The robotic era of radical prostatectomy: A retrospective analysis of patient characteristics in contemporary robotic and open prostatectomy

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Background: As new treatment options become available without being tested in randomized controlled trials, trends in the patient populations receiving these novel therapies often emerge prior to the determination of ideal patient selection factors. In the case of robotic-assisted laparoscopic radical prostatectomy (RALRP), biases in patient selection for this relatively new procedure may influence the evaluation of postoperative outcomes in comparison to open retropubic radical prostatectomy (RRP). This study describes the disease-specific characteristics of patients currently undergoing RALRP and RRP in a contemporary fashion at a single institution. Methods: A total of 1,088 patients who had surgery since the inception of RALRP at our institution (2003–2007) were identified for analysis. The cohort was divided into two groups based on surgical technique (RALRP versus open RRP). Characteristics of the patient pool analyzed included age at surgery, Kattan Nomogram (KN) score, preoperative prostate-specific antigen (PSA), Gleason sum (GS) at biopsy, and pathological tumor stage. Unpaired t-tests with Welch correction and Mann-Whitney tests were used to determine the differences in patient characteristics between the two surgical approaches. Results: The median age was 61. The mean preoperative PSA was 6.2, and GS 2–6, 7, and 8–10 of 48.2%, 40.4%, and 11.4%, respectively. 519 and 569 patients underwent RALRP and RRP, respectively. There was a significant difference between GS (p<0.0001) and tumor stage (p=0.002) between patients undergoing the two approaches. There were trends in favor of younger age, decreased preoperative PSA, and better KN scores in the RALRP group, but these observations lacked statistical significance (age: p=0.06, PSA: p= 0.07, KN: p=0.15). Conclusions: Although there is insufficient evidence to declare an overall difference in patient characteristics between these two surgical approaches in our patient population, trends toward lower-risk patients in the RALRP group suggest a series of patient selection forces for this procedure. These observations have the potential to influence the results obtained in retrospective analyses comparing outcomes between RALRP and open RRP.

No significant financial relationships to disclose.

Optical nonlocalities and additional waves in epsilon-near-zero metamaterials

We analyze the optical properties of plasmonic nanorod metamaterials in the epsilon-near-zero regime and show, both theoretically and experimentally, that the performance of these composites is strongly affected by nonlocal response of the effective permittivity tensor. We provide the evidence of interference between main and additional waves propagating in the room-temperature nanorod metamaterials and develop an analytical description of this phenomenon. Additional waves are present in the majority of low-loss epsilon-near-zero structures and should be explicitly considered when designing applications of epsilon-near-zero composites, as they represent a separate communication channel.

Increased fear- and stress-related anxiety-like behavior in mice lacking tuberoinfundibular peptide of 39 residues

Tuberoinfundibular peptide of 39 residues (TIP39) is synthesized by two groups of neurons, one in the subparafascicular area at the caudal end of the thalamus and the other in the medial paralemniscal nucleus within the lateral brainstem. The subparafascicular TIP39 neurons project to a number of brain regions involved in emotional responses, and these regions contain a matching distribution of a receptor for TIP39, the parathyroid hormone 2 receptor (PTH2-R). We have now evaluated the involvement of TIP39 in anxiety-related behaviors using mice with targeted null mutation of the TIP39 gene (Tifp39). Tifp39(-/-) mice (TIP39-KO) did not significantly differ from wild-type (WT) littermates in the open field, light/dark exploration and elevated plus-maze assays under standard test conditions. However, the TIP39-KO engaged in more active defensive burying in the shock-probe test. In addition, when tested under high illumination or after restraint, TIP39-KO displayed significantly greater anxiety-like behavior in the elevated plus-maze than WT. In a Pavlovian fear-conditioning paradigm, TIP39-KO froze more than WT during training and during tone and context recall but showed normal fear extinction. Disruption of TIP39 projections to the medial prefrontal cortex, lateral septum, bed nucleus of the stria terminalis, hypothalamus and amygdala likely account for the fear- and anxiety-related phenotype of TIP39-KO. Current data support the hypothesis that TIP39 modulates anxiety-related behaviors following environmental provocation.

Reduced plaque formation induced by rosiglitazone in an STZ-diabetes mouse model of atherosclerosis is associated with downregulation of adhesion molecules

Adhesion molecules have been implicated in the development and progression of cardiovascular disease, which is highly prevalent in people with diabetes. Adhesion molecules can mediate adhesion of leukocytes to the endothelium. Furthermore, P-selectin expressed on platelets is able to mediate the adhesion of leukocytes to platelets. In this study, we examine the in-vivo and in-vitro effects of rosiglitazone with particular emphasis on three important adhesion molecules (VCAM-1, ICAM-1 and P-selectin). In the aorta of STZ-diabetic apolipoprotein E-deficient (apoE KO) mice, rosiglitazone significantly reduced both total and arch plaque area. The mechanism for this appeared to be reduced macrophage infiltration into the atherosclerotic plaque which was also associated with reduced mRNA levels for VCAM-1, ICAM-1, MCP-1 and P-selectin in the aorta. In-vitro studies revealed reduced cell adhesion of monocytic cells (THP-1) to fibrinogen and endothelial cells (HUVEC) after incubation with rosiglitazone. Furthermore, the reduction in leukocyte adhesion also correlated with significant reductions in mRNA levels for VCAM-1, ICAM-1 and P-selectin indicating that reduced macrophage infiltration in atherosclerotic plaques may occur as a result of a direct effect of rosiglitazone on adhesion molecules in both monocytes and endothelial cells. Thus, we have shown that rosiglitazone appears to have direct anti-atherosclerotic effects in an animal model of diabetes-associated atherosclerosis which are at least partly due to effects on VCAM-1, ICAM-1, MCP-1 and P-selectin expression which leads to decreased leukocyte adhesion and macrophage infiltration.

Post-160-km race illness rates and decreases in granulocyte respiratory burst and salivary IgA output are not countered by quercetin ingestion

This study measured the influence of the flavonoid quercetin on immune changes and incidence rates of upper respiratory tract infections in ultramarathoners competing in the 160-km Western States Endurance Run. Sixty-three runners were randomized to quercetin and placebo groups, and under double-blinded methods ingested 1000 mg/day quercetin for 3 wks before, during, and 2 wks after the race. Thirty-nine of the 63 subjects (n = 18 for quercetin, n = 21 for placebo) finished the race and provided blood and saliva samples the morning before the race and 15 - 30 min postrace. Upper respiratory tract infections were assessed during the week before and the 2-wk period after the race using an illness symptom checklist. Race times did not differ significantly between quercetin and placebo groups. Significant pre- to postrace decreases were measured for natural killer cells (43 %), granulocyte respiratory burst activity (55 %), and salivary IgA output (48 %), and increases for neutrophil (288 %) and monocyte (211 %) cell counts, with no significant group differences. Postrace illness rates did not differ between groups. In conclusion, quercetin supplementation for 3 wks before and 2 wks after the Western States Endurance Run had no effect on illness rates, perturbations in leukocyte subset counts, or decreases in granulocyte respiratory burst activity and salivary IgA.

Immune changes: 2 h of continuous vs. intermittent cycling

Immune changes following 2 h of intensive cycling with or without rest intervals were measured in trained cyclists (n = 12) who functioned as their own controls during two test sessions that were separated by two weeks. Subjects cycled for 2.0 h at approximately 64 % Watts(max) continuously (C) or with 3-min rest intervals (R) interspersed every 10 min (2.6 h total time), with the order of the sessions randomized. Blood samples were collected 30-min pre-exercise, and immediately and 1-h postexercise, and assayed for blood leukocyte subset counts, plasma IL-6, IL-10, IL-1ra, IL-8, PHA-induced lymphocyte proliferation, and natural killer cell activity (NKCA). Significant time effects were measured for all immune measures, but no significant differences in the pattern of change were found between C and R exercise trials. In conclusion, immune changes induced by 2 h of intense and prolonged exercise paralleled those measured when athletes rested 3 min every 10 min of exercise.

Antitumor activity of dual-specific T cells and influenza virus

Activation and expansion of T cells are important in disease resolution, but tumors do not usually satisfy these immune requirements. Therefore, we employed a novel strategy whereby dual-specific T cells were generated that could respond to both tumor and influenza virus, reasoning that immunization with influenza virus would activate and expand tumor-specific cells, and inhibit tumor growth. Dual-specific T cells were generated by gene modification of influenza virus-specific mouse T cells with a chimeric gene-encoding reactivity against the erbB2 tumor-associated antigen. Dual-specific T cells were demonstrated to respond against both tumor and influenza in vitro, and expanded in vitro in response to influenza to a much greater degree than in response to tumor cells. Following adoptive transfer and immunization of tumor-bearing mice with influenza virus, dual-specific T cells expanded greatly in numbers in the peritoneal cavity and spleen. This resulted in a significant increase in time of survival of mice. However, tumors were not eradicated, which may have been due to the observed poor penetration of tumor by T cells. This is the first demonstration that the potent immunogenic nature of an infectious agent can be utilized to directly impact on T-cell expansion and activity against tumor in vivo.

Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity

The high risk of anterior cruciate ligament (ACL) injuries in female athletes may be related to hormonal fluctuations resulting in an increased laxity of ligaments and muscles. This study examined changes in lower limb musculotendinous stiffness (MTS) and knee laxity over the course of the menstrual cycle and investigated the interaction of warm-up on MTS. Eleven female netball players aged 16-18 years who were not using hormonal contraceptives and demonstrated regular menstrual cycles participated in this study. Test-sessions were conducted at onset of menses, mid-follicular phase, ovulation and mid-luteal phase. ACL laxity was determined at each test-session using a KT2000 knee arthrometer. MTS was assessed prior to, and following a standardised warm-up. Repeated measures ANOVA revealed significant (P < 0.05) main effects of test-session and warm-up on MTS. MTS was found to significantly decrease by 4.2% following the warm-up intervention. MTS was significantly lower at week 3 (ovulatory phase) in contrast to weeks 1 and 2 (8.7 and 4.5%, respectively). For knee laxity measures, repeated measures ANOVA revealed no significant (P < 0.05) differences across the menstrual cycle. A reduction in MTS results in greater reliance on reflexive response from the contractile components of the muscle due to a decreased contribution from passive elastic structures and will also increase electromechanical delay. Given that extreme loads are applied to the knee joint within milliseconds, the contractile components cannot respond quickly enough to counteract these sudden and potentially damaging forces. These effects are augmented following a moderate warm-up. Oestrogen fluctuations had no significant effect on anterior knee laxity, however, the effects on MTS over the 28-day cycle were considerable. Future studies should use matched subjects who are using the monophasic oral contraceptive pill to investigate the effects of oestrogen supplementation on lower limb MTS.

Changes in Selected Biochemical, Muscular Strength, Power, and Endurance Measures during Deliberate Overreaching and Tapering in Rugby League Players

The purpose of this study was to examine the influence of overreaching on muscle strength, power, endurance and selected biochemical responses in rugby league players. Seven semi-professional rugby league players (.VO(2max) = 56.1 +/- 1.7 mL . kg (-1) . min (-1); age = 25.7 +/- 2.6 yr; BMI = 27.6 +/- 2.0) completed 6 weeks of progressive overload training with limited recovery periods. A short 7-day stepwise reduction taper immediately followed the overload period. Measures of muscular strength, power and endurance and selected biochemical parameters were taken before and after overload training and taper. Multistage fitness test running performance was significantly reduced (12.3 %) following the overload period. Although most other performance measures tended to decrease following the overload period, only peak hamstring torque at 1.05 rad . s (-1) was significantly reduced (p < 0.05). Following the taper, a significant increase in peak hamstring torque and isokinetic work at both slow (1.05 rad . s (-1)) and fast (5.25 rad . s (-1)) movement velocities were observed. Minimum clinically important performance decreases were measured in a multistage fitness test, vertical jump, 3-RM squat and 3-RM bench press and chin-up (max) following the overload period. Following the taper, minimum clinically important increases in the multistage fitness test, vertical jump, 3-RM squat and 3-RM bench press and chin-up (max) and 10-m sprint performance were observed. Compared to resting measures, the plasma testosterone to cortisol ratio, plasma glutamate, plasma glutamine to glutamate ratio and plasma creatine kinase activity demonstrated significant changes at the end of the overload training period (p < 0.05). These results suggest that muscular strength, power and endurance were reduced following the overload training, indicating a state of overreaching. The most likely explanation for the decreased performance is increased muscle damage via a decrease in the anabolic-catabolic balance.

Salmonella surveillance in raw and cooked meat and meat products in the Republic of Ireland from 2002 to 2004

The food industry, under the regulation of the Department of Agriculture and Food (DAF) in the Republic of Ireland, is required to undertake all microbiological testing in relation to zoonoses control, in laboratories approved by DAF. These laboratories submit a monthly report of all tests undertaken, together with all presumptive Salmonella isolates for confirmation, typing and storage to the Central Veterinary Research Laboratory (CVRL). Details of Salmonella tests on 110,229 raw and 25,189 cooked meat samples from 25 laboratories were recorded over the 3-year period 2002-2004. Salmonella spp. were isolated from 1.0% of the 110,229 raw meat samples and 0.1% of the 25,189 cooked meat samples tested. The percentage of raw meat samples contaminated with Salmonella decreased over the three-year period from 1.2% to 0.9%. There was no seasonal trend in the isolation of Salmonella from any of the meats or meat products. Recoveries of the organism were highest for turkey and chicken meats at 3.1% and 2.8%, respectively, followed by porcine meats at 2.1%. The recoveries were much lower for ovine meats and meat products at 0.2% and bovine meat and meat products at 0.16%.