[Assessment of energy density during laser photoselective vaporisation of the prostate: A retrospective monocentric study]

INTRODUCTION

Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes.

METHODS

A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups.

RESULTS

A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03).

CONCLUSION

The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction.

LEVEL OF PROOF

3.

Hair keratin pattern in human hair follicles grown in vitro

The keratin family includes epithelial (soft) keratins and hair (hard) keratins, and can be divided into acidic type I and basic to neutral type II subfamilies. Recently, nine type I and six type II hair keratin genes have been characterized through the screening of a human PAC library. The expression of these genes in the hair follicle was determined in vivo and a combined catalog of acidic and basic hair keratins was established. In this study, we investigated the expression and localization of most of the human hair keratin members of both types in human hair grown in vitro. We show that in vitro growth of hair follicles for 10 days in complete William's E culture medium did not alter the expression pattern of hair keratins. Similarly to the in vivo situation, each hair keratin was localized in precise and discrete compartments of the follicle, ranging from the matrix to the upper cortex and/or the hair cuticle. This study shows that the increase in length of in vitro grown follicles was accompanied by the proper hair shaft keratinization process. It also shows that hair follicle integrity was maintained in vitro, both in terms of gross morphology and molecular organization despite the complexity of the keratin expression pattern.

On the use of Micro-Imager to directly visualize drug distribution in human skin

Knowledge of drug distribution into the skin has always been considered as a key parameter of both safety and efficiency. We describe here the use of a new and powerful device to directly visualize and quantify the skin distribution of a radioactively labelled compound on histological sections.

Expression of peroxisome proliferator activated receptors (PPARs) in human hair follicles and PPAR alpha involvement in hair growth

Peroxisome proliferator-activated receptors (PPARs), which belong to the nuclear hormone receptor superfamily, have recently been described as potent key regulators of epidermal development. As 1,25-dihydroxyvitamin D3, retinoic acid and triiodothyronine are known to exert effects on skin and hair follicle growth through similar receptors, we decided to investigate both the expression pattern of the PPAR alpha, -delta and -gamma subtypes and their role in human hair follicles. Using reverse transcriptase-polymerase chain reaction and immunohistochemistry, we established that PPAR alpha, -delta and -gamma were expressed in both dermal and epithelial human hair follicle cells. Additionally, we evaluated the dose effect of clofibrate, a PPAR alpha ligand, on the survival of human hair follicles in culture. A beneficial effect was observed within a narrow range of concentrations.

Thyroid hormone receptor beta1 is expressed in the human hair follicle

To understand better the mechanisms by which thyroid hormone can exert its effects on the hair follicle, we looked for the expression of members of the thyroid hormone receptor (TR) family in human hair follicles. Immunoreactive TRs were detected in both dermal and epithelial compartments of the human pilosebaceous unit. Using reverse transcriptase-polymerase chain reaction, we established that TRbeta1 was the predominant form of TR expressed in the human hair follicle. In addition, we investigated the effects of 3,3', 5-triiodo-L-thyronine (T3) on the survival of human hair follicles in vitro, to understand the role of this thyroid hormone on hair follicle homeostasis. A physiological level of free T3 significantly enhanced human hair survival in vitro.

Expression of retinoid nuclear receptor superfamily members in human hair follicles and its implication in hair growth

Since clinical evidence of hair loss and hair depigmentation following etretinate therapy has been reported, we decided to study the expression levels of several members of the retinoid nuclear receptor superfamily in dermal and epithelial compartments of the human hair follicle. Additionally, we evaluated the effects of several ligands for these receptors on human hair growth in culture in vitro. We observed that the cellular/ cytoplasmic retinoic acid (RA) binding protein-II and the retinoid-X-receptor-alpha were constantly and strongly expressed in both compartments at levels comparable to those of vitamin D receptor. In dermal papilla cells, by contrast with RAR beta which was always expressed, RAR alpha and RAR gamma were not constantly expressed. In dermal sheath fibroblasts, both RAR alpha, RAR beta and RAR gamma mRNAs were moderately expressed, while in the epithelial compartment, namely the plucked hair, we observed the expression of the same genes in the absence of RAR beta. We also observed that RAR agonists all-trans RA and CD367 inhibited the survival of human hair follicles in culture in vitro, while RXR agonist CD2425 stimulated hair growth and survival at levels comparable to those of 1 alpha,25-dihydroxyvitamin D3, suggesting that RXR agonists might stimulate hair growth in humans in vivo.

The exogenous surfactant Curosurf enhances phosphatidylcholine content in isolated type II cells

The exogenous surfactant, Curosurf, contains proteins as well as phospholipids. We investigated the possibility that these might affect the reutilization of exogenous phospholipid by type II alveolar cells isolated from rat lung. The time course of incorporation into lamellar bodies of radioactivity from tritiated dipalmitoyl-phosphatidylcholine (DPPC) contained within liposomes was studied. Rates of uptake were compared between liposomes prepared from pure phospholipids and from Curosurf. The incorporation of labelled choline into newly synthesized phosphatidylcholine was also determined in the presence of both preparations. The rate of DPPC incorporation over the first 4 h was the same, but, after 6 and 8 h, the radioactivity associated with lamellar bodies was about 40% higher from Curosurf liposomes. By contrast, both Curosurf and the phospholipid mixture enhanced choline incorporation into phosphatidylcholine to the same extent. We conclude that Curosurf enhances the surfactant-related phosphatidylcholine content of type II cells by two mechanisms, one of which depends on the presence of proteins in exogenous surfactant. The difference in incorporation of radioactivity from liposome-associated labelled dipalmitoyl-phosphatidylcholine cannot be explained just by an increase in reutilization of choline from degraded dipalmitoyl-phosphatidylcholine.

Pro-inflammatory cytokine cascade in human plucked hair

Using reverse transcriptase polymerase chain reaction we showed that freshly plucked human anagen hair expressed both type 1 (80 kD) and type 2 (60 kD) interleukin (IL)-1 receptor mRNAs. The IL-1 receptor type 1 was functional since after in vitro stimulation of plucked hair with IL-1 alpha, we observed the induction of mRNA(s) for the inflammatory cytokines IL-1 beta, tumour necrosis factor alpha and IL-6 as well as for the chemokines monocyte chemotactic and activating factor and IL-8. In addition, the growth of dissected human anagen hairs in culture in vitro was significantly and dose-dependently inhibited by IL-1 alpha as a consequence of hair bulb degradation. These observations, together with those of other authors in IL-1 alpha transgenic mice evidence the inhibitory role of IL-1 on human hair growth. Therefore, in order to identify individuals with high inflammatory potential in their hair follicle environment, we designed a rapid and simple assay to detect variations in the level of IL-1 alpha production in the overnight supernatant of plucked hairs in culture. We observed that 32.7% of the specimens from the volunteers tested (n = 116) could be considered highly inflammatory in terms of IL-1 alpha production. Altogether, these results suggest that in alopecia androgenetica, hair growth might be negatively influenced by IL-1, directly produced by the outer root sheath keratinocytes. Consequently, identifying the "inflammatory alopecic individual' might be of clinical interest to discriminate among individuals for whom anti-IL-1 strategies might be of therapeutic relevance.

[Mega-ureter, mega-bladder and familial diabetes insipidus (author's transl)]

The authors relate a case of bilateral mega-ureter with mega-bladder caused by familial diabetes insipidus. Its treatment with ADH substances like gave a normal diuresis and a very important improvement in bilateral urinary tract distension.