Tumor inhibitory effects of intravesical Ganoderma lucidum instillation in the syngeneic orthotopic MB49/C57 bladder cancer mice model

ETHNOPHARMACOLOGICAL RELEVANCE

Ganoderma lucidum (GL) has been traditionally used in oriental medicine as superior health tonic, and there are numerous scientific evidences of its antitumorigenic activities.

AIM OF THE STUDY

To evaluate the intravesical chemopreventive effects of ethanol extract of GL (GLe) on bladder cancer.

MATERIALS AND METHODS

Intravesical therapy is defined as the direct instillation of a liquid drug into bladder through a catheter. Bacille Calmette-Guerin(BCG) solution is applied intravesically as a conventional immunotherapy for preventing recurrence of bladder cancer. By adopting the MB49/C57 bladder cancer mice model, an overall 60 MB49-implanted mice were randomized into 3 groups and treated according to 3 treatment arms, including GLe, BCG and PBS. Additionally, wild-type mice without MB49 cell inoculation and treated with PBS were used as the negative control group. Testing agents were instilled intravesically for 2 h and repeated after one week for evaluating the effects on preventing the tumor formation and growth. The treated-mice were closely monitored for major adverse effects.

RESULTS

GLe demonstrated more potent cytotoxic effects than BCG on MB49 cells, although both in dose-dependent manner. In the MB49-implanted mice, 80 µg/ml GLe was shown to delay the tumor formation by one week, whereas the averaged tumor volume measured at endpoint was 3.6-fold and 4.6-fold smaller than that of the BCG or PBS, respectively. However, no significant effects were observed on body weight and hematuria.

CONCLUSION

Current findings in mice suggested intravesical GLe therapy as an effective and safe chemopreventive strategy for inhibiting bladder tumor formation.

Successful intravenous thrombolysis of a wake-up stroke with underlying valvular atrial fibrillation

A 42-year-old female admitted with new-onset atrial fibrillation had a wake-up stroke on the high-dependency unit and the time last seen well (TLSW) was 6.5 h. She suffered left-sided body weakness and her National Institutes of Health Stroke Scale (NIHSS) score was 17. An emergency CT perfusion showed right M1 segment occlusion with more than 50% penumbra. She was given recombinant tissue plasminogen activator (r-tPA) at 9 h from TLSW. An immediate diagnostic angiogram with intention to treat, owing to the presence of large vessel occlusion, showed complete reperfusion after intravenous r-tPA. She was discharged with NIHSS of 2, and at 3-month follow up her Modified Rankin Scale was 0. We demonstrated a successful reperfusion and excellent clinical recovery with intravenous thrombolysis in a patient who presented with a wake-up stroke with underlying valvular atrial fibrillation despite evidence of large vessel occlusion.

Halogenated Tetraazapentacenes with Electron Mobility as High as 27.8 cm2 V-1 s-1 in Solution-Processed n-Channel Organic Thin-Film Transistors

Molecular engineering of tetraazapentacene with different numbers of fluorine and chlorine substituents fine-tunes the frontier molecular orbitals, molecular vibrations, and π-π stacking for n-type organic semiconductors. Among the six halogenated tetraazapentacenes studied herein, the tetrachloro derivative (4Cl-TAP) in solution-processed thin-film transistors exhibits electron mobility of 14.9 ± 4.9 cm² V^-1 s^-1 with a maximum value of 27.8 cm² V^-1 s^-1 , which sets a new record for n-channel organic field-effect transistors. Computational studies on the basis of crystal structures shed light on the structure-property relationships for organic semiconductors. First, chlorine substituents slightly decrease the reorganization energy of the tetraazapentacene whereas fluorine substituents increase the reorganization energy as a result of fine-tuning molecular vibrations. Second, the electron transfer integral is very sensitive to subtle changes in the 2D π-stacking with brickwork arrangement. The unprecedentedly high electron mobility of 4Cl-TAP is attributed to the reduced reorganization energy and enhanced electron transfer integral as a result of modification of tetraazapentacene with four chlorine substituents.

Management of complications of ketamine abuse: 10 years' experience in Hong Kong

Ketamine is an N-methyl-d-aspartate receptor antagonist, a dissociative anaesthetic agent and a treatment option for major depression, treatment-resistant depression, and bipolar disorder. Its strong psychostimulant properties and easy absorption make it a favourable candidate for substance abuse. Ketamine entered Hong Kong as a club drug in 2000 and the first local report of ketamine-associated urinary cystitis was published in 2007. Ketamine-associated lower-urinary tract symptoms include frequency, urgency, nocturia, dysuria, urge incontinence, and occasionally painful haematuria. The exact prevalence of ketamine-associated urinary cystitis is difficult to assess because the abuse itself and many of the associated symptoms often go unnoticed until a very late stage. Additionally, upper-urinary tract pathology, such as hydronephrosis, and other complications involving neuropsychiatric, hepatobiliary, and gastrointestinal systems have also been reported. Gradual improvement can be expected after abstinence from ketamine use. Sustained abstinence is the key to recovery, as relapse usually leads to recurrence of symptoms. Both medical and surgical management can be used. The Youth Urological Treatment Centre at the Prince of Wales Hospital, Hong Kong, has developed a four-tier treatment protocol with initial non-invasive investigation and management for these patients. Multidisciplinary care is essential given the complex and diverse psychological factors and sociological background that underlie ketamine abuse and abstinence status.

The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection

We tested the hypotheses that the global incidence of bladder cancer was increasing but its mortality was reducing and its incidence was positively correlated with country-specific socioeconomic development. We retrieved data on age-standardized incidence and mortality rates/100,000 from the GLOBOCAN database in 2012. Temporal patterns were examined for 39 countries from the Cancer Incidence in Five Continents volumes I-X and other national registries. We evaluated the correlation between the incidence/mortality rates and Human Development Index (HDI)/ logarithmic values of Gross Domestic Product per capita (GDP). The average annual percent change of the incidence and mortality rates in the most recent 10 years was examined by joinpoint regression analysis. The highest incidence rates were observed in Southern Europe, Western Europe and North America. The mortality rates were the highest in Western Asia and Northern Africa. The incidence was positively correlated with HDI (r = 0.66 [men]; r = 0.50 [women]) and to a lesser extent logarithmic values of GDP per capita (r = 0.60 [men]; r = 0.50 [women], all p < 0.01). Many European countries experienced incidence rise. A substantial mortality reduction was observed in most countries, yet increases in mortality rates were observed in the Philippines and Iceland. These findings identified countries where more preventive actions are required.

Characteristics and clinical outcomes of living renal donors in Hong Kong

INTRODUCTION

In Asia, few reports are available on the outcomes for living renal donors. We report the short- and long-term clinical outcomes of individuals following living donor nephrectomy in Hong Kong.

METHODS

We retrospectively reviewed the characteristics and clinical outcomes of all living renal donors who underwent surgery from January 1990 to December 2015 at a teaching hospital in Hong Kong. Information was obtained from hospital records and territory-wide electronic patient records.

RESULTS

During the study period, 83 individuals underwent donor nephrectomy. The mean (± standard deviation) follow-up time was 12.0 ± 8.3 years, and the mean age at nephrectomy was 37.3 ± 10.0 years. A total of 44 (53.0%), four (4.8%), and 35 (42.2%) donors underwent living donor nephrectomy via an open, hand-port assisted laparoscopic, and laparoscopic approach, respectively. The overall incidence of complications was 36.6%, with most being grade 1 or 2. There were three (9.4%) grade 3a complications; all were related to open donor nephrectomy. The mean glomerular filtration rate was 96.0 ± 17.5 mL/min/1.73 m² at baseline and significantly lower at 66.8 ± 13.5 mL/min/1.73 m² at first annual follow-up (P<0.01). The latest mean glomerular filtration rate was 75.6% ± 15.1% of baseline. No donor died or developed renal failure. Of the donors, 14 (18.2%) developed hypertension, two (2.6%) had diabetes mellitus, and three (4.0%) had experienced proteinuria.

CONCLUSION

The overall perioperative outcomes are good, with very few serious complications. The introduction of a laparoscopic approach has decreased perioperative blood loss and also shortened hospital stay. Long-term kidney function is satisfactory and no patients developed end-stage renal disease. The incidences of new-onset medical diseases and pregnancy-related complications were also low.

A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone. She was steroid free and had no bleeding or thrombotic event over two years follow up.

The adjuvant value of Herba Cistanches when used in combination with statin in murine models

Statins are well known to have muscle toxicity problem. Herba Cistanches (HC) is a Chinese herb traditionally used for pain in the loins and knees. Our previous in vitro study suggested that it could protect against statin-induced muscle toxicity. However, its in vivo protective effect has never been investigated. The objective of this study was to determine if the aqueous extract of HC (HCE) could prevent simvastatin-induced muscle toxicity in rats, and whether HCE could also exert beneficial effects on reducing high-fat diet-induced hypercholesterolemia and elevated liver cholesterol, thereby reducing the dose of simvastatin when used in combined therapy. From our results, HCE significantly restored simvastatin-induced reduction in muscle weights and reduced elevated plasma creatine kinase in rats. HCE also improved simvastatin-induced reduction in muscle glutathione levels, muscle mitochondrial membrane potential, and reduced simvastatin-induced muscle inflammation. Furthermore, HCE could exert reduction on liver weight, total liver lipid levels and plasma lipid levels in high-fat-fed mice. In conclusion, our study provided in vivo evidence that HCE has potential protective effect on simvastatin-induced toxicity in muscles, and also beneficial effects on diet-induced non-alcoholic fatty liver and hyperlipidemia when being used alone or in combination with simvastatin at a reduced dose.

Reduced prostate cancer risk with green tea and epigallocatechin 3-gallate intake among Hong Kong Chinese men

BACKGROUND

In vitro and in vivo studies suggested that polyphenol epigallocatechin 3-gallate (EGCG) in tea may have anti-carcinogenic effect on prostate cells, but this protective effect has less been examined in epidemiology studies. We aimed to investigate the association between prostate cancer (PCA) risk and habitual green tea intake among Chinese men in Hong Kong; meanwhile, the relationship with EGCG was also explored.

METHODS

We consecutively recruited 404 PCA cases and 395 controls from the same hospital who had complete data on habitual tea consumption, including green, oolong, black and pu'er tea. We reconstructed the level of EGCG intake according to a standard questionnaire and the analytic values for EGCG extracted from the literature published by Lin et al. in 2003. We calculated odds ratios (ORs) for tea consumption and EGCG intake using unconditional multiple logistic regression, and examined their exposure--response relationships with PCA risk.

RESULTS

A total of 32 cases and 50 controls reported habitual green tea drinking, showing an adjusted OR of 0.60 (95% confidence interval (CI): 0.37, 0.98). A moderate excess risk was observed among the habitual pu'er tea drinkers (OR=1.44, 95% CI: 1.02, 1.91). A significantly lower intake of EGCG was observed among cases (54.4 mg) than the controls (72.5 mg), which resulted in an inverse gradient of PCA risk with the increasing intake of EGCG (test for trend, P=0.015).

CONCLUSION

PCA risk among Chinese men in Hong Kong was inversely associated with green tea consumption and EGCG intake, but these results need to be replicated in larger studies.

Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms

INTRODUCTION

Currently there is no structured prostate cancer screening programme in Asia. Early diagnosis of prostate cancer in Asia is by an opportunistic case-finding approach, that is, offering prostate-specific antigen testing to an individual without obvious symptoms of prostate cancer. In this study, we investigated the relationship between the mode of presentation and the characteristics of prostate cancers diagnosed in our hospital.

METHODS

We recruited 120 consecutive Chinese patients with prostate cancer newly diagnosed from September 2011 to February 2013 in a regional hospital in Hong Kong. Patient demographics, symptoms, presentation, staging, and risk profiles were collected and analysed.

RESULTS

The number of subjects diagnosed during a health check (group 1), investigated for symptoms with no/low suspicion of prostate cancer (group 2), investigated for symptoms where prostate cancer was suspected (group 3), or who had undergone transurethral prostatectomy (group 4) were 12 (10.0%), 53 (44.2%), 46 (38.3%), and nine (7.5%), respectively. Overall mean age was 71.0 (range, 54-90) years, and patients in group 3 were significantly older than those in groups 1 and 2 (P<0.001). Patients in group 3 had a significantly higher level of serum prostate-specific antigen, higher incidence of abnormal digital rectal examination, and more metastatic disease at presentation than the other groups. Nonetheless, more than 50% of the prostate cancers in groups 1 and 2 were of intermediate risk or higher staging at presentation. After a median follow-up of 32 months, cancer-specific survival was 100% for each of groups 1, 2, and 4 but was only 76.8% for group 3 (P=0.006).

CONCLUSIONS

Patients with prostate cancer who presented with prostate cancer-related symptoms had more metastatic disease and poorer survival than patients diagnosed by a case-finding approach. Moreover, more than half of those patients diagnosed by case finding belonged to intermediate- or higher-risk groups for which active treatment was recommended.

Adaptation and external validation of the European randomised study of screening for prostate cancer risk calculator for the Chinese population

BACKGROUND

To adapt the well-performing European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator to the Chinese setting and perform an external validation.

METHODS

The original ERSPC risk calculator 3 (RC3) for prostate cancer (PCa) and high-grade PCa (HGPCa) was applied to a development cohort of 3006 previously unscreened Hong Kong Chinese men with initial transrectal biopsies performed from 1997 to 2015, age 50-80 years, PSA 0.4-50 ng ml^-1 and prostate volume 10-150 ml. A simple adaptation to RC3 was performed and externally validated in a cohort of 2214 Chinese men from another Hong Kong hospital. The performance of the models were presented in calibration plots, area under curve (AUC) of receiver operating characteristics (ROCs) and decision curve analyses.

RESULTS

PCa and HGPCa was diagnosed in 16.7% (503/3006) and 7.8% (234/3006) men in the development cohort, and 20.2% (447/2204) and 9.7% (214/2204) men in the validation cohort, respectively. The AUCs using the original RC3 model in the development cohort were 0.75 and 0.84 for PCa and HGPCa, respectively, but the calibration plots showed considerable overestimation. In the external validation of the recalibrated RC3 model, excellent calibration was observed, and discrimination was good with AUCs of 0.76 and 0.85 for PCa and HGPCa, respectively. Decision curve analyses in the validation cohort showed net clinical benefit of the recalibrated RC3 model over PSA.

CONCLUSIONS

A recalibrated ERSPC risk calculator for the Chinese population was developed, and it showed excellent discrimination, calibration and net clinical benefit in an external validation cohort.

In vivo and in vitro anti-inflammatory effects of Zao-Jiao-Ci (the spine of Gleditsia sinensis Lam.) aqueous extract and its mechanisms of action

ETHNOPHARMACOLOGICAL RELEVANCE

Zao-Jiao-Ci (ZJC), as the spine of Chinese Honey locust (Gleditsia sinensis Lam.), is traditionally used as Chinese medicine to reduce inflammation.

AIM OF THE STUDY

The present study aimed to investigate an anti-inflammatory effect of ZJC aqueous extract both in vitro and in vivo, as well as its underlying mechanisms.

MATERIALS AND METHODS

Anti-inflammatory effect of ZJC aqueous extract was evaluated by using carrageenan-induced paw edema in rats. In addition, the inhibitory effects of ZJC on nitric oxide production, intracellular reactive oxygen species production, pro-inflammatory mediator expression and prostaglandin E₂ (PGE₂) production were determined by using LPS-activated RAW 264.7 cells. The anti-oxidant activity of ZJC was assessed using 2,2'-azino-bis-3-ethylbenzthiazoline-6-sulfonic acid assay.

RESULTS

ZJC aqueous extract showed significant suppressive effect on paw edema in rats at 100mg/kg. Moreover, ZJC aqueous extract decreased the expression of cyclooxygenase (COX)-2 and significantly decreased the PGE2, tumor necrosis factor-α, interleukin (IL)-1β and IL-6 production in LPS-activated macrophages in dose-dependent manners. ZJC aqueous extract inhibited the mRNA expression of these inflammatory cytokines as well. Furthermore, ZJC aqueous extract was found as an anti-oxidant and could inhibit ROS production in the LPS-induced cells.

CONCLUSIONS

These findings show the potential of ZJC aqueous extract as a naturally occurring COX-2 inhibitor to reduce inflammation.

The protective effect of Herba Cistanches on statin-induced myotoxicity in vitro

ETHNOPHARMACOLOGICAL RELEVANCE

Herba Cistanches (HC, Cistanche deserticola or Cistanche tubulosa) is a Chinese herb traditionally used for muscle problems. Previous studies demonstrated that HC extract could reduce muscle damage and improve ATP storage in post-exercised rats. However, its effect on statin-induced muscle toxicity has never been investigated.

AIM

The objective of this study was to determine if the aqueous extract of HC (HCE) could prevent simvastatin-induced toxicity in L6 rat skeletal muscle cells; and whether verbascoside is the major bioactive constituent which contributes to the effects.

MATERIALS AND METHODS

MTT was performed to determine the effects of HCE (0-2000µg/ml) or verbascoside (0-160µM) on simvastatin (10µM)-treated L6 cells. Annexin V-FITC/PI apoptosis assay and Caspase 3 assay were performed to determine the protective role of HCE on simvastatin-induced cell death, and to evaluate if HCE exerted its protective effect through the caspase pathway. ATP production was measured to investigate if HCE could prevent simvastatin-induced reduction in ATP production in vitro.

RESULTS

Simvastatin significantly increased apoptotic cell death in L6 cells. HCE significantly exerted a dose-dependent reduction on simvastatin-induced apoptotic cells, possibly via caspase-3 pathway. Simvastatin reduced the ATP production in L6 cells, which was dose-dependently prevented by HCE. There was only a trend but not significant effect (except at high dose) of verbascoside on the protection of simvastatin-induced muscle toxicity.

CONCLUSIONS

In conclusion, we demonstrated for the first time that HCE could exert dose-dependent protective effect on simvastatin-induced toxicity in vitro, which was unlikely due to the presence of verbascoside. Our study suggested the potential use of HC under the situation of simvastatin-induced muscle toxicity.

Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse

OBJECTIVE

To investigate the prevalence of lower urinary tract symptoms in adolescents and the effects of psychotropic substance use.

METHODS

This was a population-based cross-sectional survey using a validated questionnaire in students from 45 secondary schools in Hong Kong randomly selected over the period of January 2012 to January 2014. A total of 11 938 secondary school students (response rate, 74.6%) completed and returned a questionnaire that was eligible for analysis. Individual lower urinary tract symptoms and history of psychotropic substance abuse were documented.

RESULTS

In this study, 11 617 non-substance abusers were regarded as control subjects and 321 (2.7%) were psychotropic substance users. Among the control subjects, 2106 (18.5%) had experienced at least one lower urinary tract symptom with urinary frequency being the most prevalent symptom (10.2%). Females had more daytime urinary incontinence (P<0.001) and males had more voiding symptoms (P=0.01). Prevalence of lower urinary tract symptoms increased with age from 13.9% to 25.8% towards young adulthood and age of ≥18 years (P<0.001). Among the substance users, ketamine was most commonly abused. Substance users had significantly more lower urinary tract symptoms than control subjects (P<0.001). In multivariate analysis, increasing age and psychotropic substance abuse increased the odds for lower urinary tract symptoms. Non-ketamine substance users and ketamine users were respectively 2.8-fold (95% confidence interval, 2.0-3.9) and 6.2-fold (4.1-9.1) more likely than control subjects to develop lower urinary tract symptoms. Females (odds ratio=9.9; 95% confidence interval, 5.4-18.2) were more likely to develop lower urinary tract symptoms than males (4.2; 2.5-7.1) when ketamine was abused.

CONCLUSIONS

Lower urinary tract symptoms are prevalent in the general adolescent population. It is important to obtain an accurate history regarding psychotropic substance use when treating teenagers with lower urinary tract symptoms.

Gastrodia and Uncaria (tianma gouteng) water extract exerts antioxidative and antiapoptotic effects against cerebral ischemia in vitro and in vivo

BACKGROUND

Gastrodia and Uncaria decoction (tianma gouteng yin) is commonly used in Chinese medicine to treat cerebral ischemia. The aim of this study was to investigate the neuroprotective effects of a water extract (GUW) of Gastrodia elata (tianma; GE) and Uncaria rhynchophylla (gouteng; UR) against ischemic insult using oxygen-glucose-deprived neuronal differentiated PC12 cells and rats subjected to middle cerebral artery occlusion (MCAO).

METHODS

GUW was prepared by boiling raw GE and UR in water, followed by the lyophilization of the resulting extract. Neuronal differentiated PC12 cells were subjected to oxygen-glucose deprivation with or without GUW. The neuroprotective effects of GUW were compared with those of the corresponding GE and UR extracts to tease apart the effects of the different herbs. The synergistic effect of GE and UR in GUW was measured using a modified version of Burgi's formulae. The neuroprotective mechanisms via Nrf2 and anti-apoptotic pathways were investigated using real time PCR and enzyme activity assays. The neuroprotective effects of GUW were studied in vivo using a rat MCAO model. Neurofunctional outcome and brain infarct volume we assessed. H&E staining, cresyl violet staining and immunohistochemistry were performed to assess the histological outcome.

RESULTS

The results of lactate dehydrogenase assay showed that GUW protected cells in a concentration-dependent manner (P < 0.001). Moreover, the neuroprotective effects of GUW were greater than those of GE + UR (P = 0.018). Burgi's formula showed that the herbs in GUW acted synergistically to protect cells from ischemic injury. GUW significantly upregulated Bcl-2 expression (P = 0.0130) and reduced caspase-3 activity by 60 % (P < 0.001). GUW upregulated Nrf-2 expression (P = 0.0066) and the antioxidant response element pathway genes. The infarct volume was reduced by 55 % at day 7 of reperfusion (P < 0.001), and significant improvements were observed in the neurological deficit score and beam-walking test at 7 days (P < 0.001). H&E and cresyl violet staining revealed higher tissue integrity in the GUW treatment group compared with MCAO rats.

CONCLUSION

GUW modulated the antioxidant system and antiapoptotic genes in oxygen-glucose deprived neuronal differentiated PC12 cells and MCAO sprague-dawley rats.

The hepatoprotective effect of the combination use of Fructus Schisandrae with statin--A preclinical evaluation

ETHNOPHARMACOLOGICAL RELEVANCE

Fructus Schisandrae is traditionally used as a liver-toning Chinese herb. Recent studies suggested Fructus Schisandrae could prevent high-fat diet-induced hepatic steatosis as well as improving anti-oxidative status within the liver, which is a proposed mechanism against statin-induced liver toxicity.

AIM

The aim of the present study was to determine if the combination use of Atorvastatin (AS) and Fructus Schisandrae aqueous extract (FSE) could (a) exert potent therapeutic effects not only on high-fat diet-induced hyperlipidemia, but also on hepatomegaly (enlarge of liver size) and hepatic steatosis (fatty liver); and (b) reduce side effects caused by intake of statin alone including increased incidence of elevated liver enzymes and liver toxicity in Sprague Dawley rats.

MATERIALS AND METHODS

We studied 5 groups of Sprague Dawley rats that were given the following treatment for 8 weeks: (i) Normal-chow diet; (ii) High-fat diet (contains 21% fat and 0.15% cholesterol); (iii) High-fat diet (contains 21% fat and 0.15% cholesterol)+0.3% Atorvastatin; (iv) High-fat diet (contains 21% fat and 0.15% cholesterol)+0.45% FSE; (v) High-fat diet (contains 21% fat and 0.15% cholesterol)+0.3% Atorvastatin+0.45% FSE. After 8 weeks of treatment, body weight, adipose tissue and liver mass were measured, and liver and plasma lipid levels were determined to evaluate to effect of FSE with or without AS treatment on diet-induced obesity, hyperlipidemia and hepatic steatosis. Liver enzyme activities, anti-oxidative status and membrane permeability transition were also assessed to determine if FSE could reduce the side effects induced by AS.

RESULTS

From the results, FSE treatment alone resulted in significant inhibitory effect on diet-induced increase in: (a) body weight; (b) fat pad mass (epididymal, perirenal and inguinal fat); (c) liver weight; (d) total liver lipid; (e) liver triglyceride and cholesterol levels; and (f) plasma lipid levels, suggesting FSE has a potential preventive beneficial effect on weight control and lipid metabolism in Sprague Dawley rats with diet-induced obesity. However, FSE supplementation exerted no further beneficial effect on diet-induced metabolic syndrome when it is combined with AS treatment, compared with rats given AS-treatment alone. At the dose of 0.45%, dietary FSE supplementation resulted in: (a) reduced liver enzymes (ALT and AST) levels; (b) reduced macrophage infiltration (CD68); (c) improved liver glutathione levels (anti-oxidative status); (d) reduced liver reactive oxidative species; (e) a trend to reduce calcium-induced membrane permeability transition within the liver. Most importantly, these improvements induced by FSE treatment were not only observed in the livers of rats given high-fat-diet, but also in high-fat-fed rats with atorvastatin-induced hepatotoxicity.

CONCLUSIONS

Taken together, these data suggested FSE has a potential beneficial effect on weight control and lipid metabolism in Sprague Dawley rats with diet-induced obesity, and the combination use of FSE with AS could significantly prevent liver toxicity and anti-oxidative status induced by AS alone.

Current management practice for bladder cancer in Hong Kong: a hospital-based cross-sectional survey

OBJECTIVES

To examine current practice in the management of bladder cancer in Hong Kong government and private hospitals.

DESIGN

Cross-sectional survey.

SETTING

All government hospitals and the major private institutions in Hong Kong, which provide urological services.

PARTICIPANTS

Urologists responding to an anonymous, self-administered, web-based questionnaire regarding practices in smoking cessation, treatment of non-muscle invasive bladder cancer and muscle invasive bladder cancer, and research into bladder cancer.

RESULTS

Of the 29 urologists from 11 government hospitals and eight private institutions who were invited, 18 from 11 (100%) government hospitals and seven from six (75%) private institutions responded, which amounted to an 86% response rate. In all, 88% of the respondents seldom or never referred their bladder cancer patients to smoking cessation programmes. Hong Kong urologists showed good compliance in the management of non-muscle invasive bladder cancer according to international guidelines. There was great variation with regard to regimens for maintenance of intravesical immunotherapy. There was underuse of perioperative systemic chemotherapy, despite wide acceptance of this practice; fewer than 10% of the patients received neo-adjuvant and adjuvant systemic chemotherapy for the treatment of muscle invasive bladder cancer. Of the surveyed urologists, 80% expressed an inadequacy of resources for bladder cancer research and 96% agreed that a local inter-hospital bladder cancer database was needed.

CONCLUSIONS

This study demonstrated great diversity in the use of intravesical immunotherapy, perioperative systemic chemotherapy, and surgical treatment of bladder cancer among urology service providers. There is a need for clear recommendations in these areas.

Age, tumour stage, and preoperative serum albumin level are independent predictors of mortality after radical cystectomy for treatment of bladder cancer in Hong Kong Chinese

OBJECTIVES

To evaluate the association between patient age, other clinical factors and mortality following radical cystectomy for treatment of bladder cancer.

DESIGN

Historical cohort study.

SETTING

A urology unit in Hong Kong.

PATIENTS

The outcomes of 117 patients who had radical cystectomies performed in one urological unit from 2003 to 2011 were reviewed. Demographic and perioperative data, including tumour stage, Charlson Comorbidity Index, and preoperative serum albumin levels were retrieved from computerised medical records. Risk factors for 30-day mortality, and cancer-specific, other-cause, and overall death rates at 5 years were calculated. The data were subsequently stratified and analysed according to age.

RESULTS

Of the 117 patients, 83 (71%) were aged 75 years or below. The mean follow-up duration was 31 (standard deviation, 29) months. Age, tumour stage, and preoperative serum albumin level, but not the Charlson Comorbidity Index, were found to be predictors of survival following radical cystectomy. The overall 30-day mortality rate was 3% in the full sample, 1% in patients aged 75 years or below, and 10% in patients aged over 75 years. There was no significant difference in 5-year cancer-caused mortalities between patients aged 75 years or below and those aged over 75 years (33% vs 33%, P=0.956). In patients older than 75 years, the 5-year other-cause and overall mortality rates were 47% and 80%, respectively; such rates were higher than those for younger patients (13% and 46%, respectively).

CONCLUSION

Age, tumour stage, and preoperative serum albumin level were predictors of survival after radical cystectomy. Non-cancer-related death played a crucial role in the overall mortality rate in elderly patients having radical cystectomy for bladder cancer.

The role of urine prostate cancer antigen 3 mRNA levels in the diagnosis of prostate cancer among Hong Kong Chinese patients

OBJECTIVE

To establish and verify the utility of measuring urine prostate cancer antigen 3 (PCA3) mRNA levels in the diagnosis of prostate cancer among Hong Kong Chinese patients.

DESIGN

Cross-sectional study.

SETTING

Urology Unit of a regional hospital in Hong Kong.

PATIENTS

This study was carried out in two parts. In the first part, 102 post-prostatic massage urine samples were collected from patients with known prostate cancer (38 patients) and controls (64 patients, with normal digital rectal examination and serum prostate-specific antigen <4 ng/mL). The urine levels of PCA3 and prostate-specific antigen mRNA were measured and the best cut-off point for differentiating cancer was determined. In the second part of the study, post-prostatic massage urine samples from 47 patients with clinically suspected prostate cancer were collected prior to prostate biopsy. The performance of PCA3 as a diagnostic aid for cancer was then assessed using the aforementioned cut-off value.

RESULTS

In the first part of the study, the best cut-off for the PCA3 ratio (defined as the ratio of the Ct value of PCA3/PSA mRNA) was 1.127. Applying this cut-off to the 47 patients with clinically suspected prostate cancer and no history of previous prostate biopsy, the sensitivity and specificity of PCA3 for diagnosing prostate cancer were 71% and 92%, respectively.

CONCLUSION

The post-prostatic massage urine PCA3 level shows utility for diagnosing prostate cancer in patients with elevated prostate-specific antigen levels that could facilitate decisions to undertake prostate biopsy and avoid unnecessary biopsies.

CFTR suppresses tumor progression through miR-193b targeting urokinase plasminogen activator (uPA) in prostate cancer

Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) is expressed in the epithelial cells of a wide range of organs/tissues from which most cancers are derived. Although accumulating reports have indicated the association of cancer incidence with genetic variations in CFTR gene, the exact role of CFTR in cancer development and the possible underlying mechanism have not been elucidated. Here, we report that CFTR expression is significantly decreased in both prostate cancer cell lines and human prostate cancer tissue samples. Overexpression of CFTR in prostate cancer cell lines suppresses tumor progression (cell growth, adhesion and migration), whereas knockdown of CFTR leads to enhanced malignancies both in vitro and in vivo. In addition, we demonstrate that CFTR knockdown-enhanced cell proliferation, cell invasion and migration are significantly reversed by antibodies against either urokinase plasminogen activator (uPA) or uPA receptor (uPAR), which are known to be involved in various malignant traits of cancer development. More interestingly, overexpression of CFTR suppresses uPA by upregulating the recently described tumor suppressor microRNA-193b (miR-193b), and overexpression of pre-miR-193b significantly reverses CFTR knockdown-enhanced malignant phenotype and abrogates elevated uPA activity in prostate cancer cell line. Finally, we show that CFTR gene transfer results in significant tumor repression in prostate cancer xenografts in vivo. Taken together, the present study has demonstrated a previously undefined tumor-suppressing role of CFTR and its involvement in regulation of miR-193b in prostate cancer development.