UroToday – Dr. Carroll asked if there was a role for perineal biopsy vs. saturation biopsy. Dr. Presti would perform saturation biopsies transrectally. Dr. Andriole recommended a grid using a template, such as the TARGET that is in clinical trial.

Dr. Getzenberg addressed the use of the Multiplex assay and use of EPCA tests in initial screening. The preliminary data for EPCA in this population is over 90% sensitivity. However, a multiplex approach incorporating several markers may prove powerful. Combining a highly sensitive marker with a highly specific marker might enhance the ROC curves for detection.

The question was posed regarding performing MRI guided biopsy. Dr. Presti stated that combining MRI with biopsy through fusion software to combine the images is under investigation. Otherwise, it can not be determined exactly where to biopsy the areas that are concerning on MRI. Dr. Carroll stated that lesions less that 5mm are missed in the UCSF experience.

Dr. Klotz supported the use of risk calculators as a method to determine who needs a repeat biopsy. A discussion was had on end-fire vs. side-fire biopsy probes. The end fire gun is better for some biopsy angles, was a comment.

PSA velocity was addressed and the data was generated using a long-term database and may not be applicable to the clinical practice over a shorter duration. Regarding the best patient for chemoprevention, it was felt that high risk patients should be treated, not low risk. Dr. Andriole could not yet commit that dutasteride was superior to finasteride, but the data would have to prove this. It would be cost-ineffective to give chemoprevention to low risk patients.

Moderated by Joseph Presti, MD, with Gerald Andriole, MD, Robert Getzenberg, MD, Mitchell Steiner, MD, and Laurence Klotz, MD, at the Annual Meeting of the American Urological Association (AUA) – May 17 – 22, 2008. Orange County Convention Center – Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2008 – UroToday

View drug information on dutasteride.

While younger people can easily get in and out of bed or sit on a couch, older people can have a much harder time of it, with conditions such as arthritis or rheumatism considerably limiting their movements. Czech and German partners, involved in the EUREKA E! 3210 SPECIFURN project, have developed a new line of furniture aimed at making life and leisure easier for the elderly and infirm. Their designs are suitable for use in old people’s homes, public urban spaces, swimming pools and railway stations.

“There is a lot to consider when designing furniture for senior citizens,” says SPECIFURN coordinator Josef Bartak of Form, in the Czech Republic. “We need to closely consider elderly people’s special needs, particularly their reduced mobility, but also other differences compared to younger members of the population.” The new designs were based on in-depth research and considerable accumulated experience among the partners.

Form, along with partners Addesign Furniture, also from the Czech Republic, and Germany’s Fidura Capital Consult, aimed to design a complete set of furniture, including wardrobe and other storage furniture, chairs and couches of varying comfort levels, bedroom furniture, a table and kitchen furniture. Chairs fell into three categories, including standard chairs and semi-armchairs, chairs with changeable positions, and armchairs with extensive features. Special features include better availability and visibility of stored items, rubberised or elastic handholds on lower furniture and wardrobes, insuring maximum safety when moving as well as passive protection against possible falls. New designs include removable upholstery for easy cleaning, suitable shaping of arm handles, and innovative mechanisms for changing furniture configuration.

An expanding market

By all accounts, populations in developed Central and Western European countries are growing older, says Bartak, due to decreasing birth rates and increasing life spans. This, he explains, can only increase the demand for specialised products and services for the elderly. Moreover, governments in all European countries are now continuously increasing spending on facilities for the aged. “We see our new designs giving rise to an even wider range of original and attractive wood-based furniture,” says Bartak, “furniture that is fully compliant with both ergonomic and ecological requirements and resistant to heavy use.”

“A firm of our size could not have afforded such an extensive programme of research and development without the help of EUREKA,” says Bartak. “We have achieved some remarkable results thanks to the important support we received.” Bartak says the new SPECIFURN designs have already been well received, making a big impact at MOBITEX 2007, a major trade fair that took place this year in Brno, in the Czech Republic. “The new furniture is unique in terms of its coherent approach to a complex series of problems associated with the aged.”

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Source: Sally Horspool

EUREKA

A new study points to the health benefits of living in neighborhoods with built-in physical activity resources.

Researchers conducted a study among community-dwelling men age 65 years or older from the Portland, Ore., metropolitan area. They sought to discover whether older men who live within one-eighth, one-quarter, or one-half mile of physical activity resources, including parks, trails and recreational facilities, are more likely than men who live farther from these resources to maintain or increase the amount of time they spend walking. Participants were enrolled from March 2000 through April 2002 at six U.S. clinical centers and were followed an average of 3.6 years to assess changes in time spent walking. The results of the study revealed a positive association among urban-dwelling older men between living within one-eighth mile of parks and one-half mile of trails and maintaining or increasing time spent walking, although the association was limited to men living in high-socioeconomic status neighborhoods.

The study’s authors said, “Proximity to physical activity resources such as parks and trails may be important for maintaining moderate physical activity over time among older men residing in high-socioeconomic status neighborhoods. These findings support an eco-social model of physical activity promotion incorporating neighborhood-level resources and parks and trails.”

Source
American Journal of Public Health

Medical experts at The University of Nottingham have shown that an innovative anti-microbial catheter could vastly improve treatment and the quality of life for many community-based dialysis patients.

Results of a study published in the leading journal Biomaterials, have shown that the catheter has the potential to ward off attack from a wider variety of pathogens and protect Continuous Ambulatory Peritoneal Dialysis (CAPD) patients from infections for up to 100 days around 20 times longer than current catheters.

CAPD offers patients with kidney failure an alternative to traditional haemodialysis, in which patients are hooked up to a dialyser to have excess waste minerals filtered from their blood. Treatment can take up to four hours and needs to be done around three times a week, having a huge impact on the patient’s quality of life.

CAPD uses a catheter directly into the patient’s peritoneal cavity to collect waste fluids and replace them with dialysis solution, which is left in the body for around five hours and does the work that would normally be done by the kidney. As it is a simple process that can be completed at home, patients can enjoy a relatively normal lifestyle.

However, the length of time the catheter needs to be left in the body and its direct insertion into the peritoneal cavity leaves the patient especially vulnerable to infection which often means the removal of the catheter and a return to traditional hospital-based haemodialysis.

The new catheter, which has been developed by experts in the School of Clinical Sciences at The University of Nottingham has been shown in the lab to kill on contact a wide range of the most common type of staphylococcal infections, including the hospital-acquired infection MRSA, and, for the first time, a number of gram negative pathogens including E coli. It has also proved to be continuously effective for 100 days.

Dr Roger Bayston, who led the study, said: “The reviewers for the journal described what we have done as a remarkable achievement. This study has not only demonstrated the potential of what this catheter can do but has established the need for rigorous and clinically-focussed laboratory evaluation of such new devices.

“The lab-based studies have already shown such robust results that the likelihood of the catheter demonstrating satisfactory clinical performance is extremely high.”

The data will also be useful for companies investigating the potential investment opportunities for the knowledge transfer of the technology.

The technology behind the catheter is a patented process whereby anti-microbial agents are inserted into the device post-manufacture so they become a molecular part of the catheter. The silicone material of the catheter is a polymer, a network formed from molecules that have tiny spaces in between them. The device is soaked in a bath of chemicals, such as chloroform, and the anti-microbial agents which causes the silicone to swell to twice its normal size, making these gaps between molecules bigger. The chloroform is then removed and the device shrinks back to its normal size encasing the anti-microbial agents inside but allowing them to move through the silicone and kill any pathogens coming into contact with the surface of the catheter.

It follows on from work at Nottingham by Dr Bayston to develop a catheter for neurosurgery and to treat brain conditions such as hydrocephalus. This catheter is now being used by around 110,000 patients around the world and has reduced their risk of infection by between 70 and 90 per cent.

The researchers also now hope to adapt it for use in central venous catheters which are used to deliver cancer drugs and nutrition, and urinary catheters, which are commonly used in the healthcare of the elderly and to manage urinary tract problems in people with spinal injuries and spina bifida. This will involve some adaptation to cover specific pathogens such as, in the case of foley catheters, Proteus which produces a biofilm on the catheter and converts urea in urine into ammonia, causing minerals and phosphates to form a painful crystallised crust at the neck of the catheter. This in turn can lead to bladder infections and, if left untreated, the more serious condition of pyelonephritis which destroys the kidneys by turning them into scar tissue and causes renal failure.

The work on the CAPD catheters has been supported by the company Martech, based in Philadelphia, USA, which has been assisting in the acquisition of FDA and EU approval and the Nottingham research team is now planning a clinical trial with Dr Richard Fluck and Dr Chris McIntyre of the Renal Unit at Derby City General Hospital.

They are keen to hear from other potential industrial partners who would be interested in assisting in taking their research forward and collaborating on technology transfer.

Nottingham University
nottingham.ac

If walking seems too simple to be an effective fitness method, think again: taking a stroll is an easy way to lower pressure and for the obese to increase aerobic fitness, according to three researchers who presented findings at the 55th Annual Meeting of the American College of Sports Medicine.

A study of 14 morbidly obese patients was designed to determine if brisk walking alone was sufficient to serve as an aerobic training stimulus, increasing heart rate to at least 70 percent of maximum. Patients were asked to determine their own brisk walking pace, and walked for one mile. All 14 achieved at least 70 percent of maximum heart rate.

“Obese patients have more body mass to move, causing the heart and cardiovascular system to have to work harder than a normal-weight person’s would,” Thomas Spring, M.S., said. “Walking is a great way for the overweight and obese to begin an exercise program, because it can be done with little instruction or equipment and is low in cost.”

Benefits of brisk walking also extend to people at-risk for high blood pressure. A British study looked at borderline hypertensive middle-aged men after they walked at various intensities and durations, to determine which type of walking reduced blood pressure the most.

Andrew Scott found that walking 30 minutes at 50 percent effort was most effective, reducing blood pressure for at least four hours.

“Our study found that walking for longer than 30 minutes or at a higher intensity had no additional effects on lowering blood pressure,” Andrew Scott, M.S., said. “Those needing to lose weight may want to exercise for a longer period of time, but our findings show that ACSM’s recommendations have significant health benefits.”

ACSM recommends at least 30 minutes of moderate physical activity five days per week for healthy adults. The guidelines also state that physical activity can be broken up into 10-minute bouts and be as effective as one longer session, a recommendation confirmed by another study on the effects of brisk walking on hypertension.

The Korean study measured decreases in blood pressure in 23 hypertensive men following 40-minute brisk walking sessions and four, 10-minute brisk walking bouts. Blood pressure was lowered by similar amounts after each type of exercise session.

“Accumulating brisk, 10-minute walks appears to be very effective for lowering blood pressure,” said Saejong Park, Ph.D., lead author. “Those with time crunches and busy schedules can fit bits of exercise in throughout the day to reap health benefits.”

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

American College of Sports Medicine

More than half of all older adults complain about having difficulties sleeping. Most don’t bother seeking treatment. Those who do usually turn either to medications, which can lead to other health problems, or behavior therapies, which are costly and often not available close to home.

Now, UCLA researchers report that practicing tai chi chih, the Westernized version of a 2,000-year-old Chinese martial art, promotes sleep quality in older adults with moderate sleep complaints. The study, which will be published in the journal Sleep, is currently available in the journal’s online edition.

In the study, 112 healthy adults ranging in age from 59 to 86 were randomly assigned to one of two groups for a 25-week period: The first group practiced 20 simple tai chi chih moves; the other participated in health education classes that included advice on stress management, diet and sleep habits.

At the beginning of the study, participants were asked to rate their sleep based on the Pittsburgh Sleep Quality Index, a self-rated questionnaire that assesses sleep quality, duration and disturbances over a one-month time interval.

The study found that the tai chi chih group showed improved sleep quality and a remission of clinical impairments, such as drowsiness during the day and inability to concentrate, compared with those receiving health education. The tai chi chih participants showed improvements in their own self-rating of sleep quality, sleep duration and sleep disturbance.

“Poor sleeping constitutes one of the most common difficulties facing older adults,” said lead study author Dr. Michael Irwin, the Norman Cousins Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and director of the UCLA Cousins Center for Psychoneuroimmunology.

Irwin noted that 58 percent of adults age 59 and older report having difficulty sleeping at least a few nights each week. However, sleep problems remain untreated in up to 85 percent of people. And for those who do seek help, the usual remedy is a sedative.

But sedatives can cause side effects, according to Irwin.

“It’s not uncommon for older adults to experience daytime confusion, drowsiness, falls and fractures, and adverse interactions with other medications they may be taking,” he said.

And while most health professionals generally agree that physical exercise enhances sleep quality, given the physical limitations of the elderly, rigorous exercise might not be an option. That’s why tai chi chih, with its gentle, slow movements, is an attractive exercise option for the elderly population.

“It’s a form of exercise virtually every elderly person can do, and this study provides more across-the-board evidence of its health benefits,” Irwin said.

The research piggybacked on a study published in April 2007 by Irwin that showed tai chi chih boosted the immune system of elderly people suffering from shingles.

Other studies done at UCLA have shown that tai chi chih can help people who suffer from tension headaches and have suggested that it may aid in decreasing high blood pressure.

The UCLA Cousins Center for Psychoneuroimmunology encompasses an interdisciplinary network of scientists working to advance the understanding of psychoneuroimmunology by linking basic and clinical research programs and by translating findings into clinical practice. The center is affiliated with the Semel Institute for Neuroscience and Human Behavior and the David Geffen School of Medicine at UCLA.

University of California, Los Angeles (UCLA)
924 Westwood Blvd., Ste. 350
Los Angeles, CA 90095
United States
ucla.edu

Scientists at the Moores Cancer Center at the University of California, San Diego, Stanford University School of Medicine and other centers have identified a mechanism by which a chronic form of leukemia can progress into a deadlier stage of the disease. The findings may provide physicians with an indicator of when this type of cancer – chronic myeloid leukemia (CML) – is progressing, enabling them to make more accurate prognoses for the disease and improved treatment choices.

“If we can predict when a patient is moving from the chronic phase in CML to the blast crisis stage, then we can hopefully intervene before it’s too late,” said Catriona H.M. Jamieson, MD, PhD, assistant professor of medicine at the UC San Diego School of Medicine and Director for Stem Cell Research at the Moores UCSD Cancer Center.

The findings, reported online during the week of February 16, 2009 in the Proceedings of the National Academy of Sciences, also shed light on the development of potentially treatment-resistant leukemia stem cells and provide insights for new strategies against CML and other cancers.

Led by Jamieson and Irving Weissman, MD, director of the Stem Cell Biology and Regenerative Medicine Institute at the Stanford University School of Medicine, the researchers discovered that when a molecular off-switch called glycogen synthase kinase (GSK) 3 beta becomes faulty in chronic stage CML cells, it fails to turn off another protein, beta-catenin. This in turn enables pre-leukemia stem cells to develop into leukemia stem cells and expand their numbers, leading to progression to the more dangerous “blast crisis” stage of CML. This errant off-switch is a potential therapeutic target, Jamieson explained.

“This paper further underscores the importance of the cell type and specific context of molecular events in the evolution of leukemia,” Jamieson said. “It also highlights the malignant consequences of GSK 3 beta deregulation.”

“This knowledge may enable us to design and develop more effective, personalized therapies for these patients,” said staff research associate and co-first author Annelie Abrahamsson.

In CML, an enzyme called ABL goes in overdrive because of a chromosomal mix-up that occurs during blood cell development. The genes ABL and BCR fuse and produce a hybrid BCR-ABL enzyme that drives the excessive proliferation of white blood cells. CML progresses from a chronic stage in hematopoietic stem cells that carry BCR-ABL to the blast crisis stage. This stage is characterized by the over-production of beta-catenin in white blood cells called granulocyte macrophage progenitors (GMP) – in effect, leukemia stem cells.

According to Jamieson, a major roadblock in predicting and stopping the conversion of chronic CML to blast crisis stage was the failure to understand what turned on beta-catenin. The team showed that by injecting blast crisis CML progenitor cells – GMP – into mice lacking working immune systems, they could “transplant” leukemia into the animals. When they did this, they discovered that GSK 3 beta levels dropped. Looking more closely, they found an aberrant “misspliced” form of GSK 3 beta that was unable to turn off beta-catenin, suggesting a potential mechanism behind the change to blast crisis stage.

The scientists also showed that the mice that had received the cells with the bad form of GSK 3 beta developed granulocytic sarcomas, tumors that are seen in patients with the most advanced form of CML.

“Many investigators have questioned the usefulness of finding and purifying leukemia and cancer stem cells,” said Weissman. “This paper shows why. The damage to the enzyme GSK 3 beta that prevents beta-catenin activation of cell proliferation occurs only in the GMP leukemia stem cells, which are only about 1 in 20 bone marrow cells. Trying to analyze the missplicing of GSK in the whole leukemia would not have worked.

“These kinds of changes in gene expression, which are not mutations, need pure cells to find them. The final proof of the cancer stem cell hypothesis will be to show whether a treatment specific for the changed gene expression eliminates the cancer in the patient.”

“Downregulating beta-catenin and GSK deregulation may have other implications in many cancers,” Jamieson said. “By studying CML, we can understand the molecular evolution of disease and the stepwise progression to cancer. It becomes a useful paradigm for understanding how cancers evolve and the pathways that are essential to escape the normal control mechanisms.”

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Other authors include: Ifat Geron, Kim-Hien Dao, DO, PhD, Charlene Barroga, PhD, Isabel Newton, MD, PhD, UCSD; Jason Gotlib, MD, Remi Creusot, PhD, Mobin Karimi, PhD, Carol Jones, PhD, James Zehnder, MD, PhD, Robert Negrin, MD, Institute of Stem Cell Biology and Regenerative Medicine, Stanford; Francis Giles, MD, University of Texas Health Science Center, San Antonio; Jeffrey Durocher, PhD, Transgenomic Inc., Gaithersberg, MD; and Armand Keating, MD, Princess Margaret Hospital, Toronto. Much of the work received funding from the National Institutes of Health, the California Institute of Regenerative Medicine and the Moores UCSD Cancer Center.

The Moores UCSD Cancer Center is one of the nation’s 41 National Cancer Institute-designated Comprehensive Cancer Centers, combining research, clinical care and community outreach to advance the prevention, treatment and cure of cancer.

Source: Steve Benowitz

University of California – San Diego

With just three weeks to go before the first anniversary of bluetongue being detected in England the JAB campaign group is urging farmers to vaccinate their livestock to stop the disease from taking hold in this country as it has in Europe.

So far this year France has reported 4,543 cases of bluetongue, including cases in Calais, and the Netherlands has just confirmed its first case of the disease in 2008. The affected small holding reported a sick cow found with serotype eight which had not been vaccinated against infection.

With the threat of bluetongue re-emergence in the UK growing by the day, JAB leaders have issued a reminder to farmers to contact their vets as soon as their region is in the protection zone and vaccine is available.

In a statement JAB said: “The amount of cases being reported across Europe shows the disease is on the move. This most recent case in Holland demonstrates that not vaccinating livestock leaves farmers vulnerable to outbreaks now the midge season has started.

“The industry has rallied behind the JAB campaign and has done tremendously well in terms of vaccination. Nearly 19 million doses have already been made available to English farmers, and with another nine million doses planned to be released in the coming weeks we need those areas that are new to the protection zone to vaccinate as soon as they are able. We must remember bluetongue could already be circulating in areas where outbreaks occurred last year so the risks to everyone are very real.

“The explosion in the number of cases on the continent also acts as a timely reminder to those farmers in the current protection zone who have not vaccinated and the dangers this presents to their unprotected livestock

“We are entering the peak period for midge activity so vaccination is the only way to prepare and protect us from any potential outbreaks that may emerge in the coming weeks.”

Notes

1. The bluetongue protection zone was extended on Monday August 11 to cover the counties of Durham and Tyne and Wear (Metropolitan Boroughs of Newcastle Upon Tyne, North Tyneside, Gateshead, South Tyneside and Sunderland) and the Unitary Authorities of Hartlepool, Darlington, Stockton-on-Tees, Middlesbrough, and Redcar and Cleveland.

2. JAB members include: NFU, National Sheep Association, National Beef Association, British Meat Processors Association , Livestock Auctioneers Association, Royal Association of British Dairy Farmers, British Veterinary Association , Country Land and Business Association, Tenant Farmers Association, Association of Independent Meat Suppliers, Dairy UK, British Cattle Veterinary Association, the Sheep Veterinary Society, the Rare Breed Survival Trust, British Alpaca Society, British Llama Society, British Wool Marketing Board, British Simmental Society, English Beef and Lamb Executive and the Sheep Centre.

NFU

UroToday – Stone disease in children seems to be on the rise since I started as a pediatric urologist. The number of children we first saw in one year, I am seeing on a monthly basis.

The latest scare has been in China with melamine-induced kidney stones. Doctors in China have gained a vast experience in childhood stone disease diagnosis and management through screening and treating childhood urinary stones thought to be induced by melamine-tainted formula.

In their review of earlier reports on animals along with recent experiences with children, they concluded that there was no evidence, either from animal experiments or from humans, to support the direct toxicity of melamine on the kidney, although a feasible follow-up and assessment might be needed.

It would be critical in my opinion to evaluate these children from a metabolic standpoint as well. Stones typically are multifactorial and all risk factors must be delineated so that recurrent epsiodes can be prevented as much as possible.

Ding J

Kidney Int. 2009 Feb 25. Epub ahead of print.
doi:10.1038/ki.2009.30

UroToday Medical Editor Pasquale Casale, MD

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2009 – UroToday

Ever since an ordinary office inkjet printer had its ink cartridges swapped out for a cargo of cells about 10 years ago and sprayed out cell-packed droplets to create living tissue, scientists and engineers have never looked at office equipment in quite the same way. They dream of using a specialized bio-inkjet printer to grow new body parts for organ transplants or tissues for making regenerative medicine repairs to ailing bodies. Both these new therapies begin with a carefully printed mass of embryonic stem cells. And now there’s progress on getting that initial mass of stem cells printed.

By extending his pioneering acoustical work that applied sound waves to generate droplets from fluids, Dr. Utkan Demirci and his team at Harvard Medical School’s (Brigham and Women’s Hospital) Bio-Acoustic Mems in Medicine Laboratory report encouraging preliminary results at an early and crucial point in a stem cell’s career known as embroid body formation. Their research results appear in the journal Biomicrofluids, published by the American Institute of Physics.

Getting the embroid body formed correctly and without mechanical trauma is key to preserving the stem cells’ astounding ability to develop into any desired tissue. Their new automated bioprinting approach appears to do this better than manual pipetting in the “hang-drop” method traditionally used.

“To have the capability to manipulate cells in a high-throughput environment reliably and repeatedly, whether it is a single cell or tens of thousands of cells in a single droplet, has the potential to enable potential solutions to many problems in medicine and engineering,” Notes Dr. Demirci.

Three research results stand out:
Enhanced uniformity of size and ability to control droplet size. These are key variables because they determine how the embroid bodies will grow.
Achieving a scalable system that can print one cell or tens of thousands per droplet – a level of precise manipulation not previously available.
Faster droplet formation. The new system delivers 160 droplets/seconds, versus 10 minutes for the hang-drop method.

The next step involves assessing the two methods to compare their effects on cell function. Says Dr. Demirci: “We are eager to take it to the next level.”

The article, “Embryonic stem cell bioprinting for uniform and controlled size embryoid body formation,” by Feng Xu, Banupriya Sridharan, SuiQi Wang, Umut Gurkan, Brian Syverud, and Utkan Demirci, appears in the journal Biomicrofluidics.

Source:
Charles E. Blue

American Institute of Physics