exercise session with constant workload using a cycle ergometer, with intensities corresponding to the level below the lactate threshold. Respiratory gas analysis and MCAVmean were measured simultaneously using the transcranial Doppler (TCD) method. PaCO?was estimated (ePaCO?) using the end-tidal pressure of CO?(PETCO?) and the tidal volume (VT). On-transient phase II of VO?and the corresponding responses of MCAVmean and ePaCO? were investigated simultaneously with the monoexponential model. Since the responses in ΔMCAVmean or ePaCO?had the overshoot phase within 3min in some cases, analysis for the fitted curves of the monoexponential model was performed during the first 5 min as well as during the total 10 min. CVR to CO?during the dynamic cyclic exercise was 5.33 % mmHg-1 and 4.78 % mmHg?1 in the 5-min and the 10-min analysis, respectively. In the 5-min and the 10-min analysis, CVR to CO?significantly correlated with the exercise intensity during the 10-min bout (r2 = 0.89 and 0.75, respectively). During the on-transient phase of dynamic exercise, CBF would be influenced by PaCO?and other factors such as the neuronal activation and cardiac output would also be involved in changing CBF

Severe Renal Hemorrhage in a Pregnant Woman Complicated with Antiphospholipid Syndrome: A Case Report

Antiphospholipid syndrome is a systemic autoimmune disease with thrombotic tendency. Consensus guidelines for pregnancy with antiphospholipid syndrome recommend low-dose aspirin combined with unfractionated or low-molecular-weight heparin because antiphospholipid syndrome causes habitual abortion. We report a 36-year-old pregnant woman diagnosed with antiphospholipid syndrome receiving anticoagulation treatment. The patient developed left abdominal pain and gross hematuria at week 20 of pregnancy. An initial diagnosis of left ureteral calculus was made. Subsequently abdominal-pelvic computed tomography was required for diagnosis because of the appearance of severe contralateral pain. Computed tomography revealed serious renal hemorrhage, and ureteral stent placement and pain control by patient-controlled analgesia were required. After treatment, continuance of pregnancy was possible and vaginal delivery was performed safely. This is the first case report of serious renal hemorrhage in a pregnant woman with antiphospholipid syndrome receiving anticoagulation treatment and is an instructive case for urological and obstetrical practitioners

Predictive factor and antihypertensive usage of tyrosine kinase inhibitor-induced hypertension in kidney cancer patients

Hypertension (HT) is the common adverse event associated with vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKI). The present study was performed to identify the predictive factors of TKI-induced HT and to determine the classes of antihypertensive agents (AHTA) that demonstrate optimal efficacy against this type of HT. The charts of 50 cases of patients that had received VEGFR-TKI treatment were retrospectively examined. The association between patient background and TKI-induced HT, and the effect of administering AHTA were analyzed. High systolic blood pressure at baseline was identified to be a predictive factor for HT. In addition, there was no difference observed between calcium channel blockers (CCBs) and angiotensin receptor II blockers (ARBs) as first-line AHTA for the control of HT. The findings of the present study may aid with predicting the onset of TKI-induced HT, as well as for its management via the primary use of either CCBs or ARBs