Prognostic value of prostate circulating cells detection in prostate cancer patients: a prospective study

In clinically organ-confined prostate cancer patients, bloodstream tumour cell dissemination generally occurs, and may be enhanced by surgical prostate manipulation. To evaluate cancer-cell seeding impact upon patient recurrence-free survival, 155 patients were prospectively enrolled then followed. Here, 57 patients presented blood prostate cell shedding preoperatively and intraoperatively (group I). Of the 98 preoperatively negative patients, 53 (54%) remained negative (group II) and 45 (46%) became intraoperatively positive (group III). Median biological and clinical recurrence-free time was far shorter in group I (36.2 months, P<0.0001) than in group II (69.6 months) but did not significantly differ in group II and III (69.6 months vs 65.0). Such 5-year follow-up data show that preoperative circulating prostate cells are an independent prognosis factor of recurrence. Moreover, tumour handling induces cancer-cell seeding but surgical blood dissemination does not accelerate cancer evolution

Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trials

<p>Abstract</p> <p>Background</p> <p>Although laparoscopic surgery has been available for a long time and laparoscopic cholecystectomy has been performed universally, it is still not clear whether open appendectomy (OA) or laparoscopic appendectomy (LA) is the most appropriate surgical approach to acute appendicitis. The purpose of this work is to compare the therapeutic effects and safety of laparoscopic and conventional "open" appendectomy by means of a meta-analysis.</p> <p>Methods</p> <p>A meta-analysis was performed of all randomized controlled trials published in English that compared LA and OA in adults and children between 1990 and 2009. Calculations were made of the effect sizes of: operating time, postoperative length of hospital stay, postoperative pain, return to normal activity, resumption of diet, complications rates, and conversion to open surgery. The effect sizes were then pooled by a fixed or random-effects model.</p> <p>Results</p> <p>Forty-four randomized controlled trials with 5292 patients were included in the meta-analysis. Operating time was 12.35 min longer for LA (95% CI: 7.99 to 16.72, p < 0.00001). Hospital stay after LA was 0.60 days shorter (95% CI: -0.85 to -0.36, p < 0.00001). Patients returned to their normal activity 4.52 days earlier after LA (95% CI: -5.95 to -3.10, p < 0.00001), and resumed their diet 0.34 days earlier(95% CI: -0.46 to -0.21, p < 0.00001). Pain after LA on the first postoperative day was significantly less (p = 0.008). The overall conversion rate from LA to OA was 9.51%. With regard to the rate of complications, wound infection after LA was definitely reduced (OR = 0.45, 95% CI: 0.34 to 0.59, p < 0.00001), while postoperative ileus was not significantly reduced(OR = 0.91, 95% CI: 0.57 to 1.47, p = 0.71). However, intra-abdominal abscess (IAA), intraoperative bleeding and urinary tract infection (UIT) after LA, occurred slightly more frequently(OR = 1.56, 95% CI: 1.01 to 2.43, p = 0.05; OR = 1.56, 95% CI: 0.54 to 4.48, p = 0.41; OR = 1.76, 95% CI: 0.58 to 5.29, p = 0.32).</p> <p>Conclusion</p> <p>LA provides considerable benefits over OA, including a shorter length of hospital stay, less postoperative pain, earlier postoperative recovery, and a lower complication rate. Furthermore, over the study period it was obvious that there had been a trend toward fewer differences in operating time for the two procedures. Although LA was associated with a slight increase in the incidence of IAA, intraoperative bleeding and UIT, it is a safe procedure. It may be that the widespread use of LA is due to its better therapeutic effect.</p

Outcome reporting in randomised controlled trials and meta-analyses of appendicitis treatments in children: a systematic review

Background: Acute appendicitis is the most common surgical emergency in children. Despite this, there is no core outcome set (COS) described for randomised controlled trials (RCTs) in children with appendicitis and hence no consensus regarding outcome selection, definition and reporting. We aimed to identify outcomes currently reported in studies of paediatric appendicitis. / Methods: Using a defined, sensitive search strategy, we identified RCTs and systematic reviews (SRs) of treatment interventions in children with appendicitis. Included studies were all in English and investigated the effect of one or more treatment interventions in children with acute appendicitis or undergoing appendicectomy for presumed acute appendicitis. Studies were reviewed and data extracted by two reviewers. Primary (if defined) and all other outcomes were recorded and assigned to the core areas ‘Death’, ‘Pathophysiological Manifestations’, ‘Life Impact’, ‘Resource Use’ and ‘Adverse Events’, using OMERACT Filter 2.0. / Results: A total of 63 studies met the inclusion criteria reporting outcomes from 51 RCTs and nine SRs. Only 25 RCTs and four SRs defined a primary outcome. A total of 115 unique and different outcomes were identified. RCTs reported a median of nine outcomes each (range 1 to 14). The most frequently reported outcomes were wound infection (43 RCTs, nine SRs), intra-peritoneal abscess (41 RCTs, seven SRs) and length of stay (35 RCTs, six SRs) yet all three were reported in just 25 RCTs and five SRs. Common outcomes had multiple different definitions or were frequently not defined. Although outcomes were reported within all core areas, just one RCT and no SR reported outcomes for all core areas. Outcomes assigned to the ‘Death’ and ‘Life Impact’ core areas were reported least frequently (in six and 15 RCTs respectively). / Conclusions: There is a wide heterogeneity in the selection and definition of outcomes in paediatric appendicitis, and little overlap in outcomes used across studies. A paucity of studies report patient relevant outcomes within the ‘Life Impact’ core area. These factors preclude meaningful evidence synthesis, and pose challenges to designing prospective clinical trials and cohort studies. The development of a COS for paediatric appendicitis is warranted

Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients

Taustasäteilyn havainnollistaminen diffuusiosumukammiolla Säteilevä ympäristö -työpajassa

Tutkimus suoritettiin kahdelle Oulun Tietomaan tiedeleiri ryhmälle ja yhdelle kouluryhmälle kahden tunnin Säteilevä ympäristö -työpajana Oulun Tietomaassa kesällä sekä syksyllä 2014. Tutkimusryhmät koostuivat pääasiassa 5.–6. vuosiluokan oppilaista. Työpajassa oppilaat rakensivat itse sumukammion, jolla he tekivät havaintoja taustasäteilystä. Tutkimus suoritettiin kyselytutkimuksena ennen työpajan aloitusta ja heti työpajan jälkeen. Kyselyillä kartoitettiin oppilaiden esitietoja ja sitä, mitä työpajasta oli jäänyt mieleen. Auttoiko sumukammio tuomaan esiin säteilyn hiukkasluonnetta? Ymmärtävätkö oppilaat havaitut radat säteilyn synnyttämiksi? Tutkimukseen osallistuneista oppilaista suurin osa oli alakoululaisia. Säteily ei kuulunut heidän opetussuunnitelmansa sisältöön, joten epäilin oppilaiden kykyä suoriutua työpajasta. Tutkimushypoteesina oletin, että alakoululaisilla ei ole esitietoja säteily- ja hiukkasfysiikasta. Tiedeleiri-ryhmissä oli muutamia yläkoululaisia. Heillä oli tietoa säteilystä koska se kuuluu yläkoulun opetussuunnitelman sisältöön. Tutkimuksessa havaittiin alakoululaisten ja yläkoululaisten opetussuunnitelmien eriävistä sisällöistä johtuvia eroja. Yläkoululaisten kanssa voidaan käyttää tarkempia ja tieteellisempiä termejä, kuin alakoululaisen kanssa. Riippumatta oppilaan osaamistasosta oppilaat onnistuivat tekemään havaintoja itse rakennetulla sumukammiolla. Työpajassa onnistuttiin havainnollistamaan taustasäteilyn synnyttämiä ratoja sumukammiossa. Säteilyn hiukkasluonne jäi osalta oppilaista ymmärtämättä vaillinaisten tietojen takia. Hiukkassäteily oli alakoululaisille liian haastavaa, sillä hiukkassäteily -termi oli heille vieras. Tulosten mukaan säteilyn koostuminen hiukkasista oli oppilaista hyväksyttävää. Oppilaat kykenivät rakentamaan pareittain sumukammion ja havainnoimaan sillä taustasäteilyä. Kaikki oppilaat onnistuivat tekemään havaintoja. Yleisin havainto oli ohut rata eli kyseessä oli beetahiukkasen tai myonin jättämä rata. Vain joka kymmenes teki useita havaintoja. Sumukammio ja ratojen havainnointi oli heille uutta. Hentojen ratojen havainnointi vaati oppilailta keskittymistä. Oppilaiden mielenkiintoa ratojen havainnoinnista vei kuivajää. Oppilaat eivät tehneet eroa syntyneiden ratojen välillä. Itse rakennetussa sumukammiossa ratojen erottaminen vaatii harjaantunutta silmää. Oppilaille pitää esittää toisistaan selvästi erottuvat radat. Työpajaa pitää kehittää niin, että radat eroavat selvästi toisistaan. Kaksi selvästi silmin havaittavaa eri rataa saadaan, kun havainnoidaan alfa- ja beetaratoja. Alfaradat synnytettäisiin sumukammioon alfalähteellä.The study was conducted throughout spring and autumn 2014 on three groups of students through the Radiant environment workshop at Oulu’s Tietomaa science centre. Two of the groups came through Tietomaa’s science camp and one was a comprehensive school class group. The groups consisted primarily of 5th and 6th grade lower comprehensive school students. In the workshop, students constructed a cloud chamber to observe background radiation. The study was conducted as a question-based survey before and after the workshop, and it charted the students’ prior background knowledge and what they learned in the workshop: Did the cloud chamber help them observe the particle nature of radiation? Do the students understand that the visible cloud chamber trails are caused by radiation? The majority of students to participate in the study were lower comprehensive school students. The concept of radiation was not a part of their curriculum: Therefore I was sceptical about their chances of managing through the workshop. My study hypothesis was that lower comprehensive school students do not possess prior knowledge on radiation or particle physics. Some of the students in the science camp groups were upper comprehensive school students, and they did possess knowledge on radiation due to it being part of the upper comprehensive curriculum. The study observed group differences due to differing curricula. With upper comprehensive school students, a more precise scientific vocabulary could be adopted. Independent of the level of prior knowledge, students succeeded in making observations using a self-constructed cloud chamber. The workshop succeeded in demonstrating trails created by background radiation in the chamber. The particle nature of radiation was not understood by all the students due to their insufficient prior knowledge. Particle radiation proved too challenging a concept for lower comprehensive school students as they had no background knowledge and did not understand the concept. According to the study results, the students found the notion that radiation consists of particles agreeable. The students, working in paired assignments, were able to construct a cloud chamber and observe the background radiation. All students succeeded in making at least one observation. The most-often made observation was a thin trail, left by a beta particle or a muon. Only ten per cent of the students were able to make multiple observations. The diffusion cloud chamber and particle trails were new to them. It required the students substantial focus to observe thin trails. The visual aspects of dry ice detracted students from the matter at hand. The students were not able to discern differences between trails, as it requires a trained eye to discern different trail types in a self-constructed cloud chamber. The students needed to be directly shown the differences in trail types, and the workshop should be improved so that trail types would be visibly different to students: Two distinctively differing types of trails can be achieved by observing alpha and beta trails. Alpha trails would be generated into the cloud chamber using a source of alpha particles

Relative concentrations of hK2/PSA mRNA in benign and malignant prostatic tissue

BACKGROUND. Prostate-specific antigen (PSA/KLK3) and human kallikrein 2 (hK2/KLK2) belong to the human kallikrein gene family. These two highly homologous genes are specifically expressed in the prostate under androgen control. Expression of these is regulated by similar mechanisms but changes in their relative expression have been observed in prostate cancer. METHODS. We determined the relative levels of PSA and hK2 mRNA in benign and malignant prostate tissue using a quantitative reverse transcription-polymerase chain reaction (RT-PCR) method. The mRNA of PSA and hK2 are reverse transcribed and amplified in one reaction with the same primers. RESULTS. The variation in the ratio of hK2/PSA mRNA was remarkably small, the difference between the highest and lowest values being three-fold. The ratio was significantly higher in WHO grade 2 compared to normal or benign prostatic hyperplasia tissue (P=0.032 and P=0.035, respectively) and in grade 3 compared to normal or benign prostatic hyperplasia tissue (P=0.006 in both). CONCLUSIONS. The new quantitative RT-PCR technique facilitates very accurate quantitation of the relative mRNA levels of homologous genes. Using this method we have shown that the ratio of hK2/PSA mRNA is higher in cancerous than in benign prostatic tissue