A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy.

BACKGROUND: Retzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite postoperative urinary continence recovery. OBJECTIVE: To compare the short-term (≤3 mo) urinary continence (UC), urinary function (UF), and UF-related bother outcomes of posterior RARP compared with standard anterior approach RARP. DESIGN, SETTING, AND PARTICIPANTS: A total of 120 patients aged 40-75 yr with low-intermediate-risk prostate cancer (per the National Comprehensive Cancer Network guidelines) underwent primary RARP at a tertiary care institution. INTERVENTION: Eligible men were randomized to receive either posterior (n=60) or anterior (n=60) RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Primary outcome was UC (defined as 0 pads/one security liner per day) 1 week after catheter removal. Secondary outcomes were short-term (≤3 mo) UC recovery, and UF and UF-related bother scores (measured by the International Prostate Symptom Score [IPSS] and IPSS quality-of-life scores, respectively) assessed at 1 and 2 wk, and 1 and 3 mo following catheter removal. Continence outcomes were objectively verified using 24-hr pad weights. UC recovery was analyzed using Kaplan-Meier method and Cox proportional hazards regression; UF and UF-related bother outcomes were compared using linear generalized estimating equations (GEEs). Perioperative complications, positive surgical margin, and biochemical recurrence-free survival (BCRFS) represent secondary outcomes reported in the study. RESULTS AND LIMITATIONS: Compared with 48% in the anterior arm, 71% men undergoing posterior RARP were continent 1 wk after catheter removal (p=0.01); corresponding median 24-h pad weights were 25 and 5g (p=0.001). Median time to continence in posterior versus anterior RARP was 2 and 8 d postcatheter removal, respectively (log-rank p=0.02); results were confirmed on multivariable regression analyses. GEE analyses showed that UF-related bother (but not UF) scores were significantly lower in the posterior versus anterior RARP group at 1 wk, 2 wk, and 1 mo on GEE analyses. Incidence of postoperative complications (12% anterior vs 18% posterior) and probability of BCRFS (0.91 vs 0.91) were comparable in the two arms. CONCLUSIONS: In this single-center randomized study, the Retzius-sparing approach of RARP resulted in earlier recovery of UC and lower UF-related bother compared with standard RARP. These results require long-term validation and reproduction by other centers, as well as studies on men with high-risk localized disease. PATIENT SUMMARY: In our hands, men with low-intermediate-risk prostate cancer undergoing Retzius-sparing robot-assisted radical prostatectomy (RARP) had earlier recovery of urinary continence and lower urinary function-related bother than those undergoing standard RARP.

Evaluation of the Efficacy of Caries Removal Using Polymer Bur, Stainless Steel Bur, Carisolv, Papacarie - An Invitro Comparative Study.

CONTEXT: Dental caries continues to affect a significant portion of the world population and treatment of the decay is associated with pain by many patients. Intervention and application of rotary instruments for treatment of carious lesions has often resulted in considerable removal of tooth structure. Chemo-mechanical method, a minimal invasive technique for caries removal was developed to overcome these shortcomings. This innovative method seems to be efficient in removing infected dentine without altering the healthy dental tissue or harming the adjacent oral mucosa. AIM: To evaluate the efficacy and efficiency of Caries removal Using Polymer Bur, Stainless Steel Bur, Carisolv and Papacarie. MATERIALS AND METHODS: A total of 120 sectioned specimens were obtained from 60 extracted teeth. Each tooth was sectioned mesiodistally in the center of the carious lesion so that two halves (buccal and lingual or palatal) having equal sized carious lesions are compared. The sectioned specimens were subdivided into four groups (Polymer Bur, Stainless Steel Bur, Carisolv, Papacarie) allotting 30 specimens to each for caries excavation. RESULTS: One-way ANOVA, Chi-square test analysis was done for comparison between groups which showed significant results with Stainless Steel Bur excavation taking less mean time when compared to other agents and Polymer Bur showed more amount of bacterial remnants after excavation whereas Carisolv and Papacarie were efficient with less dentinal tubule destruction and bacterial remnants after excavation. Further inter comparison between groups was done using Paired t-test and Fischer's Exact-test. CONCLUSION: The Mean time taken by Stainless Steel Bur excavation was found to be less and caused more amount of dentinal tubule destruction when compared to Polymer Bur, Carisolv and Papacarie. Chemo-mechanical methods found to be more efficient with lesser amount of bacterial remnants and dentinal tubule destruction after caries excavation when compared to conventional methods.

Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate(®), Laser and Biodentine(TM)- an In Vivo Study.

INTRODUCTION: Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament. It is the most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp. AIM: To evaluate the success and efficacy of Mineral Trioxide Aggregate (MTA), Lasers and Biodentine as pulpotomy agents both clinically and radiographically. MATERIALS AND METHODS: In the present study, 60 primary molars in children whose pulpal status warranted pulpotomy were selected and randomly assigned into three groups that included MTA, Laser and Biodentine allocating 20 teeth to each group. The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns. Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation. RESULTS: Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria. Kruskal-Wallis ANOVA, Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months. The results showed that maximum success rate was found in MTA group. However, the comparison between three groups was statistically not significant (p<0.05). CONCLUSION: Pulpotomies performed with either MTA, Laser or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to Formocresol.

A method for the calculation of the adsorbed phase volume and pseudo-saturation pressure from adsorption isotherm data on activated carbon.

We propose a new method for evaluating the adsorbed phase volume during physisorption of several gases on activated carbon specimens. We treat the adsorbed phase as another equilibrium phase which satisfies the Gibbs equation and hence assume that the law of rectilinear diameters is applicable. Since invariably the bulk gas phase densities are known along measured isotherms, the constants of the adsorbed phase volume can be regressed from the experimental data. We take the Dubinin-Astakhov isotherm as the model for verifying our hypothesis since it is one of the few equations that accounts for adsorbed phase volume changes. In addition, the pseudo-saturation pressure in the supercritical region is calculated by letting the index of the temperature term in Dubinin's equation to be temperature dependent. Based on over 50 combinations of activated carbons and adsorbates (nitrogen, oxygen, argon, carbon dioxide, hydrocarbons and halocarbon refrigerants) it is observed that the proposed changes fit experimental data quite well.

Anticancer activity of a broccoli derivative, sulforaphane, in barrett adenocarcinoma: potential use in chemoprevention and as adjuvant in chemotherapy.

INTRODUCTION: The incidence of Barrett esophageal adenocarcinoma (BEAC) has been increasing at an alarming rate in western countries. In this study, we have evaluated the therapeutic potential of sulforaphane (SFN), an antioxidant derived from broccoli, in BEAC. METHODS: BEAC cells were treated with SFN, alone or in combination with chemotherapeutic, paclitaxel, or telomerase-inhibiting agents (MST-312, GRN163L), and live cell number determined at various time points. The effect on drug resistance/chemosensitivity was evaluated by rhodamine efflux assay. Apoptosis was detected by annexin V labeling and Western blot analysis of poly(ADP-ribose) polymerase cleavage. Effects on genes implicated in cell cycle and apoptosis were determined by Western blot analyses. To evaluate the efficacy in vivo, BEAC cells were injected subcutaneously in severe combined immunodeficient mice, and after the appearance of palpable tumors, mice were treated with SFN. RESULTS: SFN induced both time- and dose-dependent decline in cell survival, cell cycle arrest, and apoptosis. The treatment with SFN also suppressed the expression of multidrug resistance protein, reduced drug efflux, and increased anticancer activity of other antiproliferative agents including paclitaxel. A significant reduction in tumor volume was also observed by SFN in a subcutaneous tumor model of BEAC. Anticancer activity could be attributed to the induction of caspase 8 and p21 and down-regulation of hsp90, a molecular chaperon required for activity of several proliferation-associated proteins. CONCLUSIONS: These data indicate that a natural product with antioxidant properties from broccoli has great potential to be used in chemoprevention and treatment of BEAC.

Sulforaphane induces cell cycle arrest by protecting RB-E2F-1 complex in epithelial ovarian cancer cells.

BACKGROUND: Sulforaphane (SFN), an isothiocyanate phytochemical present predominantly in cruciferous vegetables such as brussels sprout and broccoli, is considered a promising chemo-preventive agent against cancer. In-vitro exposure to SFN appears to result in the induction of apoptosis and cell-cycle arrest in a variety of tumor types. However, the molecular mechanisms leading to the inhibition of cell cycle progression by SFN are poorly understood in epithelial ovarian cancer cells (EOC). The aim of this study is to understand the signaling mechanisms through which SFN influences the cell growth and proliferation in EOC. RESULTS: SFN at concentrations of 5-20 microM induced a dose-dependent suppression of growth in cell lines MDAH 2774 and SkOV-3 with an IC50 of ~8 microM after a 3 day exposure. Combination treatment with chemotherapeutic agent, paclitaxel, resulted in additive growth suppression. SFN at ~8 microM decreased growth by 40% and 20% on day 1 in MDAH 2774 and SkOV-3, respectively. Cells treated with cytotoxic concentrations of SFN have reduced cell migration and increased apoptotic cell death via an increase in Bak/Bcl-2 ratio and cleavage of procaspase-9 and poly (ADP-ribose)-polymerase (PARP). Gene expression profile analysis of cell cycle regulated proteins demonstrated increased levels of tumor suppressor retinoblastoma protein (RB) and decreased levels of E2F-1 transcription factor. SFN treatment resulted in G1 cell cycle arrest through down modulation of RB phosphorylation and by protecting the RB-E2F-1 complex. CONCLUSIONS: SFN induces growth arrest and apoptosis in EOC cells. Inhibition of retinoblastoma (RB) phosphorylation and reduction in levels of free E2F-1 appear to play an important role in EOC growth arrest.

Ritonavir blocks AKT signaling, activates apoptosis and inhibits migration and invasion in ovarian cancer cells.

BACKGROUND: Ovarian cancer is the leading cause of mortality from gynecological malignancies, often undetectable in early stages. The difficulty of detecting the disease in its early stages and the propensity of ovarian cancer cells to develop resistance to known chemotherapeutic treatments dramatically decreases the 5-year survival rate. Chemotherapy with paclitaxel after surgery increases median survival only by 2 to 3 years in stage IV disease highlights the need for more effective drugs. The human immunodeficiency virus (HIV) infection is characterized by increased risk of several solid tumors due to its inherent nature of weakening of immune system. Recent observations point to a lower incidence of some cancers in patients treated with protease inhibitor (PI) cocktail treatment known as HAART (Highly Active Anti-Retroviral Therapy). RESULTS: Here we show that ritonavir, a HIV protease inhibitor effectively induced cell cycle arrest and apoptosis in ovarian cell lines MDH-2774 and SKOV-3 in a dose dependent manner. Over a 3 day period with 20 muM ritonavir resulted in the cell death of over 60% for MDAH-2774 compared with 55% in case of SKOV-3 cell line. Ritonavir caused G1 cell cycle arrest of the ovarian cancer cells, mediated by down modulating levels of RB phosphorylation and depleting the G1 cyclins, cyclin-dependent kinase and increasing their inhibitors as determined by gene profile analysis. Interestingly, the treatment of ritonavir decreased the amount of phosphorylated AKT in a dose-dependent manner. Furthermore, inhibition of AKT by specific siRNA synergistically increased the efficacy of the ritonavir-induced apoptosis. These results indicate that the addition of the AKT inhibitor may increase the therapeutic efficacy of ritonavir. CONCLUSION: Our results demonstrate a potential use of ritonavir for ovarian cancer with additive effects in conjunction with conventional chemotherapeutic regimens. Since ritonavir is clinically approved for human use for HIV, drug repositioning for ovarian cancer could accelerate the process of traditional drug development. This would reduce risks, limit the costs and decrease the time needed to bring the drug from bench to bedside.

Telomere maintenance in laser capture microdissection-purified Barrett's adenocarcinoma cells and effect of telomerase inhibition in vivo.

PURPOSE: The aims of this study were to investigate telomere function in normal and Barrett's esophageal adenocarcinoma (BEAC) cells purified by laser capture microdissection and to evaluate the effect of telomerase inhibition in cancer cells in vitro and in vivo. EXPERIMENTAL DESIGN: Epithelial cells were purified from surgically resected esophagi. Telomerase activity was measured by modified telomeric repeat amplification protocol and telomere length was determined by real-time PCR assay. To evaluate the effect of telomerase inhibition, adenocarcinoma cell lines were continuously treated with a specific telomerase inhibitor (GRN163L) and live cell number was determined weekly. Apoptosis was evaluated by Annexin labeling and senescence by beta-galactosidase staining. For in vivo studies, severe combined immunodeficient mice were s.c. inoculated with adenocarcinoma cells and following appearance of palpable tumors, injected i.p. with saline or GRN163L. RESULTS: Telomerase activity was significantly elevated whereas telomeres were shorter in BEAC cells relative to normal esophageal epithelial cells. The treatment of adenocarcinoma cells with telomerase inhibitor, GRN163L, led to loss of telomerase activity, reduction in telomere length, and growth arrest through induction of both the senescence and apoptosis. GRN163L-induced cell death could also be expedited by addition of the chemotherapeutic agents doxorubicin and ritonavir. Finally, the treatment with GRN163L led to a significant reduction in tumor volume in a subcutaneous tumor model. CONCLUSIONS: We show that telomerase activity is significantly elevated whereas telomeres are shorter in BEAC and suppression of telomerase inhibits proliferation of adenocarcinoma cells both in vitro and in vivo.

Development of CYP3A4 inhibition models: comparisons of machine-learning techniques and molecular descriptors.

Computational models of cytochrome P450 3A4 inhibition were developed based on high-throughput screening data for 4470 proprietary compounds. Multiple models differentiating inhibitors (IC(50) <3 microM) and noninhibitors were generated using various machine-learning algorithms (recursive partitioning [RP], Bayesian classifier, logistic regression, k-nearest-neighbor, and support vector machine [SVM]) with structural fingerprints and topological indices. Nineteen models were evaluated by internal 10-fold cross-validation and also by an independent test set. Three most predictive models, Barnard Chemical Information (BCI)-fingerprint/SVM, MDL-keyset/SVM, and topological indices/RP, correctly classified 249, 248, and 236 compounds of 291 noninhibitors and 135, 137, and 147 compounds of 179 inhibitors in the validation set. Their overall accuracies were 82%, 82%, and 81%, respectively. Investigating applicability of the BCI/SVM model found a strong correlation between the predictive performance and the structural similarity to the training set. Using Tanimoto similarity index as a confidence measurement for the predictions, the limitation of the extrapolation was 0.7 in the case of the BCI/SVM model. Taking consensus of the 3 best models yielded a further improvement in predictive capability, kappa = 0.65 and accuracy = 83%. The consensus model could also be tuned to minimize either false positives or false negatives depending on the emphasis of the screening.

Differential modulation of voltage-dependent K+ currents in colonic smooth muscle by oxidants.

The effect of oxidants on voltage-dependent K+ currents was examined in mouse colonic smooth muscle cells. Exposure to either chloramine-T (Ch-T), an agent known to oxidize both cysteine and methionine residues, or the colon-specific oxidant monochloramine (NH2Cl) completely suppressed the transient outward K+ current (Ito) while simultaneously enhancing the sustained delayed rectifier K+ current (Idr). In contrast, the cysteine-specific oxidants hydrogen peroxide (H2O2) and 5,5'-dithiobis(2-nitrobenzoic acid) (DTNB) exhibited partial and slow suppression of Ito by inducing a shift in channel availability of -18 mV without affecting Idr. After enhancement by NH2Cl or Ch-T, Idr was sensitive to 10 mM tetraethylammonium but not to other K+ channel blockers, suggesting that it represented activation of the resting Idr and not a separate K+ conductance. Extracellular dithiothreitol (DTT) partially reversed the effect of H2O2 and DTNB on Ito but not the actions of NH2Cl and Ch-T on either Idr or Ito. Dialysis of myocytes with GSH (5 mM) or DTT (5 mM) prevented suppression of Ito by H2O2 and DTNB but did not alter the effects of NH2Cl or Ch-T on either Idr or Ito. Ch-T and NH2Cl completely blocked Ito generated by murine K(v)4.1, 4.2, and 4.3 in Xenopus oocytes, an effect not reversible by intracellular DTT. In contrast, intracellular DTT reversed the effect of H2O2 and DTNB on the cloned channels. These results suggest that I(to) is suppressed via modification of both methionine and cysteine residues, whereas enhancement of Idr likely results from methionine oxidation alone.

Monochloramine selectively inhibits the transient outward potassium current in colonic smooth muscle.

BACKGROUND: During colitis, activated neutrophils elaborate biologically active oxidants into the bowel wall. Colonic contraction, governed by plasma membrane ion channels in smooth muscle cells (SMCs), is markedly abnormal in colitis. The transient outward K(+) current (I(TO)) is an important determinant of electrical excitability in colonic SMCs. The aim of this study was to characterize the effect of the colon-specific oxidant monochloramine (NH(2)Cl) on I(TO) in SMCs of the mouse colon. METHODS: The effects of NH(2)Cl on I(TO) in freshly isolated single SMCs were examined with the whole cell patch clamp techniques. Cloned K(v)4 currents were measured in Xenopus oocytes with a 2-electrode voltage clamp. RESULTS: NH(2)Cl induced rapid, irreversible, and potent (EC(50) = 520 +/- 40 nmol/L) inhibition of I(TO). The cell-impermeant oxidant taurine monochloramine did not affect I(TO). NH(2)Cl did not alter the kinetics of I(TO) activation or inactivation. Voltage-dependent availability of I(TO) was unaffected by NH(2)Cl, as was recovery from inactivation. NH(2)Cl abolished currents that were elicited by cloned K(v)4 channels. CONCLUSIONS: NH(2)Cl selectively inhibits I(TO) at concentrations within the range that are produced during colitis. Suppression of I(TO) by NH(2)Cl in SMCs occurs by an effect on the channel alpha subunit mediated from within the cytosol. Oxidant-induced changes in ion channel activity in colonic SMCs may contribute to abnormal motility in colitis.

Electrogenic ion transport in mammalian colon involves an ammonia-sensitive apical membrane K+ conductance.

It is remarkable that high ammonia concentrations can be present within the colonic lumen without compromising normal epithelial function. We investigated the impact of luminal ammonia on Cl- secretion in native tissue. Stripped human colonic mucosa and unstripped rat distal colon were used. Paired samples were mounted in modified Ussing chambers for electrophysiological studies. In rat distal colon, apical ammonia dose-dependently blocked forskolin-activated short-circuit current with an IC50 to approximately 5 mM. Basolateral NH4Cl was less effective. Luminal methylamine (50 mM), chromanol 293B (10-50 microM), and Ba2+ (5 mM) blocked cAMP-activated short-circuit current but apical clotrimazole (100 microM) was without effect. In stripped human colonic mucosa, luminal but not basolateral NH4Cl (10 mM) and luminal Ba2+ (5 mM) suppressed forskolin-activated short-circuit current. Ammonia may be an endogenous regulator of colonic water and salt secretion. Apical K+ channels may be involved in the regulation of cAMP-stimulated Cl- secretion in mammalian colon.