Burden of comorbidities: Osteoporotic vertebral fracture during non-small cell lung cancer - the BONE study

INTRODUCTION

Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS).

METHODS

We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method.

RESULTS

We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m2 (OR: 5.62, 95%CI 1.84-17.20, p = 0.002), lower TVBD (OR: 0.982 per HU, 95%CI 0.97-0.99, p = 0.001) and corticosteroid use (OR: 4.77, 95%CI: 1.76-12.89, p = 0.001). OPVF was not significantly associated with OS.

CONCLUSIONS

Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.

MeaningBERT: assessing meaning preservation between sentences

In the field of automatic text simplification, assessing whether or not the meaning of the original text has been preserved during simplification is of paramount importance. Metrics relying on n-gram overlap assessment may struggle to deal with simplifications which replace complex phrases with their simpler paraphrases. Current evaluation metrics for meaning preservation based on large language models (LLMs), such as BertScore in machine translation or QuestEval in summarization, have been proposed. However, none has a strong correlation with human judgment of meaning preservation. Moreover, such metrics have not been assessed in the context of text simplification research. In this study, we present a meta-evaluation of several metrics we apply to measure content similarity in text simplification. We also show that the metrics are unable to pass two trivial, inexpensive content preservation tests. Another contribution of this study is MeaningBERT (https://github.com/GRAAL-Research/MeaningBERT), a new trainable metric designed to assess meaning preservation between two sentences in text simplification, showing how it correlates with human judgment. To demonstrate its quality and versatility, we will also present a compilation of datasets used to assess meaning preservation and benchmark our study against a large selection of popular metrics.

Non-overweight depressed patients who respond to antidepressant treatment have a higher risk of later metabolic syndrome: findings from the METADAP cohort

BACKGROUND

Major depressive disorder (MDD) is a complex disorder with a significant public health burden. Depression remission is often associated with weight gain, a major risk factor for metabolic syndrome (MetS). The primary objective of our study was to assess prospectively the impact of response to antidepressant treatment on developing MetS in a sample of MDD patients with a current major depressive episode (MDE) and who are newly initiating their treatment.

METHODS

In the 6-month prospective METADAP cohort, non-overweight patients, body mass index <25 kg/m2, with MDD and a current MDE were assessed for treatment response after 3 months of treatment, and incidence of MetS after 3 and 6 months of treatment. Outcome variables were MetS, number of MetS criteria, and each MetS criterion (high waist circumference, high blood pressure, high triglyceridemia, low high-density lipoprotein-cholesterolemia, and high fasting plasma glucose).

RESULTS

In total, 98/169 patients (58%) responded to treatment after 3 months. A total of 2.7% (1/38) developed MetS out of which 12.7% (10/79) (p value < 0.001) had responded to treatment after 3 months. The fixed-effect regression models showed that those who responded to treatment after 3 months of follow-up had an 8.6 times higher odds of developing MetS (odds ratio = 8.58, 95% confidence interval 3.89-18.93, p value < 0.001).

CONCLUSION

Compared to non-responders, non-overweight patients who responded to treatment after 3 months of antidepressant treatment had a significantly higher risk of developing MetS during the 6 months of treatment. Psychiatrists and nurses should closely monitor the metabolic profile of their patients, especially those who respond to treatment.

Understanding the influence of online information, misinformation, disinformation and reinformation on COVID-19 vaccine acceptance: Protocol for a multicomponent study

Background

The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children.

Objective

The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines.

Methods

Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature.

Results

As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months.

Conclusions

The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/41012

A Framework for Developing Pharmacotherapy for Agitation in Alzheimer's Disease: Recommendations of the ISCTM* Working Group

Dementia is characterized by a significant decline in one of several cognitive domains such as memory, language and executive function, affecting independence and representing a significant deterioration from a previous level of functioning (1). Alzheimer’s Disease (AD) represents the most common form of dementia and contributes up to 70% of the almost 50 million dementia cases worldwide, a number that is projected to double in 20 years (2).

Exploring polypharmacy with artificial intelligence: data analysis protocol

BACKGROUND

Polypharmacy is common among older adults and it represents a public health concern, due to the negative health impacts potentially associated with the use of several medications. However, the large number of medication combinations and sequences of use makes it complicated for traditional statistical methods to predict which therapy is genuinely associated with health outcomes. The project aims to use artificial intelligence (AI) to determine the quality of polypharmacy among older adults with chronic diseases in the province of Québec, Canada.

METHODS

We will use data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS). QICDSS contains information about prescribed medications in older adults in Quebec collected over 20 years. It also includes diagnostic codes and procedures, and sociodemographic data linked through a unique identification number for each individual. Our research will be structured around three interconnected research axes: AI, Health, and Law&Ethics. The AI research axis will develop algorithms for finding frequent patterns of medication use that correlate with health events, considering data locality and temporality (explainable AI or XAI). The Health research axis will translate these patterns into polypharmacy indicators relevant to public health surveillance and clinicians. The Law&Ethics axis will assess the social acceptability of the algorithms developed using AI tools and the indicators developed by the Heath axis and will ensure that the developed indicators neither discriminate against any population group nor increase the disparities already present in the use of medications.

DISCUSSION

The multi-disciplinary research team consists of specialists in AI, health data, statistics, pharmacy, public health, law, and ethics, which will allow investigation of polypharmacy from different points of view and will contribute to a deeper understanding of the clinical, social, and ethical issues surrounding polypharmacy and its surveillance, as well as the use of AI for health record data. The project results will be disseminated to the scientific community, healthcare professionals, and public health decision-makers in peer-reviewed publications, scientific meetings, and reports. The diffusion of the results will ensure the confidentiality of individual data.

Estimating the prevalence of autism spectrum disorder in Lebanon

This cross-sectional survey examines the prevalence rate of Autism spectrum disorder (ASD) in 818 children (16-48 months) across all Lebanese regions. Screening was done using the revised form of the Modified-Checklist for Autism in Toddlers. Based on the total score of items failed, children were classified into 3 categories of ASD risk (low, moderate and high). Phone calls follow-up interviews and clinical assessments for diagnosis ascertainment were conducted. Given the caregivers' reluctance to participate, the prevalence rate was estimated between 49 and 513 per 10,000 with a male predominance. Our prevalence estimation, even under restrictive assumptions, is higher than elsewhere in the Arab region. Anti- stigma interventions adapted to the socio-cultural context are needed prior to future research in the field.

Bioremediation of PAH-contaminated shooting range soil using integrated approaches

Serious contamination of polycyclic aromatic hydrocarbons (PAHs) occurs at outdoor shooting ranges due to the accumulation of clay target fragments containing coal tar or petroleum pitch. These contaminated sites are characterized with high-molecular-weight PAHs that are low in bioavailability and recalcitrant to bioremediation. We evaluated the effectiveness of different remediation strategies, used individually or in combinations, to decontaminate PAHs in a shooting range soil. The treatments included vegetation with bermudagrass [Cynodon dactylon (L.) Pers] or switchgrass [Panicum virgatum]), bioaugmentation of Mycobacterium vanbaalenii PYR-1, and addition of surfactants (Brij-35, rhamnolipid biosurfactant, or Brij-35/sodium dodecyl sulfate mixture). The initial total PAH concentration in the shooting range soil was 373 mg/kg and consisted of primarily high-molecular-weight PAHs (84%). Planting of bermudagrass and switchgrass resulted in 36% and 27% ∑₁₆PAH reduction compared to the non-vegetated control, respectively. Bermudagrass enhanced soil dehydrogenase activity and both vegetation treatments also increased polyphenol oxidase activity. Bioaugmentation of M. vanbaalenii PYR-1 had a significant effect only on the dissipation of high-molecular-weight PAHs, leading to a 15% decrease (∑₁₀PAH) compared to the control. In the non-vegetated soil, Brij-35/sodium dodecyl sulfate mixture increased PAH degradation compared to the no surfactant control. The increased PAH biodegradation in the vegetated and bioaugmented treatments improved lettuce [Lactuca sativa] seed germination, suggesting reduced toxicity in the treated soils. Phytoremediation using bermudagrass or switchgrass with bioaugmentation of M. vanbaalenii PYR-1 was an effective in situ remediation option for shooting range soils with heavy PAH contamination.

Direct etching at the nanoscale through nanoparticle-directed capillary condensation

We report a method to locally deliver a chemical etchant at the nanoscale in the vapor phase by capillary condensation forming a meniscus at the nanoparticle/substrate interface. The process is simple, scalable and does not require functionalization of the nanoparticles. Furthermore, it does not rely on any specific chemical properties of the materials other than the solution being aqueous and the wettability properties of the surfaces involved, which should enable its application to other material and chemical combinations. In particular, in this work we demonstrate the proposed process by periodically pattering a SiO₂ layer using a self-assembled monolayer of polystyrene particles exposed to HF vapors. The patterned SiO₂ layer is then used as a mask to etch a pattern of inverted nanopyramids on Si. The silicon nanopatterning has been demonstrated for particles sizes ranging from 800 nm down to 100 nm, providing pyramids with a size down to 50 nm for 100 nm nanoparticles.

Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions

BACKGROUND

Electrical impedance spectroscopy (EIS) is a noninvasive diagnostic technique that measures tissue impedance.

OBJECTIVES

To evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI).

METHODS

Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). EIS measurement was performed at the first visit following dermoscopic photography. Normally, an EIS score of ≥ 4 is considered positive; however, this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥ 7 the lesion was excised immediately owing to the high risk of melanoma. Lesions with a score < 7 were monitored with standard SDDI over a 3-month period.

RESULTS

From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83·1% [95% confidence interval (CI) 76·3-88·7]. Five of the six melanomas found in this study had an EIS score ≥ 7, with a sensitivity for melanoma diagnosis of 83·3% (95% CI 35·9-99·6). When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS = 6) giving a sensitivity for the diagnosis of melanoma overall of 100% (95% CI 54·1-100; six of six malignant melanomas excised) and a specificity of 69·5% (95% CI 61·5-76·6; 107 of 154 benign lesions not excised).

CONCLUSIONS

If utilizing a protocol where an EIS score ≤ 3 requires no SDDI and ≥ 7 requires immediate excision, it reduced the need for SDDI by 46·9% (n = 75/160; 95% CI 39·0-54·9).

Abstract WMP8: Results of Trevo Acute Ischemic Stroke Thrombectomy Registry: Predictors of Clinical Outcome

Background and Purpose: Recent randomized clinical trial (RCTs) demonstrated efficacy of mechanical thrombectomy using stent-retrievers in acute ischemic stroke (AIS) patients. The main purpose of TRevo ACute Ischemic StroKe (TRACK) stent-retriever thrombectomy multicenter registry is to demonstrate safety and efficacy in real life clinical practice.

Methods: The investigator-initiated TRACK multicenter registry recruited 24 sites in north America to submit demographic, clinical, site-adjudicated angiographic, and outcome data on consecutive AIS patients treated with Trevo stent-retriever device as the first treatment option. Standard clinical safety (symptomatic intracranial hemorrhage (sICH), and mortality) and efficacy (revascularization and disability) outcomes and predictors of clinical outcome were analyzed.

Results: 624 patients were enrolled in the TRACK registry. Median age was 68 years (range 16-94, 118 (18.1%) >80), male gender was 51.4%, and 67.7% were white. The median National Institutes of Health Stroke Severity Scale (NIHSS) was 17 (IQR 13-22). Transfer cases were 50.6% with IV-rtPA use in 318 cases (51.3%). Median onset to groin puncture (OTG) time was 283 min (IQR 198.5-443), and groin puncture to revascularization was 66 min (IQR 37.5-103). Anterior circulation occlusion was 86.2% (MCA/M2 in 55.2% followed by ICA in 15.9% and M2 in 12.7%). Use of GA was in 389 cases (62.3%), number of passes were ≤ 3 in 92% of the cases (1: 45.2%, 2:28%, and 3:18.7%), 291 (46.7%) had BGC use. Rescue use was seen in 21.7%. Revascularization of ≥ TIMI 2 was 81.8% and ≥ TICI 2b was 70%. The primary outcome of mRS of ≥ 2 was 48.3% in the full cohort, and 50.6% in TREVO-2 like group. sICH and mortality were 7.2%, and 20.1% in the full cohort vs 6.9% and 17.5% in the TREVO-2 like group, respectively. The independent predictors of clinical outcome were lower baseline NIHSS, younger age, use of BGC, successful recanalization, and no general anesthesia (GA).

Conclusions: The real life clinical practice Trevo registry demonstrated good clinical outcome and high rate of recanalization. Younger age, lower baseline NIHSS, use of balloon guide catheter, successful recanalization, and avoiding endotrachaeal GA independent predictors of good clinical outcome.

High-Throughput Screening: Update on Practices and Success

High-throughput screening (HTS) has become an important part of drug discovery at most pharmaceutical and many biotechnology companies worldwide, and use of HTS technologies is expanding into new areas. Target validation, assay development, secondary screening, ADME/Tox, and lead optimization are among the areas in which there is an increasing use of HTS technologies. It is becoming fully integrated within drug discovery, both upstream and downstream, which includes increasing use of cell-based assays and high-content screening (HCS) technologies to achieve more physiologically relevant results and to find higher quality leads. In addition, HTS laboratories are continually evaluating new technologies as they struggle to increase their success rate for finding drug candidates. The material in this article is based on a 900-page HTS industry report involving 54 HTS directors representing 58 HTS laboratories and 34 suppliers.

Selective product amplification of thymine photodimer by recognition-directed supramolecular assistance

Two symmetric ditopic supramolecular templates (1 and 2) each presenting two hydrogen bonding recognition subunits were synthesized. Each such subunit comprises the same donor and acceptor pattern, capable of binding a substrate molecule with complementary hydrogen bonding groups to form a supramolecular complex. Substrate molecules, such as thymine or uracil derivatives, yield 2 : 1 complexes with the acceptors involving two hydrogen bonds to each subunit with ideal orientation for subsequent [2 + 2] dimerization upon photoirradiation. Selective syn photoproduct formation and concomitant suppression of the trans isomer are favored by orientation of the two guest nucleobases within the template cleft. Complementary donor and acceptor hydrogen bonding induced positioning of the two substrates and steric hindrance within the template clefts are responsible for the selective product formation.

Assessment of the plasma desorption time-of-flight mass spectrometry technique for pesticide adsorption and degradation on 'as-received' treated soil samples

The assessment of the plasma desorption time-of-flight mass spectrometry (PD-TOFMS) technique as a tool for direct characterization of pesticides adsorbed on agricultural soil is made for the first time in this study. Pellets of soils impregnated by solutions of three pesticides, namely norflurazon, malathion and oxyfluorfen, as well as deposits of these solutions onto aluminum surfaces, were investigated to this end. The yield values of the most characteristic peaks of the negative ion mass spectra were used to determine both the lowest concentrations detected on soils and limits of detection from thin films. The lowest values on soils are for malathion (1000 ppm range), and the largest for norflurazon (20,000 ppm), which is close to the limit of detection (LOD) found for the pesticide on the aluminum substrate (approximately 0.2 microg . cm(-2)). Different behaviors were observed as a function of time of storage in the ambient atmosphere or under vacuum; norflurazon adsorbed on soil exhibited high stability for a long period of time, and a rapid degradation of malathion with the elapsed time was clearly observed. The behavior of oxyfluorfen was also investigated but segregation processes seem to occur after several days. Although by far less sensitive than conventional methods based on extraction processes and used for real-world analytical applications, this technique is well suited to the study of the transformations occurring at the sample surface. A discussion is presented of the future prospects of such experiments in degradation studies.

Behavior of triadimefon in two Lebanese soils

The retention and fate of triadimefon fungicide were studied under two environmental conditions. Field studies were conducted on two soils, a sandy loam soil (Fanar) and a clay soil (Raouda). Fanar is a wet coastal area while Raouda is a dry agricultural area of the Bekaa plain located at an elevation of 870 m above sea level. Triadimefon was applied with a jet sprayer at 267 g a.i.ha(-1) and 200 g a.i.ha(-1) at Fanar and Raouda, respectively. Reconstituted soil columns (600 x 30 mm) glasses, were used to study the fungicide movement and metabolism in the two soils. Analyses of triadimefon and its metabolites were carried out using gas chromatography (GC) and high performance liquid chromatography (HPLC). The results indicated a weak reversibility of the adsorbed fraction in the clay soil. Clay is considered an important factor in triadimefon adsorption. Triadimefon mobility in the sandy-loam soil was relatively high in comparison with behavior in the clay soil where about half of the applied fungicide was detected in the upper 25 cm of soil, six days after treatment. Rapid degradation of triadimefon to triadimenol was observed in the two soils. The observed half-life was 8 days in sandy-loam and 13 days in clay soils.

Reasons for underreporting of notifiable diseases by Syrian paediatricians

We investigated reasons for underreporting of notifiable diseases among Syrian paediatricians. Self-administered questionnaires and self-addressed envelopes were sent to all paediatricians listed in the recent records of the Syrian Medical Association. Of 723 questionnaires, 55 were returned by the post office due to an incorrect address. Only 160 questionnaires [23.9%] were answered. Approximately 50% of paediatricians gave two reasons for underreporting: lack of reporting forms and ignorance of reporting telephone numbers. Nearly 70% indicated that the most important improvements would be the availability of easy reporting forms and a condensed and feasible list of notifiable diseases.

Reasons for underreporting of notifiable diseases by Syrian paediatricians

We investigated reasons for underreporting of notifiable diseases among Syrian paediatricians. Self-administered questionnaires and self-addressed envelopes were sent to all paediatricians listed in the recent records of the Syrian Medical Association. Of 723 questionnaires, 55 were returned by the post office due to an incorrect address. Only 160 questionnaires (23.9%) were answered. Approximately 50% of paediatricians gave two reasons for underreporting: lack of reporting forms and ignorance of reporting telephone numbers. Nearly 70% indicated that the most important improvements would be the availability of easy reporting forms and a condensed and feasible list of notifiable diseases.

Gastro-oesophageal reflux associated with nocturnal gastric acid breakthrough on proton pump inhibitors

BACKGROUND

Nocturnal gastric acid breakthrough, defined as intragastric pH < 4 for more than 1 h in the overnight period, is observed in up to 70% of normal subjects on proton pump inhibitors taken twice daily. The frequency of this breakthrough in patients with gastro-oesophageal reflux and accompanying oesophageal reflux during this period has not been studied.

AIM

To examine the frequency of nocturnal break-through and accompanying oesophageal acid exposure in patients with gastro-oesophageal reflux treated with proton pump inhibitors twice daily.

METHODS

Prolonged ambulatory pH records from 76 patients on twice daily proton pump inhibitors between January 1991 and July 1997 were analysed for the presence of nocturnal gastric acid breakthrough and accompanying oesophageal pH < 4. Studies from 31 normal subjects on twice daily proton pump inhibitors constituted the control group.

RESULTS

Nocturnal gastric acid breakthrough was seen in 70% of 61 patients with gastro-oesophageal reflux, 80% of 15 patients with Barrett's oesophagus and 67% of normal controls (P=N.S.). Oesophageal acid exposure was seen in 33% of gastro-oesophageal reflux patients, 50% of Barrett's oesophagus patients and 8% of normal controls (P < 0.03). No difference was found between patients taking omeprazole or lansoprazole.

CONCLUSION

Nocturnal acid breakthrough is frequently seen on proton pump inhibitors twice daily and is often accompanied by oesophageal reflux. This has important implications for medical therapy in patients with severe gastro-oesophageal reflux and Barrett's oesophagus.

Comparison of 6-s-cis- and 6-s-trans-locked analogs of 1alpha,25-dihydroxyvitamin D3 indicates that the 6-s-cis conformation is preferred for rapid nongenomic biological responses and that neither 6-s-cis- nor 6-s-trans-locked analogs are preferred for genomic biological responses

The hormone 1alpha,25-dihydroxyvitamin D3 [1alpha,25(OH)2D3] generates biological responses via both genomic and rapid, nongenomic mechanisms. The genomic responses utilize signal transduction pathways linked to a nuclear receptor (VDRnuc) for 1alpha,25(OH)2D3, while the rapid responses are believed to utilize other signal transduction pathways that may be linked to a putative membrane receptor for 1alpha,25(OH)2D3. The natural seco steroid is capable of facile rotation about its 6,7 single carbon bond, which permits generation of a continuum of potential ligand shapes extending from the 6-s-cis (steroid like) to the 6-s-trans (extended). To identify the shape of conformer(s) that can serve as agonists for the genomic and rapid biological responses, we measured multiple known agonist activities of two families of chemically synthesized analogs that were either locked in the 6-s-cis (6C) or 6-s-trans (6T) conformation. We found that 6T locked analogs were inactive or significantly less active than 1alpha,25(OH)2D3 in both rapid responses (transcaltachia in perfused chick intestine, 45Ca2+ influx in ROS 17/2.8 cells) and genomic (osteocalcin induction in MG-63 cells, differentiation of HL-60 cells, growth arrest of MCF-7 cells, promoter transfection in COS-7 cells) assays. In genomic assays, 6C locked analogs bound poorly to the VDRnuc and were significantly less effective than 1alpha,25(OH)2D3 in the same series of assays designed to measure genomic responses. In contrast, the 6C locked analogs were potent agonists of both rapid response pathways and had activities equivalent to the conformationally flexibile 1alpha,25(OH)2D3; this represents the first demonstration that 6-s-cis locked analogs can function as agonists for vitamin D responses.

Effect of agents used in perforation repair on osteoblastic cells

The effects of dental materials on osteoblastic responses in bone were measured using biosynthesis of matrix proteins, osteopontin (OPN), and osteocalcin (OCN) as indices. Materials used in perforation repair were standardly mixed and extracted in sterile water for 10 days. Extracts were added to the medium of osteoblastic ROS 17/2.8 cells and cultured for 48 h. Water incubated in parallel served as the vehicle/dilution control. 1,25-Dihydroxyvitamin D3, which increases biosynthesis of OPN and OCN, served as the positive control. After culture, total cellular RNA was isolated from individual monolayers, and Northern blotting was performed to quantitate mRNA levels encoding OCN and OPN. mRNA levels in treated samples were compared with controls, and significant differences were detected for several materials. Changes in matrix biosynthesis were modest (< 2-fold), compared with 1,25-dihydroxyvitamin D3 (6-fold). Materials used in perforation repair may produce small, but measurable effects on osteoblastic responses.

[Implantation of the Ultrex type inflatable penile prosthesis. Four years experience]

During the last 4 years, 12 patients had an implantation of the AMS Ultrex2 penile prosthesis : 4 of these patients were impotent after a cystoprostatectomy, 4 patients had vascular insufficiency, 2 patients had psychogenic impotency, one patient was diabetic and one patient had a spinal cord injury. The complication rate was low (16%): one patient necessitated a surgical revision of the prosthesis after disconnection of the tubulure. A second patient had a urethral stenosis treated by dilation. The degree of satisfaction of both patient and partner was satisfactory.

Target gene activation by 1,25-dihydroxyvitamin D3 in osteosarcoma cells is independent of calcium influx

Analogs of the seco-steroid hormone, 1,25-dihydroxyvitamin D3 [1,25-(OH)-2D3] can preferentially stimulate genomic or nongenomic signaling pathways in osteoblasts. In this study, we used 1,25-(OH)2D3 analogs and voltage-sensitive Ca2+ channel (VSCC) ligands, including dihydropyridines (Bay K 8644 and nitrendipine), in an osteosarcoma cell model to examine the relationship between 1,25-(OH)2D3-stimulated Ca2+ influx and genomic and nongenomic pathways leading to osteoblast activation. Northern blotting experiments demonstrated that an analog of 1,25-(OH)2D3, 1,24-dihydroxy-22-ene-24-cyclopropyl D3, increased messenger RNA (mRNA) levels of both osteopontin (OPN) and osteocalcin (OCN) without triggering Ca2+ influx through VSCCs. Nitrendipine (an inhibitor of L-type VSCCs) did not block the mRNA increase induced by either analog 1,24-dihydroxy-22-ene-24-cyclopropyl D3 or 1,25-(OH)2D3. 1-Deoxy analogs of 1,25-(OH)2D3, 25-hydroxy-16-ene-23-yne-D3, or 25-hydroxy-23-yne-D3, which stimulate Ca2+ influx, did not produce mRNA accumulation for OPN and OCN, consistent with their poor binding to nuclear receptors. Likewise, Bay K 8644, an agonist of VSCCs that produces Ca2+ influx, did not increase mRNA levels for OPN or OCN. Experiments using a construct derived from the sequence of the genomic OPN promoter region and a luciferase reporter confirmed the analog specificity in stimulating transcription. Together these results indicate that 1,25-(OH)2D3-mediated up-regulation of genes encoding OPN and OCN is independent of Ca2+ influx and suggest that the stimulation of Ca2+ influx by 1,25-(OH)2D3 is not required for target gene activation.

Piezolith extracorporeal shockwave lithotripsy: the Hotel-Dieu de France experience

A total of 1500 patients underwent treatment with the Wolf Piezolith 2300 extracorporeal shockwave lithotripter for renal, ureteral, and bladder stones. Follow-up data were available at 3 months for 1435 patients. At that time, the overall stone-free rate was 82.7%: 82.4% for patients with renal stones, 81.0% for those with ureteral stones, and 100% for those with bladder stones. The overall success rate was 92.3%: 93.8% for patients with renal stones, 87.1% for those with ureteral stones, and 100% for those with bladder stones. The auxiliary treatment rate was 14.9%, and the retreatment rate was 53%. The effectiveness quotient was 49.2%. The Wolf Piezolith 2300 is an effective treatment for most stones smaller than 30 mm.

[Treatment of sexual impotency by intra-cavernous injections of prostaglandin E1. Report of 180 patients]

As already reported, PGE1 induces a valid erection, when administered intracavernously, without causing prolonged erection or general side effects. We have tested PGE1 (< 20 micrograms) in 180 patients suffering from organic erectile impotence, a complete erection was observed in 130 (72.2%), while incomplete erection was noted in 37 (20.5%). In both groups (92.7%) erection was sufficient for sexual intercourse. Among the best results, 41 patients had previously received high doses intracavernous injection of papaverine, without any benefit, and 15 patients have cavernosal venous leakage documented by cavernosometry and cavernosography before prostaglandin E1 test. Tumescence without rigidity was noted in 13 (7.2%). Of these 167 patients, 95 entered an autoinjection protocol for treatment of erectile dysfunction, using special device. In our series neither systemic reaction nor prolonged erection occurred. No fibrosis of cavernous tissue or scar formation was observed after up to 125 injections. However, 19 patients (10.5%) reported burning sensations during the entire period of erection and one patient (0.5%) had an haematoma at the site of the injection. PGE1 is effective in inducing artificial penile erection and it has a role in the diagnosis and treatment of erectile dysfunction, it is considered to be a more suitable agent than other vasoactive drugs.

22-Oxacalcitriol: dissection of 1,25(OH)2D3 receptor-mediated and Ca2+ entry-stimulating pathways

22-Oxa-1,25-dihydroxyvitamin D3 (oxacalcitriol, or OCT) is a bioactive analogue of 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] with lower calcemic activity than the parent compound. We investigated the ability of OCT to stimulate 1) genomic pathways mediated by nuclear receptors for 1,25(OH)2D3 versus 2) nongenomic pathways mediated by voltage-sensitive Ca2+ channels in growth phase rat osteosarcoma cells (ROS 17/2.8) and in chick intestine. Effects on nuclear receptor-mediated pathways were evaluated by measuring the ability of OCT to compete with [3H]1,25(OH)2D3 for soluble receptors. We also measured the ability of OCT to increase mRNA encoding osteoblast marker proteins osteopontin (OPN) and osteocalcin (OCN), which are both increased by 1,25(OH)2D3. Effects on Ca2+ entry into osteoblasts were measured using 45Ca2+ influx assays. The rapid stimulation of calcium absorption (transcaltachia) in chick intestine treated with OCT also was measured. We found that OCT bound to the nuclear receptor with lower binding affinity [relative competitive index (RCI) = 48.1 for ROS 17/2.8; RCI = 14.8 for chick intestine] than 1,25(OH)2D3 (RCI = 100). Like 1,25(OH)2D3, OCT increased mRNA levels of OPN and OCN in ROS 17/2.8 cells over a 48-h period. In contrast, OCT had no effect on transmembrane influx of 45Ca2+ across ROS cell membranes, whereas uptake was stimulated within 1 min by 1 nM 1,25(OH)2D3. In transcaltachia assays in perfused duodenum, OCT stimulated absorption with a maximum response at 6.5 nM.(ABSTRACT TRUNCATED AT 250 WORDS)

Extraperitoneal endosurgical lymphadenectomy with insufflation in the staging of bladder and prostate cancer

A new technique of endosurgical pelvic lymph node dissection was performed for the staging of 10 prostate and 8 bladder cancers. The technique, involving an exclusive extraperitoneal space development with CO2 insufflation, is described in detail. Using the standard endosurgical (laparoscopic) equipment, we performed a complete bilateral ilio-obturator lymph node dissection in 15 patients (83%). In the remaining three patients, because of technical difficulties, only unilateral dissection was performed. The average operating time was 84 minutes. Morbidity was low (one instance of sepsis). Prospective assessment of CO2 homeostasis showed that arterial CO2 pressure (PaCO2) increased significantly but could be controlled by increasing minute ventilation output. Our results show that perioperative assessment of end-tidal CO2 partial pressure is necessary and sufficient for the adaptation of minute ventilation output. Two patients with prostate cancer had positive nodes. No intraoperative or postoperative morbidity related to the procedure was observed in patients submitted to radical surgery. Extraperitoneal endosurgical pelvic lymphadenectomy with CO2 insufflation is a rapid, safe, and effective method in the staging of urologic pelvic malignancies and represents an alternative to traditional open surgery as well as to conventional transperitoneal laparoscopic lymphadenectomy.

Distribution of water between extracellular and intracellular compartments of incised wounds of rabbits

The distribution of water between the extracellular and intracellular compartments in incised wounds of skin, muscle and stomach has been studied in healthy rabbits and the progress of healing monitored by the determination of tensile strength for 120 days. It has been shown that, after wounding, there is an immediate expansion of the extracellular space. The increase is most marked during the first 24 hours and is maximal by this time in wounds of the skin and the muscle. During the first 30 days of healing, all incised tissues contain similar amounts of extracellular water which constitute approximately one-half of the total tissue mass, irrespective of the size of the extracellular space prior to wounding. There is an inverse relationship between the increase in the amount of extracellular water and the size of the extracellular space prior to wounding. All incised tissues maintain an elevated, and similar, concentration of extracellular water for more than 120 days. The period of maximal gain in tensile strength corresponds to the period of maximal expansion of the extracellular space which signifies a particularly active phase in the wound healing process. The intracellular space in wounds of muscle and stomach is reduced for more than 120 days, but no significant changes are seen in the intracellular water of wounds of skin. It has been concluded that expansion of the extracellular space is essential for wound healing, and it can, therefore, serve as a sensitive indicator of tissue injury.