Limited prognostic role of routine serum markers (AP, CEA, LDH and NSE) in oligorecurrent prostate cancer patients undergoing PSMA-radioguided surgery

INTRODUCTION

We evaluated the prognostic role of pre-salvage prostate-specific membrane antigen-radioguided surgery (PSMA-RGS) serum levels of alkaline phosphatase (AP), carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), and neuron-specific enolase (NSE).

MATERIALS AND METHODS

Patients who consecutively underwent PSMA-RGS for prostate cancer (PCa) oligorecurrence between January 2019 and January 2022 were selected. Biomarkers were assessed one day before surgery. Cox regression and logistic regression models tested the relationship between biochemical recurrence-free survival (BFS), 6- and 12-month biochemical recurrence (BCR), and several independent variables, including biomarkers.

RESULTS

153 consecutive patients were analyzed. In the univariable Cox regression analysis, none of the biomarkers achieved predictor status (AP: hazard ratio [HR] = 1.03, 95% CI 0.99, 1.01; p = 0.19; CEA: HR = 1.73, 95% CI 0.94, 1.21; p = 0.34; LDH: HR = 1.01, 95% CI 1.00, 1.01; p = 0.05; NSE: HR = 1.02, 95% CI 0.98, 1.06; p = 0.39). The only independent predictor of BFS was the number of positive lesions on PSMA PET (HR = 1.17, 95% CI 1.02, 1.30; p = 0.03). The number of positive lesions was confirmed as independent predictor for BCR within 6 and 12 months (BCR < 6 months: odds ratio [OR] = 1.1, 95% CI 1.0, 1.3; p = 0.04; BCR < 12 months: OR = 1.1, 95% CI 1.0, 1.3; p = 0.04).

CONCLUSION

The assessment of AP, CEA, LDH, and NSE before salvage PSMA-RGS showed no prognostic impact. Further studies are needed to identify possible predictors that will optimize patient selection for salvage PSMA-RGS.

Effects of isolation and confinement on gastrointestinal microbiota-a systematic review

Purpose

The gastrointestinal (GI) microbiota is a complex and dynamic ecosystem whose composition and function are influenced by many internal and external factors. Overall, the individual GI microbiota composition appears to be rather stable but can be influenced by extreme shifts in environmental exposures. To date, there is no systematic literature review that examines the effects of extreme environmental conditions, such as strict isolation and confinement, on the GI microbiota.

Methods

We conducted a systematic review to examine the effects of isolated and confined environments on the human GI microbiota. The literature search was conducted according to PRISMA criteria using PubMed, Web of Science and Cochrane Library. Relevant studies were identified based on exposure to isolated and confined environments, generally being also antigen-limited, for a minimum of 28 days and classified according to the microbiota analysis method (cultivation- or molecular based approaches) and the isolation habitat (space, space- or microgravity simulation such as MARS-500 or natural isolation such as Antarctica). Microbial shifts in abundance, alpha diversity and community structure in response to isolation were assessed.

Results

Regardless of the study habitat, inconsistent shifts in abundance of 40 different genera, mainly in the phylum Bacillota (formerly Firmicutes) were reported. Overall, the heterogeneity of studies was high. Reducing heterogeneity was neither possible by differentiating the microbiota analysis methods nor by subgrouping according to the isolation habitat. Alpha diversity evolved non-specifically, whereas the microbial community structure remained dissimilar despite partial convergence. The GI ecosystem returned to baseline levels following exposure, showing resilience irrespective of the experiment length.

Conclusion

An isolated and confined environment has a considerable impact on the GI microbiota composition in terms of diversity and relative abundances of dominant taxa. However, due to a limited number of studies with rather small sample sizes, it is important to approach an in-depth conclusion with caution, and results should be considered as a preliminary trend. The risk of dysbiosis and associated diseases should be considered when planning future projects in extreme environments.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022357589.

Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy

OBJECTIVES

Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated.

METHODS

Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens.

RESULTS

This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low-grade biopsy.

CONCLUSIONS

High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.

Single-lesion Prostate-specific Membrane Antigen Protein Expression (PSMA) and Response to [177Lu]-PSMA-ligand Therapy in Patients with Castration-resistant Prostate Cancer

Initial reports of a clinical response in patients treated with the radioligand [¹⁷⁷Lu]-PSMA-617 for castration-resistant prostate cancer (CRPC) are promising, despite known inter- and intrapatient heterogeneity. In metastatic CRPC, we examined the association of baseline immunohistochemical (IHC) expression of prostate-specific membrane antigen (PSMA) in a single lesion and responsiveness to [¹⁷⁷Lu]-PSMA-617 therapy, measured as the PSMA maximum standardized uptake value (SUV_max). Between 2015 and 2020, 19 patients with multiple metastases underwent single-lesion biopsy, [⁶⁸Ga]-PSMA positron emission tomography (PET) imaging, and treatment with [¹⁷⁷Lu]-PSMA-617. A monoclonal anti-PSMA antibody was used to semiquantitatively assess PSMA IHC in the biopsy specimen. Imaging evaluation of the biopsied single lesion and overall response was performed according to Positron Emission Tomography Response Criteria in Solid Tumors. The PSMA IHC histoscore correlated positively with pretreatment same-site PSMA SUV_max (r_s = 0.6). Nine patients had imaging after three cycles of [¹⁷⁷Lu]-PSMA-617 and were included in the lesion-specific analysis. Of these, five patients (55.6%) had an SUV_max response at the biopsy site, but three experienced overall progression. The histoscore was unable to predict the lesion-specific change in SUV_max (95% confidence interval [CI] −44.2 to 69.2) or PSA (95% CI−125.2 to 17.2). There was no correlation between single-lesion SUV_max and overall progression (r_s = 0.1) on [⁶⁸Ga]-PSMA PET imaging. Additional studies need to interrogate the clinical consequence of PSMA expression heterogeneity in metastases and the association with response to [¹⁷⁷Lu]-PSMA-671.

Patient summary

Treatment with a radioactive binding molecule called [¹⁷⁷Lu]-PSMA-617 for men with prostate cancer resistant to castration (CRPC) is showing promise. We investigated the association between the presence of PSMA protein in metastatic lesions at biopsy and response to [¹⁷⁷Lu]-PSMA-617 among men with metastatic CRPC. We found that assessment of PSMA presence at biopsy is not a reliable predictor of response to [¹⁷⁷Lu]-PSMA-617. Additional studies are needed to better determine which CRPC metastatic sites will respond to this therapy.

Single-lesion PSMA protein expression and response to Lu-177 PSMA therapy in patients with castration-resistant prostate cancer

5065

Background: The recent introduction of Lu-177 PSMA for the treatment of castration-resistant prostate cancer (CRPC) has been met with much excitement. Initial reports of clinical response are promising, despite known inter- and intra-patient molecular heterogeneity. In this study, we examined the utility of PSMA protein expression in metastatic tumor tissues as a predictor of lesion-specific response to Lu-177 PSMA therapy in men with CRPC. Methods: Between 2015-2020, 19 patients with metastases at multiple sites underwent metastatic lesion biopsy, Ga-68 PSMA PET imaging, and subsequent treatment with three cycles of Lu-177 PSMA. A monoclonal anti-PSMA antibody (EPITOMICS (USA), 1:50) was used to semi-quantitatively assess PSMA protein expression in the biopsy specimen. The histoscore (range 0-300) was derived from intensity and extent of the immunohistochemistry staining and was determined by experienced genitourinary pathologists. Imaging evaluation was performed according to the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) criteria. We assessed the association of the PSMA protein expression in metastatic tumor tissues and the lesion-specific response to Lu-177 PSMA therapy. Results: In 12 patients with biopsy specimens available for staining, PSMA expression correlated with enhancement (SUVmax) of the biopsy site on Ga-68 PSMA PET imaging (rs = 0.63). Of the nine patients with repeat imaging after Lu-177 PSMA therapy, five (55.6%) had a lesion-specific response at the site of biopsy. PSMA expression on immunohistochemistry was unable to accurately predict lesion-specific response in univariable analysis (p = 0.81, 95% CI 94.6-76.6). Among the five men with a lesion-specific response, three (60%) experienced overall progression based on PERCIST. There was no association between lesion-specific response and overall progression (p = 0.64). Conclusions: In patients with multiple metastases, PSMA protein expression from a single site biopsy was not predictive of site-specific Lu-177 PSMA response based on PERCIST. Additional studies are necessary to further interrogate the clinical consequence of PSMA expression heterogeneity in metastatic sites as well as the mechanisms underpinning resistance to Lu-177 PSMA in patients with CRPC.

Flow cytometry for assessing the efficacy of interspecific gynogenesis induction in sturgeon

The efficacy of ploidy analysis for separating progeny of Siberian sturgeon Acipenser baerii after induced gynogenesis was demonstrated using sperm of a paternal species differing in ploidy level from the maternal species. Gynogenesis was induced in tetraploid A. baerii with UV-C irradiated sperm from the diploid sterlet Acipenser ruthenus and vice-versa. The success of sperm UV irradiation and diploidy restoration by heat-shock was estimated based on the ploidy level of progeny, confirmed by microsatellite parentage assignment. Hatching rates of interspecific gynogenotes were comparable with rates reported for gynogenesis induction using sperm and eggs of the same species. Juvenile mortality was similar to that observed in the control hybrids. The efficiency and reliability of this method may foster its use for production of gynogenotes in aquaculture, potentially allowing interspecific gynogenesis to replace intraspecific.

Efficacy and toxicity of praziquantel in helminth-infected barbel (Barbus barbus L.)

This study evaluated efficacy and toxicity of the pyrazinoisoquinoline anthelmintic praziquantel (PZQ) in barbel infected with metacercariae of Diplostomum spathaceum and adult Pomphorhynchus laevis, and assessed antioxidant biomarkers and the lipid peroxidation response in juvenile barbel post-treatment. The estimated 96-hr LC50 of PZQ was 28.6 mg/L. For evaluation of efficacy, barbel naturally infected with D. spathaceum were exposed to a 10 and 20 mg/L PZQ 4-day bath treatment. Both concentrations were 100% effective against D. spathaceum and significantly (p < .01) affected the activity of catalase, superoxide dismutase, glutathione reductase and glutathione-S-transferase as well as levels of reduced glutathione in liver and muscle. The efficacy of orally administered PZQ was assessed in adult barbel naturally infected with P. laevis. Fish were administered 10, 30 and 50 mg/kg of body weight and examined via gut dissection after 6 days. The 50 mg/kg dose significantly decreased the intensity of infection. Praziquantel is a feasible bath treatment for barbel infected with D. spathaceum and has potential for oral treatment of broodfish infected with P. laevis.

Environmental benefits and concerns on safety: communicating latest results on nanotechnology safety research-the project DaNa2.0

The use of nanotechnology and advanced materials promises to revolutionise many areas of technology and improve our daily life. In that respect, many positive effects on the environment are expected, either directly, by developing new technologies for remediation, filtering techniques or energy generation, or indirectly, by e.g. saving resources due to lower consumption of raw materials, or lower energy and fuel consumption due to reduced weight of vehicles. However, such beneficial effects of new technologies are often confronted by concerns regarding the safety of novel substances or materials. During the past 10 years, great effort has been put into research on potential hazards of nanomaterials towards environmental organisms. As the methodology for reliable assessment of nanomaterials was immature, many studies reporting contradictory results have been published, hindering both risk assessment for nanomaterials, as well as the knowledge communication to all involved stakeholders. Thus, DaNa^2.0 serves as a platform to implement trusted knowledge on nanomaterials for an objective discussion.

Trace metal levels in serum and urine of a population in southern Brazil

This study aimed to evaluate serum and urine concentrations of several trace metals of a non-directly exposed population in southern Brazil and establish reference values. Serum and urine samples were obtained from 240 volunteers (175 males and 65 females, age ranging from 18 to 74 years old). Levels of arsenic, chromium, cobalt, copper, lead, nickel, manganese and zinc were determined by means of dynamic reaction cell inductively coupled plasma mass spectrometry (DRC-ICP-MS). Comparison between genders resulted in no significant difference for all metals but serum copper, as concentrations are higher in females than males. For most metals assessed, a negative correlation between serum concentrations and age was found, but no significant correlation was found between urine concentrations and age.

Isomeric transitions in size-selected methanol hexamers probed by OH-stretch spectroscopy

We have measured the isomeric transition between the energetically lowest lying isomers of S6 and C2-symmetry of (CH3OH)6. The clusters are size-selected by deflection in collisions with He, and the isomers are identified by their infrared spectra of the OH-stretching vibration. The measurements are carried out at three source temperatures 253, 300 and 373 K which correspond to the cluster temperatures 93, 106 and 135 K. The latter ones are estimated by a relaxation model that accounts for the cluster formation and the energy released by the condensation. The transition takes place at a cluster temperature of about 102 K which is in agreement with the Molecular Dynamics simulation of such a transition at about 117 K using a realistic model potential.

Ionization potentials of large sodium doped ammonia clusters

In a continuous neat supersonic expansion ammonia clusters are generated and doped with sodium atoms in a pickup cell. Thus clusters of the form Na(NH(3))(n) are produced that are photoionized by a tunable dye laser system. The ions are mass analyzed in a reflectron time-of-flight mass spectrometer, and the wavelength dependent ion signals serve for the determination of the ionization potentials (IP) of the different clusters in the size range 10< or =n< or =1500. Aside from a plateau for 10< or =n< or =17 and smaller steps at n=24, 35, and 59 on the average a continuous decrease of the IP with cluster size is observed. The IPs in this size range are linear with (n+1)(-13) and extrapolate to IP(n=infinity)=1.66+/-0.01 eV. The slope is consistent with a dielectric continuum model of the solvated electron and the dielectric constant of the solid. The extrapolated IPs are compared with results obtained for negative ammonia cluster ions and metallic solutions in liquid ammonia. Differences are explained by the presence of counterions and their various distances from the solvated electron.

Adding up provincial expenditures on health care for Manitobans: a POPULIS project. Population Health Information System

OBJECTIVES

Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization.

RESEARCH DESIGN

This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba.

RESULTS

Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.

A prospective study of the use of liquid oral dietary supplements in nursing homes

OBJECTIVE

To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight.

DESIGN

A prospective, descriptive, anthropological study.

SETTING

Two proprietary nursing homes with 105 and 138 beds.

PARTICIPANTS

Purposive sampling was used to select 40 residents from among the 100 residents who were not eating well. Dietary data were collected on this sub-sample of 40 residents.

MEASUREMENTS

Participant observation, in-depth interviews, event analysis, bedside dysphagia screenings, oral health examinations, body weight, body mass index (BMI), and chart review were used to collect data. Dietary data were collected over a 3-day period, and data were gathered on how supplements were ordered, served, and consumed.

RESULTS

Supplements had been ordered for 29 of the subsample of 40 residents. Only nine of 29 residents were served the correct number and type of supplements as ordered by their physicians, and only two residents consumed the full amount of supplement as ordered. The overall mean percentage of supplement consumed compared with that ordered was 55.1%. Although supplements were ordered primarily to prevent weight loss and to facilitate weight gain, nearly half (n = 14) of the residents continued to lose weight. Supplements were ordered without investigating the underlying factors contributing to weight loss, such as inadequate staffing and lack of supervision at mealtime, undiagnosed dysphagia, and poor oral health. Without evaluation of these factors, it is unknown which residents might benefit from oral supplements.

CONCLUSION

Findings indicate that supplements were used nonspecifically as an intervention for weight loss in nursing home residents without regard to dose, diagnosis and management of underlying problem(s), amount of supplement consumed, and outcome. Further research is needed to establish when supplements should be ordered, how to ensure that they will be taken, and whether they are effective.

[Monotherapy with the ACE-inhibitor ramipril or the calcium antagonist nitrendipine in essential hypertension]

Angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists have, by reason of their potentially favourable pharmacological profile, become increasingly established in the treatment of hypertension in recent years. In a double-blind randomized study with an initial placebo phase, carried out by practising physicians and thus aimed at the "usual" practice patients with essential hypertension, we assessed (1) the antihypertensive effect and tolerability of an ACE inhibitor (ramipril, 5 mg/d) or a calcium antagonist (nitrendipine, 20 mg/d) given in a single daily dose, and (2) a possible age-dependent blood pressure (BP) effect of these therapies. In the 4 weeks' placebo phase, the two treatment groups were comparable as regards average age (49.6 and 49.4 years), age-range (27-67 and 25-64 years) and BP. Fifty-two patients completed the following 6 weeks' phase with active drug therapy. On ramipril (n = 26), the BP measured 24-25 hours after the last drug administration was reduced in the supine position from an average of 155/102 to 142/91 mmHg (mean reduction -10.1%) and in the upright position from 156/106 to 141/96 mmHg (-9.3%). Nitrendipine (n = 26) reduced the average BP from 155/102 to 147/94 mmHg (-6.8%) and from 155/106 to 146/99 mmHg (-6.6%) respectively. BP-lowering effects of both treatments were largely independent of age. Including the patients who discontinued the study prematurely because of side effects (1 on ramipril, 4 on nitrendipine), the "intention to treat analysis" shows BP normalization rates (diastolic < or = 90 mm Hg) of 55% (ramipril) and 30% (nitrendipine) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Ligand effects on membrane lipids associated with sodium, potassium-activated adenosine triphosphatase: comparative spin probe studies with rat brain and heart enzyme preparations

Physical properties of membrane lipids associated with rat or dog brain and heart Na+, K+-ATPase preparations were compared using an electron spin resonance probe, 5-doxyl stearate. The degree of acyl chain order of the membrane lipids was greater for brain enzyme than for heart enzyme preparations; membrane lipids in the rat heart enzyme preparations were the most disordered. In the absence of added ligands, membrane lipids did not appear to undergo a detectable temperature-dependent rearrangement or structural transition. An apparent transition was observed in the simultaneous presence of Na+, Mg2+, and ATP. These ligands increased lipid order at temperatures above the structural transition, but not below it. In the presence of the above ligands, K+ caused a marked decrease in the transition temperature in the rat brain enzyme preparations, but only a modest decrease in rat heart enzyme preparations. Arrhenius plots of rat brain and heart Na+, K+-ATPase activity revealed a break point roughly corresponding to respective membrane lipid transition temperatures observed in the presence of Na+, K+, Mg2+, and ATP. A low concentration of ouabain (1 microM) failed to affect either the lipid transition temperature estimated by the spin probe or the value of lipid order of the rat brain enzyme preparations observed in the presence of Na+, Mg2+, and ATP, but markedly reduced the effect of K+ to lower the transition temperature observed in the presence of the above ligands. A high concentration (100 microM) of ouabain which was needed to completely inhibit rat heart enzyme eliminated the thermally induced structural rearrangement observed in the presence of Na+, Mg2+, and ATP, apparently through a nonspecific lipid perturbation. These results indicate that differences in the physical properties of the membrane lipids per se are unlikely to account for the low affinity of rat heart Na+, K+-ATPase for ouabain and also suggest that the use of high concentrations of ouabain required to completely inhibit Na+, K+-ATPase activity may cause nonspecific changes in addition to inhibition of Na+, K+-ATPase or the sodium pump.

[Progesterone and unconjugated estriol in amniotic fluid and serum in diabetic patients during induction of labor]

Progesterone and unconjugated estriol are radioimmunologically estimated in 42 diabetic patients in amniotic fluid and serum during last weeks of pregnancy and in the course of oxytocin-induced parturition. As unconjugated estriol rises in progressing weeks of pregnancy progesterone remains unchanged in both investigated fluids. The quotient progesterone unconjugated estriol correlates with affection to labour. There is no statistically significant change in both steroid hormones during induced labour.

[Endogenous prostaglandins and steroid hormones in premature labor induction in diabetic patients]

Prostaglandins E and F2 alpha as well as two steroid hormones, progesterone and unconjugated oestriol, were measured in amniotic fluid of 30 diabetics. The prostaglandin levels of all patients went up with significance after the os uteri had clearly opened. No rise in prostaglandin levels was recordable from induction of labour without opening of the os uteri. High primary prostaglandin levels, prior to induction of labour, and low progesterone/oestriol quotients were observed along with short-time courses of parturition. On the other hand, low prostaglandin values prior to induction of labour and slow rise during induction were recordable from protracted courses of labour.

Prenatal diagnosis of anterior duplication anomaly (dicephalus diauchenos) by ultrasonography

A 29 year old gravida 3, para 1 was referred in the 32nd pregnancy week for ultrasonography when a twin pregnancy was suspected. We found a fetal duplication with two heads in parallel position, biparietal diameter 81 mm (Fig. 1), a joint thoracic cavity measuring 86 x 92 mm (Fig. 2), reduced amniotic liquid and decreased spontaneous movements. The pelvic radiogram confirmed our suspension of an anterior duplication anomaly and showed only two arms and two legs for both fetuses but brought no additional information. The amniofetography failed. The contrast media ended up in the joint peritoneal cavity of the fetuses (Fig. 3). Delivery was in the 36th week by Cesarean section. The weight of the conjoint twins (Fig. 4) was 3210 grams, length 43 cm, and head circumference of each was 32 cm. Both fetuses showed independent respiratory movements and both briefly cried. Death occurred after 12 hours. Fig. 5 shows remnants of a scapula and Fig. 6 demonstrates a stump like leg remanent. Our prenatal diagnosis of an anterior duplication was confirmed by the autopsy. After a prenatal diagnosis of a duplication anomaly we recommend Cesarean section in term pregnancies. Considerations when deciding on the management of the pregnancy should include survival chances following possible surgical separation. If the diagnosis if made before the 24th week termination of the pregnancy might be considered.

[Pregnancy and delivery after renal transplantation (author's transl)]

A case report is given on a 21-years-old woman who became pregnant 18 months after renal transplantation. In spite of relatively unfavourable conditions (match 0,25; hypertension) renal function showed a good adaptation throughout the gestation. In the 38. week of pregnancy the woman was successfully delivered of a 2440 g healthy female child by vacuum extraction. There were no effects of the immunsuppressive drugs on the newborn. It is the third case of a successful delivery after renal transplantation in the GDR.