Impact of magnetic resonance imaging-guided prostate biopsy in the supine position on the detection of significant prostate cancer in an inhomogeneous patient cohort

OBJECTIVE

The aim of this study was to determine the tumour detection rate of magnetic resonance-guided biopsy (MRGB) in the supine position for significant prostate cancer in an inhomogeneous patient cohort.

MATERIALS AND METHODS

Thirty-two consecutive patients with a total prostate-specific antigen > 4 ng/ml and/or a tumour-suspicious palpable lesion upon digital rectal examination and a cancer-suspicious region in multiparametric magnetic resonance imaging (MRI) underwent MRGB in a standard 1.5 T magnet. Diagnostic MRI was performed in 20 patients at the authors' institute and 12 men at another location. Eight patients were investigated at 3 T and 24 at 1.5 T. Twenty men had prior negative biopsies and 12 were biopsy naïve. All biopsies were performed in the supine position using a table-mounted device and an 18 G biopsy gun.

RESULTS

The overall tumour detection rate was 53% (17/32). Two cores (median; range 1-4) were extracted. Clinically significant cancers were found in 94% (16/17). None of the patients showed any postbiopsy complications. The prostate volumes of patients with cancer were significantly lower (39.3 ml) than those of men without cancer (49.7 ml). No significant differences were found between the numbers of tumour-positive and tumour-negative collected cores. In a median follow-up of 14 months, no cancer was detected in the negative biopsy group.

CONCLUSION

MRGB in the supine position can be a valuable tool to detect significant prostate cancer, even in a patient cohort with different prebiopsy pathways. The biopsy method could be a reasonable alternative to MRGB in the prone position.

[Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT). Alternative therapy for patients with oligometastatic spinal metastases]

BACKGROUND

Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients.

METHOD AND RESULTS

Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated.

CONCLUSION

The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.

Comparison of enzymatic digestion and mechanical dissociation of human testicular tissues

OBJECTIVE

To compare mechanical dissociation, employing the Medimachine system, and enzymatic digestion of human testicular tissues with respect to the proportion of spermatogonia and somatic cells, with the long-term objective of establishing human spermatogonial cultures.

DESIGN

Experimental basic science study.

SETTING

Reproductive biology laboratory.

PATIENT(S)

Testicular tissues were obtained from patients with gender dysphoria on the day of sex reassignment surgery. On the basis of the histological evaluation, tissue samples with complete spermatogenesis (fresh, n = 6; cryopreserved, n = 7) and with meiotic arrest (cryopreserved, n = 4) were selected.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The composition of testicular cell suspensions was assessed performing quantitative real-time polymerase chain reaction (qPCR) analyses for germ cell-specific (FGFR3, SALL4, UTF1, MAGE-A4) and somatic marker genes (ACTA2 and VIM). Additionally, flow-cytometric analyses were used to evaluate the percentage of SALL4-and vimentin-positive cells.

RESULT(S)

While Medimachine dissociation yielded higher cell numbers in all patient groups, viability of cells was highly variable and correlated with the histological status of the tissue. Interestingly, qPCR analysis revealed a significantly decreased expression of the somatic marker genes ACTA2 and VIM and an increased expression of the spermatogonial marker genes FGFR3 and SALL4 after Medimachine dissociation. These findings were corroborated by flow-cytometric analyses that demonstrated that the proportion of SALL4-positive cells was up to 4 times higher after mechanical dissociation.

CONCLUSION(S)

Medimachine dissociation of human testicular tissues is comparably fast and leads to an enrichment of SALL4-positive spermatogonia. The use of this method may therefore constitute an advantage for the establishment of human spermatogonial cell cultures.

In a sweet mood? Effects of experimental modulation of blood glucose levels on mood-induction during fMRI

Glucose is the primary source of energy for the human brain. Previous literature has shown that varying blood glucose levels may have a strong impact on behaviour, subjective mood, and the intensity of the BOLD signal measured in fMRI. Therefore, blood glucose levels varying even within the normal range may interact with cognitive and emotional processing as well as BOLD signal. Here, in a placebo-controlled, double-blind crossover study on 20 healthy women, we show that overnight fasting, compared to an elevated glucose condition, influences brain activation and the affective state during mood induction. Results indicate that our brain may compensate for low glucose levels during fasting by stronger recruitment of the brain areas relevant to the task at hand. Additionally, we systematically tested the effect of prior cognitive effort on behavioural and neural patterns and found that elevated activation is only associated with maintained performance as long as no prior cognitively challenging task is administered. Prior cognitive effort leads to deteriorated performance and a further increase in emotion-associated brain activation in the pregenual anterior and posterior cingulate, the superior frontal gyrus, and the pre-SMA. These results are in line with the strength model of self-regulation. Our results corroborate the strength model of self-regulation and extend it to affect regulation processes. Additionally, our observations suggest that experimentally controlling for fasting state or glucose levels may be beneficial, especially when studying processes that involve self-regulation.

Monitoring the internal structure of poly(N-vinylcaprolactam) microgels with variable cross-link concentration

The combination of a set of complementary techniques allows us to construct an unprecedented and comprehensive picture of the internal structure, temperature dependent swelling behavior, and the dependence of these properties on the cross-linker concentration of microgel particles based on N-vinylcaprolactam (VCL). The microgels were synthesized by precipitation polymerization using different amounts of cross-linking agent. Characterization was performed by small-angle neutron scattering (SANS) using two complementary neutron instruments to cover a uniquely broad Q-range with one probe. Additionally we used dynamic light scattering (DLS), atomic force microscopy (AFM), and differential scanning calorimetry (DSC). Previously obtained nuclear magnetic resonance spectroscopy (NMR) results on the same PVCL particles are utilized to round the picture off. Our study shows that both the particle radius and the cross-link density and therefore also the stiffness of the microgels rises with increasing cross-linker content. Hence, more cross-linker reduces the swelling capability distinctly. These findings are supported by SANS and AFM measurements. Independent DLS experiments also found the increase in particle size but suggest an unchanged cross-link density. The reason for the apparent contradiction is the indirect extraction of the parameters via a model in the evaluation of DLS measurements. The more direct approach in AFM by evaluating the cross section profiles of observed microgel particles gives evidence of significantly softer and more deformable particles at lower cross-linker concentrations and therefore verifies the change in cross-link density. DSC data indicate a minor but unexpected shift of the volume phase transition temperature (VPTT) to higher temperatures and exposes a more heterogeneous internal structure of the microgels with increasing cross-link density. Moreover, a change in the total energy transfer during the VPT gives evidence that the strength of hydrogen bonds is significantly affected by the cross-link density. A strong and reproducible deviation of the material density of the cross-linked microgel polymer chains toward a higher value compared to the respective linear chains has yet to be explained.

[Schizophrenia and other psychotic disorders in DSM-5: summary of the changes compared to DSM-IV]

With the introduction of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) numerous changes in the area of the schizophrenia spectrum and psychotic disorders have been implemented. Establishing a metastructure based on the characteristics of the spectrum of psychopathological disturbances should improve clarity. The classical subtypes of schizophrenia were eliminated and specific psychopathological dimensions for the assessment of disease severity were added. The special role of Schneiderian first rank symptoms was abandoned and a higher delineation towards schizoaffective disorders is made. The nosological status of catatonia is clarified and occurs together with a consistent use of catatonic disturbances over all chapters. The attenuated psychosis syndrome is added as a new condition for further study. The shared psychotic disorder in the sense of a folie à deux is no longer maintained. However, the initial goal to integrate more disorder-specific etiopathogenetic information into the reconceptualization could not be achieved. Contemporaneously to the development process of DSM-5 the National Institute of Mental Health (NIMH) carried out the research domain criteria project (RDoC) attempting to incorporate the current growth in knowledge of genetics, neurocognitive and cognitive sciences in future diagnostic systems. This article gives an overview of the changes that have been made within the revision process from DSM-IV to DSM-5.

Effects of methylphenidate on the behavior of male 5xFAD mice

Alzheimer's disease is a neurodegenerative disorder characterized by a loss of memory and spatial orientation. It is also reported that the dopamine system is affected. Dopamine plays a prominent role in motor functions, motivation, emotion, arousal and reward, and it is important for learning and memory. One model that represents characteristic hallmarks of Alzheimer's disease is the 5xFAD mouse model, in which parenchymal plaque load starts at 2months of age. Transgenic 5xFAD mice show the first behavioral deficits at 6months, which are evident at 9months of age. In this study, we investigated the pharmacological influence of methylphenidate (MPH) on behavioral deficits of 5xFAD mice. Using a battery of behavioral tests, we observed no influence of MPH on anxiety in the elevated plus maze, whereas the locomotion and explorative activity in the open field was increased in transgenic and non-transgenic 5xFAD mice after the application of MPH. Further MPH inhibits habituation in the open field in healthy 5xFAD littermates after the application of 10mg/kg MPH. On the other hand, 10mg/kg MPH improved spatial memory in 6-month-old transgenic 5xFAD males, i.e., at a time point when deficits start to occur. However, in 9-month-old transgenic mice, MPH did not improve persisting learning and memory deficits. We concluded that MPH might improve the non-cognitive, apathy-like behavior (indicated by a reduced exploration), but it has no influence on sustained Alzheimer typical learning and memory deficits.

[Assessment of legal capacity and testamentary capacity]

The assessment of legal capacity and testamentary capacity require thorough knowledge of the legal framework and the relevant case law. This paper explains the concept of the legal capacity to contract and the concept of testamentary capacity with respect to German civil law. The relevance of major mental disorders for the assessment of legal capacity and testamentary capacity is discussed.

Food loss rates at the food retail, influencing factors and reasons as a basis for waste prevention measures

This paper quantifies food loss rates for fruit & vegetables, dairy products and bread & pastry as well as donations to social services. In addition potential influencing factors and reasons for food losses are investigated in order to provide a basis for the development of waste prevention measures. Detailed data from 612 retail outlets all over Austria, which covered the period of one year, were analysed and sorting analyses of discarded food were carried out in a small sample of retail outlets. Food loss amounts to 1.3% of the sales of dairy products, 2.8% for bread & pastry and 4.2% for fruit & vegetables. Returned bread amounts to additional 9.7% of the sales of bread & pastry. The food loss rates are similar to the results of previous publications. At present, 7% of the food loss is donated to social services, 38% of retail outlets do not donate any articles at all. Food loss rates are declining with increasing sales areas, increasing numbers of purchases per year and increasing sales of the retail outlet, but explain only 33% or less of the variation of food loss rates. Large differences between retail outlets of comparable structure indicate potential for reduction. More than a quarter of discarded food articles did not show any flaws besides the expiration of the best before or sell-by date. Waste prevention approaches should focus on avoiding returns, transfer of best practices, information and education of employees and customers as well as strengthening the donation to social services.

Obsessive-compulsive symptoms in at-risk mental states for psychosis: associations with clinical impairment and cognitive function

OBJECTIVE

Obsessive-compulsive symptoms (OCS) constitute a major comorbidity in schizophrenia. Prevalence estimations of OCS for patients with at-risk mental states (ARMS) for psychosis vary largely. It is unclear how ARMS patients with or without comorbid OCS differ regarding general psychosocial functioning, psychotic and affective symptoms and neurocognitive abilities.

METHOD

At-risk mental states patients (n = 233) from the interventional trial PREVENT (Secondary Prevention of Schizophrenia) were stratified according to the presence or absence of comorbid OCS and compared on several clinical variables.

RESULTS

Patients, who fulfilled the criteria for obsessive-compulsive disorder (OCD) or presented with subclinical OCS (ARMSposOCS sample), did not significantly differ from patients without OCS (ARMSnegOCS) with regard to gender, age, premorbid verbal intelligence and levels of education. Furthermore, similar severity of depressive syndromes, basic cognitive, attenuated psychotic and brief limited intermittent psychotic symptoms were found. However, ARMSposOCS patients showed more impairment of psychosocial functioning and higher general psychopathology. In contrast, they scored higher in cognitive tasks measuring working memory and immediate verbal memory.

CONCLUSION

Findings extend upon previous results due to the multidimensional assessment. Subsequent longitudinal studies might elucidate how comorbid OCS influence differential treatment response, especially to cognitive behavioural interventions and the transition rates to psychosis.

Neural Correlates of Unsuccessful Memory Performance in MCI

People with mild cognitive impairment (MCI) are at an elevated risk of developing Alzheimer’s disease or other forms of dementia. Although the neural correlates of successful memory performance in MCI have been widely investigated, the neural mechanisms involved in unsuccessful memory performance remain unknown. The current study examines the differences between patients suffering from stable amnestic MCI with multiple deficit syndromes and healthy elderly controls in relation to the neural correlates of both successful and unsuccessful encoding and recognition. Forty-six subjects (27 controls, 19 MCI) from the HelMA (Helmholtz Alliance for Mental Health in an Aging Society) completed a comprehensive neuropsychological test battery and participated in an fMRI experiment for associative face-name memory. In patients, the areas of frontal, parietal, and temporal cortices were less involved during unsuccessful encoding and recognition. A temporary dysfunction of the top-down control of frontal or parietal (or both) areas is likely to result in a non-selective propagation of task-related information to memory.

Behavioral and EEG changes in male 5xFAD mice

Transgenic animal models of Alzheimer's disease (AD) are widely used to investigate mechanisms of pathophysiology and cognitive dysfunctions. A model with a very early development of parenchymal plaque load at the age of 2months is the 5xFAD mouse (Tg6799, Oakley et al. 2006). These 5xFAD mice over-express both human amyloid precursor protein (APP) and human presenilin 1 (PS1). Mice from this line have a high APP expression correlating with a high burden and an accelerated accumulation of the 42 amino acid species of amyloid-β (Aβ). The aim of this study was the behavioral and functional investigations of 5xFAD males because in most studies females of this strain were characterized. In comparison to literature of transgenic 5xFAD females, transgenic 5xFAD males showed decreased anxiety in the elevated plus maze, reduced locomotion and exploration in the open field and disturbances in learning performance in the Morris water maze starting at 9months of age. Electroencephalogram (EEG) recordings on 6month old transgenic mice revealed a decrease of delta, theta, alpha, beta and gamma frequency bands whereas the subdelta frequency was increased. EEG recordings during sleep showed a reduction of rapid eye movement sleep in relation to the amount of total sleep. Thus, 5xFAD males develop early functional disturbances and subsequently behavioral deficits and therefore they are a good mouse model for studying Alzheimer's disease.