The Role of Natriuretic Peptides in Predicting Adverse Outcomes After Cardiac Surgery: An Updated Systematic Review

The increasing global burden of cardiovascular disease, particularly, in the aging population, has led to an increase in high-risk cardiac surgical procedures. The current preoperative risk stratification scores, such as the European System for Cardiac Operative Risk Evaluation and the Society for Thoracic Surgeons score, have limitations in their predictive accuracy and tend to underestimate the mortality risk in higher-risk populations. This systematic review aimed to evaluate the utility of natriuretic peptides, brain natriuretic peptide (BNP) and its precursor prohormone (N-terminal prohormone BNP), as predictive biomarkers for adverse outcomes after cardiac surgery. A comprehensive search strategy was performed, and 63 studies involving 40,667 patients who underwent major cardiac operations were included for data extraction. Preoperative levels of BNP and N-terminal prohormone BNP seemed to be associated with an increased risk of short- and long-term mortality, postoperative heart failure, kidney injury, and length of intensive care unit stay. However, their predictive value for postoperative arrhythmias and myocardial infarction was less established. Our findings suggest that natriuretic peptides may play an important role in risk prediction in patients who underwent cardiac surgery. The addition of these biomarkers to the existing clinical risk stratification strategies may enhance their predictive accuracy. However, this needs to be endorsed by data derived from wide-scale clinical trials.

The Impact Of Active Chest Tube Clearance Technology On Surgical Outcomes After Cardiac Surgery: An Updated Systematic Review And Meta-Analysis

OBJECTIVE

Active chest tube clearance technology (ACT) systems were introduced to improve the patency of chest tubes and to reduce the potential complications associated with inadequate mediastinal blood drainage after cardiac surgical procedures. The purpose of this study is to assess the impact of ACT on the incidence of chest tube clogging, retained blood syndromes (RBS), re-exploration for bleeding, and the incidence of postoperative atrial fibrillation (POAF) after cardiac surgical procedures.

METHODS

A database search was conducted using Medline, Embase, Cochrane Library, and Web of Science. Only articles comparing the use of ACT to conventional chest tube drainage after cardiac surgery were screened. Included articles were restricted to adult patients and English language only.

RESULTS

Nine of the 841 articles screened were included in this review. Two studies were randomized controlled trials (RCT) and seven were observational studies. Pooled estimates showed RBS, surgical re-exploration rates, and POAF were significantly less common in the ACT group.

CONCLUSION

Our meta-analysis suggests that the use of ACT may be beneficial in reducing the incidence of postoperative complications associated with inadequate drainage of mediastinal blood after cardiac surgery. However, more robust evidence is required to endorse these findings and support the routing use of ACT in clinical practice.

Development, multi-institutional external validation, and algorithmic audit of an artificial intelligence-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA) for patients undergoing radical prostatectomy: a retrospective cohort study

BACKGROUND

Accurate prediction of side-specific extraprostatic extension (ssEPE) is essential for performing nerve-sparing surgery to mitigate treatment-related side-effects such as impotence and incontinence in patients with localised prostate cancer. Artificial intelligence (AI) might provide robust and personalised ssEPE predictions to better inform nerve-sparing strategy during radical prostatectomy. We aimed to develop, externally validate, and perform an algorithmic audit of an AI-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA).

METHODS

Each prostatic lobe was treated as an individual case such that each patient contributed two cases to the overall cohort. SEPERA was trained on 1022 cases from a community hospital network (Trillium Health Partners; Mississauga, ON, Canada) between 2010 and 2020. Subsequently, SEPERA was externally validated on 3914 cases across three academic centres: Princess Margaret Cancer Centre (Toronto, ON, Canada) from 2008 to 2020; L'Institut Mutualiste Montsouris (Paris, France) from 2010 to 2020; and Jules Bordet Institute (Brussels, Belgium) from 2015 to 2020. Model performance was characterised by area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), calibration, and net benefit. SEPERA was compared against contemporary nomograms (ie, Sayyid nomogram, Soeterik nomogram [non-MRI and MRI]), as well as a separate logistic regression model using the same variables included in SEPERA. An algorithmic audit was performed to assess model bias and identify common patient characteristics among predictive errors.

FINDINGS

Overall, 2468 patients comprising 4936 cases (ie, prostatic lobes) were included in this study. SEPERA was well calibrated and had the best performance across all validation cohorts (pooled AUROC of 0·77 [95% CI 0·75-0·78] and pooled AUPRC of 0·61 [0·58-0·63]). In patients with pathological ssEPE despite benign ipsilateral biopsies, SEPERA correctly predicted ssEPE in 72 (68%) of 106 cases compared with the other models (47 [44%] in the logistic regression model, none in the Sayyid model, 13 [12%] in the Soeterik non-MRI model, and five [5%] in the Soeterik MRI model). SEPERA had higher net benefit than the other models to predict ssEPE, enabling more patients to safely undergo nerve-sparing. In the algorithmic audit, no evidence of model bias was observed, with no significant difference in AUROC when stratified by race, biopsy year, age, biopsy type (systematic only vs systematic and MRI-targeted biopsy), biopsy location (academic vs community), and D'Amico risk group. According to the audit, the most common errors were false positives, particularly for older patients with high-risk disease. No aggressive tumours (ie, grade >2 or high-risk disease) were found among false negatives.

INTERPRETATION

We demonstrated the accuracy, safety, and generalisability of using SEPERA to personalise nerve-sparing approaches during radical prostatectomy.

FUNDING

None.

Lung transplantation and concomitant cardiac surgical procedures: A systematic review and meta-analysis

BACKGROUND

Lung transplantation is an effective treatment option for end-stage lung diseases. In some cases, these patients may also have underlying cardiac disease which may require surgical intervention before or during transplantation. Concomitant cardiac surgery may often be preferred, as reduced lung function precludes these patients from pre-transplant surgery. Our meta-analysis sought to examine the impact of lung transplantation paired with concomitant cardiac surgery on long-term mortality.

METHODS

We conducted a systematic review of the MEDLINE, Embase, and Cochrane databases. Our primary outcome was overall mortality. Secondary outcomes included length of stay (LOS) in hospital and serious postoperative complication rates. We used a meta-analytic model to determine the differences in the above outcomes between patients who underwent lung transplantation with or without concomitant cardiac surgery.

RESULTS

Out of the 1876 articles screened, 7 met our pre-determined inclusion criteria. Lung transplantation with concomitant cardiac surgery was not associated with increased mortality compared to lung transplantation alone (hazard ratio = 1.02; 95% confidence interval [CI] = 0.80-1.31; I²  = 0%; p = .99). LOS in hospital was not significantly different between groups (standardized mean difference = 0.32; 95% CI = -0.91 to 1.55). Postoperative complication rates were also reported but not analyzed due to missing data.

CONCLUSIONS

There was no significant difference in mortality rates in patients undergoing lung transplantation with or without concomitant cardiac surgery at 1, 3, and 5 years. However, postoperative complication rates were higher in the concomitant group. The decision to perform concomitant procedures should be tailored to each patient's clinical condition.

Exploring the value of using patient-oriented MRI reports in clinical practice - a pilot study

PURPOSE

Standard radiology reports (SRR) are designed to communicate information between doctors. With many patients having instantaneous access to SRRs on patient portals, interpretation without guidance from doctors can cause anxiety and panic. In this pilot study, we designed a patient-centred prostate MRI template report (PACERR) to address some of these challenges and tested whether PACERRs improve patient knowledge and experience.

MATERIALS AND METHODS

Patients booked for clinical prostate MRI were randomly assigned to SRR or SRR + PACERR. Questionnaires included multiple-choice that targeted 4 domains (understanding, usefulness, next steps, emotional experience) hypothesized to improve with patient-centred reports and short answer questions, testing knowledge regarding MRI results. Clinical encounters were observed and recorded to explore whether adding PACERR improved communication. Likert scaled-responses and short-answer questions were compared using Mann-Whitney U test and Kruskal-Wallis test.

RESULTS

Of the 40 participants, the majority were MRI naïve (70%). Patients receiving a PACERR had higher scores in the categories of patient understanding (mean: 4.17 vs. 3.39, p=0.006), usefulness (mean: 4.58 vs. 3.07, p<0.001), and identifying next steps (mean: 1.89 vs. 3.03, p=0.003) but not emotional experience (mean: 4.18 vs. 3.79, p=0.22). PACERR participants found the layout and design more patient friendly (mean: 4.47 vs. 2.61, p<0.001) and easier to understand (mean: 4.37 vs. 2.38, p<0.001). In the knowledge section, overall, the PACERR arm scored better (87% vs. 56%, p=0.004).

CONCLUSION

With the addition of prostate MRI PACERR, participants had better understanding of their results and felt more prepared to involve themselves in discussions with their doctor.

The first complete genome sequence of an iflavirus from the endoparasitoid wasp Tetrastichus brontispae

The complete genome sequence of a novel iflavirus isolated from the gregarious and koinobiont endoparasitoid Tetrastichus brontispae, tentatively named "Tetrastichus brontispae RNA virus 3" (TbRV-3), was determined by total RNA and Sanger sequencing. The complete genome is 9998 nucleotides in length, 8934 nt of which encodes a putative polyprotein of 2978 amino acids. TbRV-3 was found to have a similar genome organization and to contain conserved domains and motifs found in other iflaviruses, with some variations. Phylogenetic analysis based on deduced amino acid sequences of the RdRp domain showed that TbRV-3 clustered with Dinocampus coccinellae paralysis virus (DcPV). However, the percent amino acid sequence identity of the putative capsid proteins of TbRV-3 and DcPV determined using BLASTp was below the species demarcation threshold (90%), suggesting that TbRV-3 is a new iflavirus. This is the first virus of the family Iflaviridae to be isolated from a wasp of the family Eulophidae.

A meta-analysis of active smoking and risk of meningioma

INTRODUCTION

Cigarette smoking has been hypothesized to be a risk factor for meningioma. However, the results of studies exploring the relationship between smoking exposure and the occurrence of meningioma are inconsistent.

METHODS

A search of PubMed, Medline, Embase, and Science Direct (up to June 2020) databases was performed. Two authors independently extracted the data. The Newcastle–Ottawa Scale was employed for judging the quality of articles. A random-effects model was utilized for meta-analysis. Association analysis between smoking and meningioma was based on the adjusted RR and the 95% CI, as reported by eligible studies. Subgroup and sensitivity analyses were performed and publication bias was assessed. Subgroup analysis was conducted by geographical region, study design, sex, study quality, and adjustments of RR score. Begg’s and Egger’s tests were employed for detecting publication bias.

RESULTS

Twelve articles, including 2 cohort studies and 10 case–control studies, and a total of 1210167 participants were identified. The pooled relative risk (RR) with 95% confidence interval (95% CI) implied that smoking was not associated with increased risk of meningioma in men and women combined (RR=1.09; 95% CI: 0.90–1.33). From the sex-stratified subgroup analysis, the risk of meningioma was significant in men (RR=1.42; 95% CI: 1.16–1.74). Risk of meningioma in women did not remain significant (RR=0.92; 95% CI: 0.73–1.16). There was a high heterogeneity in the results (I²=58.4%, p=0.002). Sensitivity analyses showed stable results and there was no evidence of publication bias.

CONCLUSIONS

Cigarette smoking is not associated with a significantly increased risk of meningioma in the whole population, but there is a positive association in men but not in women.

Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study

Background

Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery.

Methods

This study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day.

Results

Preoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day.

Conclusions

Preoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.

Alteration of the phagocytosis and antimicrobial defense of Octodonta nipae (Coleoptera: Chrysomelidae) pupae to Escherichia coli following parasitism by Tetrastichus brontispae (Hymenoptera: Eulophidae)

Although parasites and microbial pathogens are both detrimental to insects, little information is currently available on the mechanism involved in how parasitized hosts balance their immune responses to defend against microbial infections. We addressed this in the present study by comparing the immune response between unparasitized and parasitized pupae of the chrysomelid beetle, Octodonta nipae (Maulik), to Escherichia coli invasion. In an in vivo survival assay, a markedly reduced number of E. coli colony-forming units per microliter was detected in parasitized pupae at 12 and 24 h post-parasitism, together with decreased phagocytosis and enhanced bactericidal activity at 12 h post-parasitism. The effects that parasitism had on the mRNA expression level of selected antimicrobial peptides (AMPs) of O. nipae pupae showed that nearly all transcripts of AMPs examined were highly upregulated during the early and late parasitism stages except defensin 2B, whose mRNA expression level was downregulated at 24 h post-parasitism. Further elucidation on the main maternal fluids responsible for alteration of the primary immune response against E. coli showed that ovarian fluid increased phagocytosis at 48 h post-injection. These results indicated that the enhanced degradation of E. coli in parasitized pupae resulted mainly from the elevated bactericidal activity without observing the increased transcripts of target AMPs. This study contributes to a better understanding of the mechanisms involved in the immune responses of a parasitized host to bacterial infections.

Combination of label-free quantitative proteomics and transcriptomics reveals intraspecific venom variation between the two strains of Tetrastichus brontispae, a parasitoid of two invasive beetles

The venom apparatus is a conserved organ in parasitoids that shows adaptations correlated with life-style diversification. Combining transcriptomics and label-free quantitative proteomics, here we explored the venom apparatus components of the endoparasitoid Tetrastichus brontispae (Eulophidae), and provide a comparison of the venom apparatus proteomes between its two closely related strains, T. brontispae-Octodonta nipae (Tb-On) and T. brontispae-Brontispa longissima (Tb-Bl). Tb-Bl targets the B. longissima pupa as its habitual host. However, Tb-On is an experimental derivative of Tb-Bl, which has been exposed to the O. nipae pupa as host consecutively for over 40 generation. Results showed that approximately 1505 venom proteins were identified in the T. brontispae venom apparatus. The extracts contained novel venom proteins, such as 4-coumarate-CoA ligase 4. A comparative venom proteome analysis revealed that significant quantitative and qualitative differences in venom composition exist between the two strains; although the most abundant venom proteins were shared between them. The differentially produced proteins were mainly enriched in fatty acid biosynthesis and melanotic encapsulation response. Six of these enriched proteins presented increased levels in Tb-On, and this result was validated by parallel reaction monitoring (PRM) analysis. Overall, our data reveal that venom composition can evolve quickly and respond to host selection.

Effects of ovarian fluid, venom and egg surface characteristics of Tetrastichus brontispae (Hymenoptera: Eulophidae) on the immune response of Octodonta nipae (Coleoptera: Chrysomelidae)

Although the importance of parasitoids as biocontrol agents has long been recognized, systematic studies of the physiological mechanisms are scarce, especially in those parasitoids that are able to successfully invade their hosts by activating host immune responses. This study explored this phenomenon by investigating the effects of ovarian fluid, venom and egg surface characteristics of Tetrastichus brontispae (Hymenoptera: Eulophidae) on host immunity. The results showed that the injection of venom alone induced higher phenoloxidase activity, while a mixture of ovarian plus venom fluids provoked higher granulocyte and plasmatocyte spreading ratios, highlighting the role that egg surface characteristics may play in successful parasitism. After thorough investigation, the presence of a hemomucin homologue was documented on the egg surface (which was named Tetrastichus brontispae adipocyte plasma membrane associated protein-like, TbAPMAP-like), while the absence of polydnaviruses, fibrous layers and virus-like filaments was confirmed. The higher encapsulation index of eggs incubated with TbAPMAP-like polyclonal antibody demonstrated the protection of the protein against encapsulation. These results contribute to our understanding of the mechanisms used by endoparasitoids to evade encapsulation during the early parasitism stage while enriching our knowledge of local active regulatory mechanisms. It is likely that this is the first study to determine the egg protective properties of TbAPMAP-like in host-parasite systems.

Altered immune function of Octodonta nipae (Maulik) to its pupal endoparasitoid, Tetrastichus brontispae Ferrière

Most studies on the contribution of the altered immune response by endoparasitoid have been restricted to the interactions between Ichneumonoidea and their hosts, while effects of parasitism by Chalcidoidea on the hosts have rarely been characterized except some wasps such as Pteromalidae. Endoparasitoid Tetrastichus brontispae Ferrière, belonging to Eulophidae (Hymenoptera), has a great potential to control some Coleopteran beetles such as Octodonta nipae, one invasive species in southern China. However, the physiological mechanism underlying the escape from the melanotic encapsulation in O. nipae pupae has not been demonstrated. In the present study, effects of parasitism on the immune function of its pupal host O. nipae were investigated. The combining results that granulocytes and plasmatocytes could phagocytize bacteria from 2 to 48h and granulocytes, plasmatocytes and oenocytoids were prophenoloxidase/phenoloxidase positive hemocytes indicated that granulocytes, plasmatocytes and oenocytoids were the main immunocompetent hemocytes in O. nipae pupae. Parasitism by T. brontispae resulted in a significant increase in the percentage of hemocytes viability and spreading at 96h, growing percentage of granulocytes at 24h but no effects on the total hemocyte counts, and an enhanced phenoloxidase activity only at 12 and 72h while a significantly longer melanization time of the hemolymph at 96h following parasitism. These results indicate that mixtures of systemic active and local active regulation are used for T. brontispae to escape host encapsulation in O. nipae pupae. The present study contributes to the understanding of the diversity of virulence strategies used by parasitoids.

Insight: implantable medical devices

Implantable electronic medical devices have achieved remarkable medical advances in the treatment of the most challenging conditions, starting with the introduction of the first implantable pacemaker in 1958. Increasing demand for innovation in existing and novel implantable devices is fuelled by the growing aging population and the increased prevalence of chronic diseases. This perspective article provides an overview of the implantable medical device ecosystem, highlights recent developments, and discusses challenges and opportunities for translation of new innovative implants enabled by microtechnologies and microfabrication.

Transcriptome immune analysis of the invasive beetle Octodonta nipae (Maulik) (Coleoptera: Chrysomelidae) parasitized by Tetrastichus brontispae Ferrière (Hymenoptera: Eulophidae)

The beetle Octodonta nipae (Maulik) (Coleoptera: Chrysomelidae) is a serious invasive insect pest of palm plants in southern China, and the endoparasitoid Tetrastichus brontispae Ferrière (Hymenoptera: Eulophidae) is a natural enemy of this pest that exhibits great ability in the biocontrol of O. nipae. For successful parasitism, endoparasitoids often introduce or secrete various virulence factors to suppress host immunity. To investigate the effects of parasitization by T. brontispae on the O. nipae immune system, the transcriptome of O. nipae pupae was analyzed with a focus on immune-related genes through Illumina sequencing. De novo assembly generated 49,919 unigenes with a mean length of 598 bp. Of these genes, 27,490 unigenes (55.1% of all unigenes) exhibited clear homology to known genes in the NCBI nr database. Parasitization had significant effects on the transcriptome profile of O. nipae pupae, and most of these differentially expressed genes were down-regulated. Importantly, the expression profiles of immune-related genes were significantly regulated after parasitization. Taken together, these transcriptome sequencing efforts shed valuable light on the host (O. nipae) manipulation mechanisms induced by T. brontispae, which will pave the way for the development of novel immune defense-based management strategies of O. nipae, and provide a springboard for further molecular analyses, particularly of O. nipae invasion.

Neuronal-derived nitric oxide modulates the activity of mouse detrusor smooth muscle

AIMS

We investigated the roles of neuronal-derived nitric oxide (NO) in the modulation of spontaneous activity of mouse detrusor smooth muscle.

METHODS

Detrusor smooth muscle strips were isolated from nNOS gene knock-out (nNOS(-/-) ) mice and their wild type siblings (nNOS(+/+) ). The properties of smooth muscle cells were assessed using intracellular electrophysiology and Ca(2+) imaging by laser-scanning confocal microscopy. The effects of an nNOS inhibitor, 7-nitro indazole (7-NI) on electrically evoked contractility were assessed using nNOS(+/+) mouse detrusor strips.

RESULTS

In spontaneously active cells, the frequency of spontaneous action potentials (sAPs) and whole cell Ca(2+) flashes in nNOS(-/-) preparations was lower than that in the nNOS(+/+) preparations. The frequency of sAPs was enhanced by a nitric oxide donor, diethylamine NONOate sodium salt (NONOate; 100 µM), both when used alone and when the cGMP pathway was blocked by 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ, 10 µM). 7-NI (100 µM) significantly suppressed the electrically evoked contraction of mouse detrusor strips.

CONCLUSIONS

We suggest that neuronal-derived NO facilitates the generation of spontaneous activity via a cGMP-independent pathway, and consequently enhances the evoked contraction of detrusor. Dysregulation of nNOS containing nerves may underlie bladder pathologies.

Danish Prostatic Symptom Score is not associated with lower urinary tract symptom severity

OBJECTIVES

Lower urinary tract symptoms (LUTS) are associated with sexual dysfunction; however, these can vary by population. Thus, the prevalence, severity, and predisposing factors for sexual dysfunction in Taiwanese men (> 40 y) who visited a urologic clinic for LUTS was determined.

METHODS

During 2005 and 2006, a prospective survey was carried out which included 412 men with LUTS. Demographic data were collected during face-to-face interviews. Sexual dysfunction and LUTS were evaluated using the Danish Prostatic Symptom Score (DAN-PSS) and the International Prostate Symptom Score (IPSS) questionnaire, respectively.

RESULTS

Mild, moderate, and severe LUTS were observed in 25.61%, 47.80%, and 26.59% of the patients, respectively. Reduced or absence of erection, reduced or no ejaculation, and pain upon ejaculation were found in 78.29%, 76.59%, and 6.11% of the patients, respectively. However, only 26.9%, 22.1%, and 4.4% of patients with erectile dysfunction (ED), ejaculatory dysfunction, and pain upon ejaculation were bothered by the sexual dysfunction, respectively. Age was significantly associated with ED, ejaculatory dysfunction (EjD), and pain with ejaculation (p < 0.001). The prevalence of sexual dysfunction increased with the severity of LUTS but was not significantly different. Patients with diabetes were 5.96 times more likely to have sexual dysfunction (95% CI = 1.39 to 25.60; p = 0.017).

CONCLUSIONS

Over 70% of LUTS patients in this study suffered from sexual dysfunction. Although age and diabetes were associated with sexual dysfunction, LUTS severity was not.

PENILE BLUNT TRAUMA INDUCED VENO-OCCLUSIVE ERECTILE DYSFUNCTION

Blunt trauma to the pelvic or perineal region of the corpora cavernosa is a risk factor for the subsequent development of persistent erectile dysfunction. The hemodynamic investigation of the integrity of the veno-occlusive mechanism has been rare in cases of traumatic impotence. We present two young men with erectile dysfunction following blunt penile or perineal trauma. Combined intracavernous injection and stimulation test, color duplex ultrasonography, and pharmacologic cavernosometry and cavernosography revealed normal arterial velocity and pulsation without cavernosal arterial fistula, but severe venous occlusion and site-specific abnormal veins were noted in both patients. They received penile vein ligation procedure and resulted in near-completely normal erectile function after a four-year followup. Penile venous ligation, especially on the site-specific veins, is still the choice of treatment for the trauma-induced penile veno-occlusive erectile dysfunction, and the result is satisfactory.

A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland

Canine atopic dermatitis sensu stricto and food-induced allergic dermatitis are common canine skin conditions, which are often considered clinically undistinguishable. Several attempts have been made to describe populations of atopic dogs and determine breed predisposition but the results were often biased by the use of hospital populations as control group. The present study aims to describe a population of Swiss atopic and food-allergic dogs and to compare it with a data set representing more than 85% of all Swiss dogs. The study, which was carried out during 1 year in several practices and teaching hospital in Switzerland, describes a group of 259 allergic dogs, determines breed predisposition for atopic dermatitis and food-induced allergic dermatitis, compares the clinical signs and features of both conditions, and outlines the clinical picture of five frequently affected breeds.

[Observation on acupoint-injection combined with manipulation training for treatment of child cerebral palsy]

OBJECTIVE

To observe the therapeutic effect of acupoint-injection combined with manipulation training on child cerebral palsy.

METHODS

The patients in the treatment group were treated with acupoint-injection combined with manipulation training and activator of brain cells, and the control group with simple manipulation training and activator of brain cells. Their therapeutic effects were compared.

RESULTS

After treatment of 3-4 courses, the total effective rate of 92.3% in the treatment group was superior to 75.9% in the control group (P < 0.05).

CONCLUSION

The therapeutic effect of acupoint-injection combined with manipulation training on child cerebral palsy is better than that of the simple manipulation training.

Epidermoid cysts of the testes in Taiwanese men

Epidermoid cyst is a rare benign tumor of the testes. The records from the last 20 years of Taiwanese patients in whom a testicular tumor was diagnosed were reviewed retrospectively. Patients with a confirmed epidermoid cyst of testis were evaluated for age, clinical assessment and follow-up. Among a total 146 testicular tumors, 28 (19%) patients had a benign tumor including 15 patients (10%; mean age 23 years, range 17-32 years) with an epidermoid cyst diagnosed pathologically. Pre-operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in 11 patients. Seven patients underwent magnetic resonance imaging after which benign epidermoid cyst was impressed in five patients. A testicular-sparing operation was performed in 12 patients after frozen sections confirmed the diagnosis. Three patients were treated by radical orchiectomy. There was no relapse after a median follow-up of 42 months (range, 2-82 months). Ultrasonography and magnetic resonance imaging of the scrotum may allow the diagnosis of epidermoid cyst of the testes to be made pre-operatively. The absence of relapse in these patients further supports the use of organ sparing surgery in these young men.

Congenital penile curvature: long-term results of operative treatment using the plication procedure

AIM

To determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea.

METHODS

From January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients.

RESULTS

Penile straightening was excellent in 62 patients (91 %) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-Five patients (51 %) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied.

CONCLUSION

Corporeal plication is an effective and durable procedure with a high rate of patient satisfaction.

Value of prostate-specific antigen in the staging of Taiwanese patients with newly diagnosed prostate cancer

Records of 71 patients diagnosed with prostate cancer were reviewed retrospectively regarding clinical stage, prostate-specific antigen (PSA), Gleason score, CT scan of pelvis, bone scan, and pelvic lymph node dissection. Fourteen patients had pelvic lymphadenopathy based on the CT scan. Of these, no patient had a PSA level <4 ng/mL, 1 patient had a PSA level between 4 and 10 ng/mL, and 3 had a PSA level between 10 and 20 ng/mL. Twelve of 13 patients with positive bone scan results had a PSA level >20 ng/mL, and 1 patient had a PSA level between 10 and 20 ng/mL. PSA can be cost-effective in selecting and identifying appropriate staging for patients with newly diagnosed prostate cancer. CT scans are not indicated in men with clinical localized prostate cancer when PSA levels are < or =10 ng/mL. Bone scan is not required for staging asymptomatic men with PSA levels of < or =20 ng/mL. Pelvic lymphadenectomy for localized prostate cancer may not be necessary if PSA levels is < or =20 ng/mL and Gleason score is < or =5.

Silicon couplers for microfluidic applications

Several types of silicon fluidic coupler have been designed, fabricated, and tested to facilitate external connections to MEMS (microelectromechanical systems) fluidic devices. By using both bulk micromachining and DRIE (deep reactive ion-etching) techniques, couplers of different geometry have been produced for use with any standard MEMS fluidic port. In addition, couplers are easily modified to accommodate any arbitrary fluidic port geometry. For ease of use, these couplers interface with PEEK (polyetheretherketone) and fused-silica capillary tubing, both of which are commonly used in HPLC (high-performance liquid chromatography) systems and are supported by a wide range of plumbing products. Coupler performance was evaluated and an operating range of at least 0-8,963 kPa (0-1,300 psig) is attainable.

Mutant G protein alpha subunit activated by Gbeta gamma: a model for receptor activation?

How receptors catalyze exchange of GTP for GDP bound to the Galpha subunit of trimeric G proteins is not known. One proposal is that the receptor uses the G protein's betagamma heterodimer as a lever, tilting it to pull open the guanine nucleotide binding pocket of Galpha. To test this possibility, we designed a mutant Galpha that would bind to betagamma in the tilted conformation. To do so, we excised a helical turn (four residues) from the N-terminal region of alpha(s), the alpha subunit of G(S), the stimulatory regulator of adenylyl cyclase. In the presence, but not in the absence, of transiently expressed beta(1) and gamma(2), this mutant (alpha(s)Delta), markedly stimulated cAMP accumulation. This effect depended on the ability of the coexpressed beta protein to interact normally with the lip of the nucleotide binding pocket of alpha(s)Delta. We substituted alanine for an aspartate in beta(1) that binds to a lysine (K206) in the lip of the alpha subunit's nucleotide binding pocket. Coexpressed with alpha(s)Delta and gamma(2), this mutant, beta(1)-D228A, elevated cAMP much less than did beta(1)-wild type; it did bind to alpha(s)Delta normally, however, as indicated by its unimpaired ability to target alpha(s)Delta to the plasma membrane. We conclude that betagamma can activate alpha(s) and that this effect probably involves both a tilt of betagamma relative to alpha(s) and interaction of beta with the lip of the nucleotide binding pocket. We speculate that receptors use a similar mechanism to activate trimeric G proteins.

Structure of a non-peptide inhibitor complexed with HIV-1 protease. Developing a cycle of structure-based drug design

A stable, non-peptide inhibitor of the protease from type 1 human immunodeficiency virus has been developed, and the stereochemistry of binding defined through crystallographic three-dimensional structure determination. The initial compound, haloperidol, was discovered through computational screening of the Cambridge Structural Database using a shape complementarity algorithm. The subsequent modification is a non-peptidic lateral lead, which belongs to a family of compounds with well characterized pharmacological properties. This thioketal derivative of haloperidol and a halide counterion are bound within the enzyme active site in a mode distinct from the observed for peptide-based inhibitors. A variant of the protease cocrystallized with this inhibitor shows binding in the manner predicted during the initial computer-based search. The structures provide the context for subsequent synthetic modifications of the inhibitor.