Patients' Knowledge of Prenatal Screening for Trisomy 21.

This study's objective was to assess the knowledge of prenatal screening for Trisomy 21 in pregnant women in one institution in Canada. A cross-sectional survey measuring demographics, knowledge of screening, and health literacy, was administered to pregnant women. Of the 135 women who completed the survey, 74% had adequate knowledge of Trisomy 21 and associated screening procedures. Twenty-eight point one percent of women did not receive any counseling. Overall, 29.5% of women did not know that the screening test was optional and 10.2% of women underwent screening prior to having been counseled. Multigravidity (p < 0.05) and prior counseling (p < 0.001) were positively correlated with knowledge while first language other than English (p < 0.001) was negatively correlated with knowledge. Given these findings, an effort needs to be made on the part of health care providers to increase counseling rates to 100%, stressing the optional nature of the test to attain true informed consent.

Kynurenine and depressive symptoms in a poststroke population.

BACKGROUND AND PURPOSE: Depression is a commonly occurring and persistent sequel of stroke affecting approximately 29% of patients. An immunological hypothesis has been put forward, and synthesis of kynurenine from tryptophan has been proposed to link inflammatory activity with neurotoxicity and neurotransmitter dysfunction. This study assessed the relationship between peripheral blood kynurenine and poststroke depressive symptoms. PATIENTS AND METHODS: This was a multisite cross-sectional observational cohort study of patients with ischemic stroke. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) scale and divided into high, medium, and low depressive symptom tertiles. Concentrations of kynurenine and tryptophan were assayed from fasting serum samples, and the kynurenine/tryptophan ratio was compared between tertiles. Serum cytokine concentrations were assayed in a subgroup of patients, and the ratio of proinflammatory (IL-6, IL-18, IFNγ, TNF, IL-1ß) to anti-inflammatory (IL-10) cytokines compared. NLM IDENTIFIER: NCT00254020. RESULTS: In these patients (n=86, 52.3% male, mean age 71.7±14.2 years), there were no differences in kynurenine/tryptophan ratios between CES-D scale tertiles (F 2,76=0.04, P=0.96) controlling for relevant covariates. For cytokines (n=53), serum IL-1ß concentrations (F 2,52=3.55, P=0.037) and serum ratios of IL-18/IL-10 (F 2,52=3.30, P=0.046), IFNγ/IL-10 (F 2,52=4.02, P=0.025), and IL-1ß/IL-10 (F 2,52=4.34, P=0.019) were elevated in the middle CES-D tertile. Post hoc analyses suggested that serum ratios of IL-18/IL-10 (ρ=0.28, P=0.04), and IL-1ß/IL-10 (ρ=0.43, P=0.001), as well as IL-1ß (ρ=0.29, P=0.04), were significantly associated with fatigue. CONCLUSION: Peripheral kynurenine/tryptophan ratios were not associated with depressive symptoms in a poststroke population. However, in exploratory analyses a proinflammatory bias was identified specifically in patients with mild depressive symptoms and associated with poststroke fatigue, suggesting an avenue for future research.

Results of high intensity focused ultrasound treatment of prostate cancer: early Canadian experience at a single center.

INTRODUCTION: High intensity focused ultrasound (HIFU) is a non-invasive technique that uses focused ultrasound waves to ablate tissue. This retrospective study evaluates the early HIFU experience at a single Canadian center. MATERIALS AND METHODS: Ninety-five patients were treated between March 2006 and December 2007 using the Sonablate-500 device (Focus Surgery, Indianapolis, IN, USA). Follow up occurred at 3 month intervals and included serial prostate-specific antigen (PSA) measurements, assessments of erectile function and continence rates with the international index of erectile function (IIEF) and expanded prostate cancer index composite (EPIC) questionnaires respectively. Early and late complications were also studied. RESULTS: There were 95 patients treated by five urologists. The mean age of patients was 64 years (range 46-91). The majority of men treated had Gleason 6 (n = 53) or Gleason 7 (n = 35) disease. The remainder had Gleason 8 (n = 5) and Gleason 9 (n = 2) prostate cancer. Prostate volume in the pre-treatment group was 30.5 cc (range 14.4 cc-73 cc). Cytoreductive androgen deprivation therapy prior to treatment was administered to 10 men. Post-HIFU with a minimum 6 months follow up (mean 10.62 months), 2% (1/59) of men had de novo moderate to severe erectile dysfunction (IIEF ≤ 11). With a minimum of 6 months follow up (mean 8.85 months), 17% (7/41) of the men had significant incontinence according to their EPIC scores. Early complications included catheter-related problems (n = 10), retention (n = 16), and urosepsis (n = 1). Late complications included need for cystoscopy (n = 25), TURP (n = 6), VIU/dilatation for stricture or bladder neck contracture (n = 13) and self-catheterization (n = 1). Prostatorectal fistula occurred in one patient who had prior radiotherapy. Salvage HIFU following radiation failure was performed in seven men. Recurrence of cancer following HIFU was diagnosed in seven men. Salvage treatment included radical prostatectomy (n = 3), radiation therapy (n = 2), repeat HIFU (n = 1), hormone therapy (n = 1). CONCLUSIONS: In our early experience HIFU treatment for prostate cancer was associated with a moderate rate of complications and failure. Further studies are required to examine long term outcomes with HIFU.