Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading

Aim: Digital rectal examination (DRE) grading and the grade of prostatomegaly on cystoscopy are routinely used in clinical practice, but its correlation to prostate volume is understudied. This study was done to assess the correlation of DRE and endoscopic grading with the prostate volume on trans-rectal ultrasound (TRUS). Materials and Methods: This study was carried out in 101 eligible patients with prostatomegaly. Each patient was evaluated for three parameters, prostate volume by TRUS examination, DRE and endoscopic grading on cystoscopy. Pearson correlation coefficient was calculated to find the correlation between variables, p<0.05 was taken to be statistically significant. Data were analyzed using the Epi Info (TM) 7.2.2.2. Results: Significant positive correlation (p<0.001) was found between TRUS Volume and DRE grading (Pearson Correlation=0.945) and TRUS volume and Endoscopic grading (Pearson Correlation=0.949). Both the grading were also significantly positively correlated (Pearson Correlation=0.989, p<0.001). Conclusion: Our attempt for correlating the digital rectal grading and endoscopic grading with prostate volume is satisfactorily validated in the clinical setting. These grades are sufficient to provide a rough estimation of the prostate volume and to classify patients with prostatomegaly.

Crenças em saúde acerca do exame do toque retal / Health beliefs about the digital rectal exam / Creencias en salud acerca del examen del toque rectal

Este trabalho buscou identificar as principais crenças de homens acerca do Exame do Toque Retal (ETR), comparando as respostas de homens que o fizeram (G1) e dos que ainda não o fizeram (G2). Utilizou-se um questionário sociodemográfico e clínico, além da técnica de evocação de palavras. No G1, as evocações relacionadas à suscetibilidade, gravidade e benefícios do exame foram mais enfatizadas. Já no G2, destacaram-se as crenças voltadas à suscetibilidade e aos benefícios de realizar o exame. Os dados encontrados sugerem que fazer o ETR pode reforçar alguns estereótipos em relação aos aspectos negativos do exame, porém não anula os aspectos positivos. Deve-se levar em consideração a relação paciente-profissional, bem como a condução do profissional durante a realização do ETR, já que barreiras podem estar sendo reforçadas nessa situação. Enfim, aponta-se para a necessidade de trabalhar a temática da busca pelo ETR não só com a população-alvo, mas também com os profissionais de saúde

This study aimed to identify the main male beliefs about the Digital Rectal Exam (DRE) comparing the responses of men who did the exam (G1) and those who did not (G2). We used a questionnaire containing sociodemographic and clinical variables, as well as free evocations. G1 showed evocations related to the susceptibility, severity, and beliefs associated with the benefits of the exam. Among G2, beliefs about susceptibility and benefits of screening were also highlighted. The results suggest that doing DRE may reinforce some stereotypes regarding negative aspects of the examination, but they do not cancel its positive aspects at all. It is necessary to take care of the patient-professional relationship and the professional's conduct during DRE, since barriers might be strengthened in that situation. Finally, we believe it is important to clarify the perception of searching for DRE not only with the target population, but also with health professionals

Este trabajo buscó identificar las principales creencias de hombres acerca del Examen del Toque Retal (ETR), comparando las respuestas de hombres que lo hicieron (G1) y de los que aún no lo hicieron (G2). Se utilizó un cuestionario sociodemográfico y clínico, además de la técnica de evocación de palabras. En el G1, las evocaciones relacionadas con la susceptibilidad, gravedad y beneficios del examen, fueron más enfatizadas. En el G2, se destacaron las creencias volcadas a la susceptibilidad y a los beneficios de realizar el examen. Los datos encontrados sugieren que hacer el ETR puede reforzar algunos estereotipos en relación a los aspectos negativos del examen, pero no anula los aspectos positivos. Se debe tener en cuenta la relación paciente-profesional, así como la conducción del profesional durante la realización del ETR, ya que las barreras pueden estar siendo reforzadas en esa situación. En fin, se apunta a la necesidad de trabajar la temática de la búsqueda por el ETR no solo con la población objetivo, sino también con los profesionales de salud

The role of saccharomyces cerevisiae DRE2 in endoplasmic reticulum stress response / 重庆医学

Objective To study the role of saccharomyces cerevisiae DRE2 in endoplasmic reticulum response induced by tunica‐mycin .Methods The der2 ::URA3 gene deletion cassette was amplified from the wild type genomic DNA by PCR ;DRE2 deficiency heterozygote strain was made by gene recombination .The heterozygote strain resistant ability to tunicamycin and the replicative li‐fespan were analyzed in this study .Results DRE2 deficiency strain was resistant to tunicamycin ,but the replicative lifespan was decreased compared to wild type strain (P< 0 .05) .Conclusion DRE2 may be involved in the yeast endoplasmic reticulum response and replicative lifespan regulation .

O pensamento clínico contemporâneo: revisitando a técnica / Contemporary clinical thought: revisiting the technique / El pensamiento clínico contemporáneo: revisitando la técnica

Este trabalho é parte de uma apresentação feita em 2012, no II Encontro Internacional André Green, realizado na Asociación Psicoanalítica Argentina. O texto retoma alguns conceitos fundamentais de Green, particularmente os conceitos de pulsão, representação e pulsão de morte. Desenvolvem-se, a partir daí, algumas ideias sobre as reformulações da técnica, interpretação, construção, contratransferência imaginativa e silêncio do analista.

'This article is part of a presentation shown in 2012, during the II International André Green Meeting, which took place at the Asociación Psicoanalítica Argentina. The text considers some of Greens basic concepts, particularly the ideas of drive, representation and death drive. From this, ideas on the reformulations of the technique, interpretation, construction, imaginative countertransference and silence of the analyst are developed.

Este trabajo es parte de una presentación realizada en el II Encuentro Internacional André Green del año 2012, en la Asociación Psicoanalítica Argentina. El texto retoma algunos conceptos fundamentales de Green, en particular los conceptos de pulsión, representación y pulsión de muerte. De ahí se desarrollan algunas ideas sobre las reformulaciones de la técnica, interpretación, construcción, contratransferencia imaginativa y silencio del analista.

Prokaryotic Expression and Purification of a Cotton Dehydration Responsive Element Binding Protein GhDBP1 and Its DNA Binding Activity / 生物化学与生物物理进展

Cotton (Gossypium hirsutum) is one of the most important economic crops in the world. Its growth and productivity were affected by environment stresses such as drought, cold and high salinity. Thus, the enhanced stress tolerance in this plant is of great importance. As the dehydration responsive element (DRE) binding protein (DBP) plays an important role in the regulation of plant resistance to environmental stresses and is quite useful for generating transgenic plants tolerant to these stresses, isolation and functional analysis of DBPs in cotton are important to cotton production. In the previous work, a DBP gene from cotton, named as GhDBP1, was isolated and its expression patterns in cotton plants was demonstrated at the transcriptional level. Here, the expression,purification and DNA binding activity of GhDBP1 were reported. The entire coding region of the GhDBP1 gene was inserted into an expression vector, pET28a, and transformed into Escherichia coli BL21 (DE3). The fusion protein was successfully expressed under IPTG induction and the purified recombinant protein was obtained by Ni-NTA affinity chromatography. Non-radioactive electrophoretic mobility shift assay revealed that the purified GhDBP1 protein was able to form a specific complex with the previously characterized DRE element. In addition, the computer modeling of the DNA-binding domain of GhDBP1 were performed using SWISS-MODEL software. The main-chain structures and the folding patterns of the DNA-binding domain of GhDBP1 were similar to the known structure of the DNA-binding domain of the Arabidopsis thaliana GCC box-binding protein AtERF1. These results indicate that GhDBP1 is a DRE-binding transcription factor and might use the structure similar to that of AtERF1 to interact with DRE sequence.

Comparative molecular study of Mycobacterium tuberculosis strains, in times of antimicrobial drug resistance / Estudio molecular comparativo de cepas de Mycobacterium tuberculosis, en tiempos de resistencia antimicrobiana a los fármacos

Strains of Mycobacterium tuberculosis were compared using two DNA fingerprinting techniques: Restriction Fragment Length Polymorphism (RFLP) and Double-Repetitive-Element-PCR (DRE-PCR). Two of these strains: IH1 (susceptible to isoniazid) and IH2 (resistant to isoniazid) were recovered from cases of pulmonary tuberculosis which occurred in two brothers who lived together. The first one was recognized on July 1999, and the second was diagnosed one year later. IH1 and IH2 showed the same pattern of bands with both molecular tests. These results suggest that single drug chemoprophylaxis may occasionally select resistant strains for that drug, which can eventually cause disease and be recognized through these tests. Strains IH3, IH4 and IH5 were obtained from sputum samples of 3 different patients, and intra-laboratory cross-contamination was suspected when it was realized that the 3 positive materials had been consecutively processed the same day by the same worker in the same biological safety cabinet. Again, the 3 strains revealed identical band patterns with RFLP and DRE-PCR, confirming the posed suspicion. The results with DRE-PCR were obtained after only 8 hours of work, without the need for subcultures. This procedure allows quick correction of treatment conducts, avoiding unnecessary exposure of people and bacteria to antimicrobial drugs.

Se compararon cepas de Mycobacterium tuberculosis utilizando 2 procedimientos de ADN fingerprinting: polimorfismo de los fragmentos de restricción (RFLP) y Double-Repetitive-Element-PCR (DRE-PCR). Dos de las cepas: IH1 (susceptible a isoniazida) e IH2 (resistente a isoniazida) se recuperaron a partir de casos de tuberculosis pulmonar que ocurrieron en dos hermanos convivientes. La primera fue aislada en julio de 1999 y la segunda un año después. IH1 e IH2 mostraron el mismo patrón de bandas por ambos procedimientos. Estos resultados sugieren que la quimioprofilaxis con una sola droga puede ocasionalmente seleccionar mutantes resistentes, las cuales pueden causar enfermedad y ser reconocidas por estos procedimientos. Las cepas IH3, IH4 e IH5 fueron aisladas de 3 pacientes diferentes, y examinadas por probable contaminación cruzada dentro del laboratorio ya que fueron procesadas el mismo día, por el mismo operador y en la misma cabina de seguridad biológica. Nuevamente, las 3 cepas revelaron el mismo patrón de bandas por RFLP y por DRE-PCR, confirmando la sospecha. Los resultados de la DRE-PCR se obtuvieron luego de 8 horas de trabajo, sin necesidad de subcultivos. Esta técnica permitiría la rápida correción de pautas de tratamiento, evitando la exposición innecesaria de personas y bacterias a drogas antimicrobianas.

Management of Refractory Epilepsy

Management of drug resistant epilepsy (DRE) requires a systematic approach consisting of (1) investigation of potential causes of DRE, (2) determination of the degree of DRE on the basis of previous drug therapy, (3) rational pharmacotherapy consisting of both monotherapy and combination therapy, and (4) referral to surgery or other alternative therapy. The scheme of rational pharmacotherapy consists of (1) first drug monotherapy (2) second drug monotherapy, (3) two drug combination therapy, (4) triple drug combination therapy, and (5) addition of second-line drug. With the introduction of many new antiepileptic drugs (AEDs) having different mechanisms of action, the combination therapy has become more effective and safer, which made the use of triple drug combination therapy feasible in practice if it includes at least one new AED. It should be acknowleged that the rational combination therapy may achieve a seizure free outcome in a significant proportion of patients with less severe DRE. For patients with surgically remediable epileptic syndromes, a systematic trial of two to three drugs may suffice an earlier referral to surgery.

Cost-effectiveness Analysis of Prostate Cancer Screening

To determine the optimal strategy for prostate cancer screening, the cost-effectiveness of screening was analyzed using a medical decision model. One hundred thousand asymptomatic males between the ages of 40 and 69 were modeled with and without screening. The subjects were divided into three 10−year age groups. We used a 5−year survival rate as an effectiveness point and assumed after 5 year survival free from prostate cancer. We considered three potential programs: 1)screening with digital rectal examination(DRE), 2)screening with prostate specific antigen(PSA), and 3)screening with a combination of DRE and PSA. The study was analyzed from the payer’s perspective, and only direct medical costs were included. For each of the three age groups, PSA screening was more cost−effective than either DRE screening or a combination of DRE and PSA screening. The cost−effectiveness ratio for the combination of DRE and PSA screening was 1.1−2.3 times more expensive than that of PSA screening. If the compliance rate for work−up exams is 80%, the cost−effectiveness of prostate cancer screening is approximate to that of gastric cancer screening. In conclusion, PSA screening is the most cost−effective strategy for prostate cancer screening when compared with both DRE and the combination of DRE and PSA screening. But prostate cancer screening should be carefully conducted, taking the cost−effectiveness of the different strategies and target groups into consideration.

The Effectiveness of Prostate Biopsy in Patients with Negative Digital Rectal Examination and Serum Prostate Specific Antigen Concentration between 4 and 10ng/ml / 대한비뇨기과학회지

PURPOSE: Most urologists, to our knowledge, recommend prostatic biopsy if serum prostate specific antigen(PSA) concentrations are between 4 and 10ng/ml(gray zone), even in the abscence of abnormal digital rectal examination(DRE). But the detection of prostate cancer has not been frequent in patients with negative DRE and gray zone of serum PSA. So, we investigated the detection rate of prostate cancer to evaluate the effectiveness of biopsy, and provide the clinical data which is needed to make an appropriate guideline for management in those patients in Korea. MATERIALS AND METHODS: We retrospectively reviewed 58 patients with negative DRE and serum PSA greater than 4ng/ml, in whom transrectal systemic biopsy was done between January 1, 1996 and July 31, 1998. Additionally we analysed 38 patients with negative DRE and serum PSA more than 4ng/ml in a Korean literature. We calculated the detection rate of prostate cancer in patients with gray zone of serum PSA and serum PSA greater than 10ng/ml, respectively. RESULTS: Prostate cancer was detected in 5 patients out of the 58 patients(8.6%), including 1 patient(3.7%) out of 27 patients with gray zone of serum PSA and 4(12.9%) out of 31 patients with serum PSA greater than 10ng/ml. Prostate cancer was detected in 4 patients out of the 38 patients in the literature(10.5%), including 1 patient(5.0%) out of 20 patients with gray zone of serum and 3 patients(16.7%) out of 18 patients with serum PSA greater than 10ng/ml. Combining the results of our current study with that of other Korean literature, total number of patients was 96, and 9(9.4%) of them proved to harbor prostate cancer, including 2 patients(4.3%) out of 47 patients with gray zone of serum PSA and 7 patients(14.3%) out of 49 patients with serum PSA greater than 10ng/ml. CONCLUSIONS: The detection rate of prostate cancer in Korean with negative DRE and gray zone of serum PSA is significantly lower than that in North American. Therefore it may not be effective to perform biopsy in all of those patients in Korea. Needed are Korean criteria of prostatic biopsy to detect prostate carcinoma in those patients, which can be acceptable in Korean.

Predictability of PSA, DRE and TRUS for Detection of Prostatic Cancer in Considering the Non-surgical Treatment of BPH Patients / 대한비뇨기과학회지

Recently, some forms of non-surgical treatment modalities for BPH such as microwave or laser induced hyperthermia have been available and its demand by patient is increasing. The advantage of these treatment is its out-patient basis of treatment(no admission & no anesthesia). However, it leaves no surgical specimens for the pathological examination and detection of stage A prostate cancer may be impossible. Therefore, early detection of prostatic cancer prior to the non-surgical treatment of BPH is considered important if there are any suspicious signs of prostate cancer from the results of prostate specific antigen (PSA), digital rectal examination (DRE), or transrectal ultrasound(TRUS). The aims of our study is to compare the predictability of the DRE, PSA, and TRUS in the detection of prostate cancer before planning to take non- surgical treatment of BPH. One hundred thirty three patients between 50 to 85 years old (mean age 67.9) with symptoms of prostatism were examined serum PSA, DRE and TRUS prior to the treatment of BPH and predictability for the detection of prostatic cancer by each test were analyzed. Of the 133 cases, 3 were diagnosed as inflammations, 1 as tuberculosis, 1 as infarct, 110 as nodular hyperplasia, 18 as prostate cancers. Positive predictability of each test were as followed: 59.3% of the patients with abnormal DRE, 57.7% of the patients with abnormal TRUS and, 34% of the patients with abnormal PSA level( > 10 ng/ml). For the 44 patients with abnormal PSA level( > l0 ng/ml) and, coexisting abnormalities on either TRUS or DRE, positive predictability was 72%. However, in the 26 patients with abnormal PSA( >10ng/ml) with normal findings at DRE and TRUS, only 2 patients have prostate cancer. Of the 17 patients showing abnormal findings at DRE and TRUS irrespective of PSA level, 15 patients(positive predictability of 90%) have prostate cancer. Of the 12 patients having abnormal DRE and TRUS with elevated PSA level(more than 10.0 ng/ml), all patients had cancer. Conclusively, cancer predictability of single application of these screening test was low. Positive predictability of the elevated PSA level above 10 ng/ml was low if there were no abnormalities at DRE and TRUS. However, if there were abnormalities at DRE and TRUS, predictability of cancer became high. It is suggested that, if there were no abnormalities found at DRE and TRUS, prostate needle biopsy seem to be necessary despite the normal level of PSA( < 4 ng/ml). For the gray zone of the PSA level( 4-10 ng/ml) with no suspicious findings at DRE and TRUS, careful observation with follow up PSA measurement could be suggested.

Effects of digital rectal examination and transurethral resection of the prostate on serum prostate Specific antigen and acid phosphatase levels / 대한비뇨기과학회지

To identify the effect of digital rectal examination (DRE) and transurethral resection of the prostate (TURP) on the serum prostate specific antigen (PSA), serum acid phosphatase and prostatic acid phosphatase (SAP/PAP) concentration a clinical trial involving 73 patients was conducted. Of the patients 65 (89 %) had benign prostatic hyperplasia (BPH) and 8(11 %) had prostate cancer (stage A1, A2). We detected no clinically significant difference between serum PSA and prostate acid phosphatase (PAP) levels obtained immediately before, at 5 to 30 minutes after rectal examination and post-TURP in 73 men. Patients were divided into four groups based on their initial serum PSA levels. The three groups with the initial PSA values (0.1 through 4 ng/ml and greater than 10 ng/ml) were found to have statistically insignificant changes in the serum PSA levels after DRE and post-TURP. The group with initial PSA levels of 4.1 through 10 ng/ml had statistically increases in serum PSA values after TURP, but the alterations in serum PSA levels in the group with the inter- mediated PSA value was not clinically important. We conclude that digital rectal examination (DRE) and transurethral resection of the prostate (TURP) have no clinically important effects on serum PSA in BPH and occult prostatic cancer (stage A1, A2) patients.