Perception and adaptation strategies of forest dwellers to climate variability in the tropical rainforest in eastern Cameroon: The case of the inhabitants of the Belabo-Diang Communal Forest.

The design of appropriate adaptation strategies to the impacts of climate change requires a contextual study of local perceptions due to the non-homogeneity of climate in a given agro-ecological area. The research objective of the current study aims to examine the evolution of climate parameters from 1983 to 2019 linked to the perceptions of local populations and appropriate adaptation measures in the Belabo-Diang Communal Forest of Cameroon. The methodological approach includes collecting and analyze climate data from 1983 to 2019; and surveying existing local perceptions and adaptive strategies among 540 households using semi-structured questionnaires. A significant increase in temperature of about 1 °C over 36 years (1983-2019) and a non-significant decrease in precipitation (95.36 mm) over the same period were observed. Local perceptions related to climate change vary according to the sector of activity and are mainly associated with more heat in the dry season (90%), late onset of rains (84%), drought recurrence (82%), less rainfall during the year (80%), and increase in the duration of drought (80%). For 82-100% of households, according to the activity sector, no appropriate adaptation measures to climate change were applied depending on activities. The adaptation measures used by less than 0-20% of respondents, include mainly the abandonment or change of activity, and modification of the agricultural calendar. With the lack of appropriate and adequate adaptation measures by the riparian populations, this study appears necessary to inform policy-makers of the need to develop and implement more appropriate strategies to enable the riparian people living in forest area of Cameroon to better adapt to these effects of climate changes.

Stillbirths in Cameroon: an analysis of the 1998-2011 demographic and health surveys.

BACKGROUND: Many countries, including Cameroon, have found it challenging to estimate stillbirths, as there are limited available reports accurately. This analysis aimed to assess stillbirth rates and identify risk factors for stillbirth in Cameroon using successive Demographic and Health Survey data. METHODS: We conducted a cross-sectional analysis of data collected during the Demographic and Health Surveys of 1998, 2004, and 2011. Data were analyzed using SPSS 20.0. Logistic regressions were used to identify factors associated with stillbirth through odds ratios (ORs) at 95% confidence intervals (CI). Results were considered statistically significant at p-value less than 0.05. RESULTS: The crude stillbirth rate was 21.4 per 1,000 births in 2004 and 24 per 1,000 births in 2011, with respective standard errors of 1.8 and 1.3. The stillbirth rate increased with the mother's age (p < 0.001). The stillbirth rate reduction was prolonged between 1998 and 2011, with an annual reduction rate of 1.6%. The study observed that residing in rural areas, low socioeconomic status, and low level of education were risk factors associated with stillbirths. CONCLUSION: Cameroon's stillbirth rate remains very high, with a slow reduction rate over the last 20 years. Although some efforts are ongoing, there is still a long way forward to bend the curve for stillbirths in Cameroon; supplementary strategies must be designed and implemented, especially among rural women, the poor, and the less educated.

Comparison of ultrasound vector flow imaging and CFD simulations with PIV measurements of flow in a left ventricular outflow trackt phantom - Implications for clinical use and in silico studies.

In this study we have compared two modalities for flow quantification from measurement data; ultrasound (US) and shadow particle image velocimetry (PIV), and a flow simulation model using computational fluid dynamics (CFD). For the comparison we have used an idealized Quasi-2D phantom of the human left ventricular outflow tract (LVOT). The PIV data will serve as a reference for the true flow field in our setup. Furthermore, the US vector flow imaging (VFI) data has been post processed with model-based regularization developed to both smooth noise and sharpen physical flow features. The US VFI flow reconstruction results in an underestimation of the flow velocity magnitude compared to PIV and CFD. The CFD results coincide very well with the PIV flow field maximum velocities and curl intensity, as well as with the detailed vortex structure, however, this correspondence is subject to exact boundary conditions.

Evaluation of efficacy 3Dimensional 4-hole trapezoid condyle plate for treatment of base of condyle fracture.

Aim: The aim of our study was to evaluate the effectiveness of open reduction and internal fixation of the base of condyle using a 3D 4-hole trapezoid condyle plate (4-HTCP). Materials and Methods: A group of 25 subjects of an age range of 21-52 years (mean 32.7 ± 8.7 years) were treated of which, 7(28%) were female and 18 (72%), were male. All the patients were examined according to standard protocol. A retromandibular approach was used in all the patients. Results: The time taken for operating on the condyle alone was recorded it was between 30 minutes to one hour in 5 (20%) patients, between one-two hours in 19 (76%) patients and greater than two hours in 1 (4%) patient. Time taken from reduction of fracture to placement of the last screw was recorded. In 15 (60%) patients the time taken was less than ten minutes, in 10 (40%) patients the time taken ranged from 10-15 minutes. 6 (24%) patients needed additional exposure to facilitate the procedure. Postoperatively all the patients were followed up for a minimum of 9 months and a maximum of 30 months (mean 19.5 ± 5.87 months). The range of mandibular movements was satisfactory. The maximum incisal opening was in the range of 25-37 mm (mean- 31.4 ± 3.38 mm)on the first post-operative day. 31.4 ± 3.4 mm 6 weeks postoperatively, 43.8 ± 4.3 mm 3 months postoperatively, 46.7 ± 2.9 mm 6 months postoperatively and 49.7 ± 4.5 mm 9 months postoperatively. Taking into consideration the transient hypofunction of the facial nerve (8%) and TMJ disorder (8%) the aggregate complication rate in our study was 16%. Conclusion: Our study concludes that 4HTCP is a reliable and rigid choice of osteosynthesis for the base of condyle fractures.

Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC).

BACKGROUND: The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. METHODS: This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. RESULTS: Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4-4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2-12.1; P < 0.001), combined local dry season + La Nina (HR = 4.6; 95%CI 1.8-11.8; P < 0.001), and combined local dry season + El Nino (HR = 4; 95% CI 1.6-9.7; P = 0.004). HM types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox regression analysis, age ≥ 55 years, exposure to pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of incident hematologic malignancy. CONCLUSION: These findings highlight the importance of aging, pollution, the dry season, El Nino and La Nina as related to global warming as determinants of hematologic malignancies among African patients from Kinshasa, DR Congo. Cancer registries in DRC and other African countries will provide more robust database for future researches on haematological malignancies in the region.

Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study.

BACKGROUND: While most child deaths are caused by highly preventable and treatable diseases such as pneumonia, diarrhea, and malaria, several sociodemographic, cultural and health system factors work against children surviving from these diseases. METHODS: A retrospective verbal/social autopsy survey was conducted in 2012 to measure the biological causes and social determinants of under-five years old deaths from 2007 to 2010 in Doume, Nguelemendouka, and Abong-Mbang health districts in the Eastern Region of Cameroon. The present study sought to identify important sociodemographic and household characteristics of the 1-59 month old deaths, including the coverage of key preventive indicators of normal child care, and illness recognition and care-seeking for the children along the Pathway to Survival model. FINDINGS: Of the 635 deceased children with a completed interview, just 26.8% and 11.2% lived in households with an improved source of drinking water and sanitation, respectively. Almost all of the households (96.1%) used firewood for cooking, and 79.2% (n = 187) of the 236 mothers who cooked inside their home usually had their children beside them when they cooked. When 614 of the children became fatally ill, the majority (83.7%) of caregivers sought or tried to seek formal health care, but with a median delay of 2 days from illness onset to the decision to seek formal care. As a result, many (n = 111) children were taken for care only after their illness progressed from mild or moderate to severe. The main barriers to accessing the formal health system were the expenses for transportation, health care and other related costs. CONCLUSIONS: The most common social factors that contributed to the deaths of 1-59-month old children in the study setting included poor living conditions, prevailing customs that led to exposure to indoor smoke, and health-related behaviors such as delaying the decision to seek care. Increasing caregivers' ability to recognize the danger signs of childhood illnesses and to facilitate timely and appropriate health care-seeking, and improving standards of living such that parents or caregivers can overcome the economic obstacles, are measures that could make a difference in the survival of the ill children in the study area.

Feasibility of iFISH patterns in hematologic malignancies among Congolese patients at Kinshasa University clinics

Objective:To analyze the feasibility of detecting Ph1 in leukemia patients in the Kinshasa University Clinics in the Democratic Republic of Congo,at KU Leuven,Belgium.Methods:Bone marrow and peripheral blood samples with chronic myeloid leukemia,acute myeloid leukemia or acute leukocytes leukemia were obtained from 32 patients in Kinshasa University clinics in the Democratic Republic of Congo and transferred to KU Leuven in Belgium for iFISH feasibility.Ph1 was detected by using a remote analysis of interphase fluorescence in situ hybridization (iFISH).Results:Out of the 32 patients involved in this study,65.6％ (n =21) of the cases were successfully tested,of which 52.4％ (n =11) were iFISH positives for the variant t(9;22)(presence of Ph1) in chronic myeloid leukemia samples and 47.6％ (n =10) negatives in all subtypes of hematological malignancies.However,there was a female predominance in chronic myeloid leukemia samples Phi-positives by iFISH,whereas no sexual influence was observed on acute subtypes of leukemia.Conclusions:iFISH analysis is feasible on samples obtained from remote sites in the Democratic Republic of Congo.However,the optimization of the sample storage is necessary to further improve iFISH's performance.

Feasibility of iFISH patterns in hematologic malignancies among Congolese patients at Kinshasa University clinics

Objective To analyze the feasibility of detecting Ph

Contribution of the Twin Arginine Translocation system to the exoproteome of Pseudomonas aeruginosa.

The opportunistic pathogen Pseudomonas aeruginosa uses secretion systems to deliver exoproteins into the environment. These exoproteins contribute to bacterial survival, adaptation, and virulence. The Twin arginine translocation (Tat) export system enables the export of folded proteins into the periplasm, some of which can then be further secreted outside the cell. However, the full range of proteins that are conveyed by Tat is unknown, despite the importance of Tat for the adaptability and full virulence of P. aeruginosa. In this work, we explored the P. aeruginosa Tat-dependent exoproteome under phosphate starvation by two-dimensional gel analysis. We identified the major secreted proteins and new Tat-dependent exoproteins. These exoproteins were further analyzed by a combination of in silico analysis, regulation studies, and protein localization. Altogether we reveal that the absence of the Tat system significantly affects the composition of the exoproteome by impairing protein export and affecting gene expression. Notably we discovered three new Tat exoproteins and one novel type II secretion substrate. Our data also allowed the identification of two new start codons highlighting the importance of protein annotation for subcellular predictions. The new exoproteins that we identify may play a significant role in P. aeruginosa pathogenesis, host interaction and niche adaptation.

Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong-Mbang health districts, Eastern Region of Cameroon.

BACKGROUND: Reducing preventable medical causes of neonatal death for faster progress toward the MGD4 will require Cameroon to adequately address the social factors contributing to these deaths. The objective of this paper is to explore the social, behavioral and health systems determinants of newborn death in Doume, Nguelemendouka and Abong-Mbang health districts, in Eastern Region of Cameroon, from 2007-2010. METHODS: Data come from the 2012 Verbal/Social Autopsy (VASA) study, which aimed to determine the biological causes and social, behavioral and health systems determinants of under-five deaths in Doume, Nguelemendouka and Abong-Mbang health districts in Eastern Region of Cameroon. The analysis of the data was guided by the review of the coverage of key interventions along the continuum of normal maternal and newborn care and by the description of breakdowns in the care provided for severe neonatal illnesses within the Pathway to Survival conceptual framework. RESULTS: One hundred sixty-four newborn deaths were confirmed from the VASA survey. The majority of the deceased newborns were living in households with poor socio-economic conditions. Most (60-80%) neonates were born to mothers who had one or more pregnancy or labor and delivery complications. Only 23% of the deceased newborns benefited from hygienic cord care after birth. Half received appropriate thermal care and only 6% were breastfed within one hour after birth. Sixty percent of the deaths occurred during the first day of life. Fifty-five percent of the babies were born at home. More than half of the deaths (57%) occurred at home. Of the 64 neonates born at a health facility, about 63% died in the health facility without leaving. Careseeking was delayed for several neonates who became sick after the first week of life and whose illnesses were less serious at the onset until they became more severely ill. Cost, including for transport, health care and other expenses, emerged as main barriers to formal care-seeking both for the mothers and their newborns. CONCLUSIONS: This study presents an opportunity to strengthen maternal and newborn health by increasing the coverage of essential and low cost interventions that could have saved the lives of many newborns in eastern Cameroon.

Physiological and proteomic responses of different willow clones (Salix fragilis x alba) exposed to dredged sediment contaminated by heavy metals.

High biomass producing species are considered as tools for remediation of contaminated soils. Willows (Salix spp.) are prominent study subjects in this regard. In this study, different willow clones (Salix fragilis x alba) were planted on heavy-metal polluted dredging sludge. A first objective was assessment of the biomass production for these clones. Using a Gupta statistic, four clones were identified as high biomass producers (HBP). For comparison, a group of four clones with lowest biomass production were selected (LBP). A second objective was to compare metal uptake as well as the physiological and proteomic responses of these two groups. All these complementary data's allow us to have a better picture of the health of the clones that would be used in phytoremediation programs. Cd, Zn, and Ni total uptake was higher in the HBPs but Pb total uptake was higher in LBPs. Our proteomic and physiological results showed that the LBPs were able to maintain cellular activity as much as the HBPs although the oxidative stress response was more pronounced in the LBPs. This could be due to the high Pb content found in this group although a combined effect of the other metals cannot be excluded.

A multiple-level study of metal tolerance in Salix fragilis and Salix aurita clones.

The response of two willow clones (Salix fragilis (Sf) and Salix aurita (Sa)) to the presence of metals (Zn, Cu, Cd, Ni) was studied. Rooted cuttings were planted in control and contaminated soil. After 100days, different parameters (biomass, chlorophyll fluorescence (Fv/Fm), pigment and sugar concentrations, electrolyte leakage and proteome-level changes) were analyzed. The growth of Sa was not influenced by metals whereas Sf produced significantly less biomass when exposed to the pollutants. Furthermore, although Sa did not show a growth reduction in the presence of metals, the overall view of the physiological results among others the changes in the accumulation of sugars and pigments indicated that metals had a more severe impact on this clone. The response at the proteome level confirmed these observations. The growth reduction and the proteomic changes in Sf indicate that this clone adjusts its metabolism to maintain cellular homeostasis. Sa on the contrary maintains growth but the physiological and proteomics data suggests that this can only be done at the cost of cellular deregulation. Therefore high biomass is not linked with a good tolerance strategy. In a long-term study the survival of Sa might be compromised making it a poorer candidate for phytoremediation efforts. BIOLOGICAL SIGNIFICANCE: In the last centuries human activity has resulted in the dispersal of heavy metals with potential phytotoxic effects over large areas. The increased knowledge of the responses of Salix-species, a group of trees with potential as biomass producer but also as phytoremediation agent, when growing on metal-polluted substrate provided by this study has the potential to help in the improved selection of clones with more or less potential for these aims. Contrary to most studies the trees in the current study were exposed to a mixture of metals, thereby facing a closer resemblance to the situation on soils polluted by human activity. Whereas many papers focused on the two main phenotypic characteristics (biomass and accumulation), fewer papers studied proteomic and physiological parameters which allow to have a global view of the tolerance of probable willow candidates for phytoremediation purposes. Our data demonstrates that higher biomass production in presence of metals is not necessarily linked with higher tolerance whereas growth reduction might indicate longer long-term tolerance. In the long term and in the purpose of a future use in phytoremediation, the survival of this high producer clone could be compromised.

Potential of kenaf (Hibiscus cannabinus L.) and corn (Zea mays L.) for phytoremediation of dredging sludge contaminated by trace metals.

The potential of kenaf (Hibiscus cannabinus L.) and corn (Zea mays L.) for accumulation of cadmium and zinc was investigated. Plants have been grown in lysimetres containing dredging sludge, a substratum naturally rich in trace metals. Biomass production was determined. Sludge and water percolating from lysimeters were analyzed by atomic absorption spectrometry. No visible symptoms of toxicity were observed during the three- month culture. Kenaf and corn tolerate trace metals content in sludge. Results showed that Zn and Cd were found in corn and kenaf shoots at different levels, 2.49 mg/kg of Cd and 82.5 mg/kg of Zn in kenaf shoots and 2.1 mg/kg of Cd and 10.19 mg/kg in corn shoots. Quantities of extracted trace metals showed that decontamination of Zn and Cd polluted substrates is possible by corn and kenaf crops. Tolerance and bioaccumulation factors indicated that both species could be used in phytoremediation.

Permanency through Wabanaki eyes: A narrative perspective from "the people who live where the sun rises".

Tribal sovereignty is a theory that has gained credibility over the past few decades, but one that the child welfare field has still not fully embraced. A mainstream reluctance to understand or accept customary adoption, unique to tribal culture, illustrates the lack of credibility given to tribal child welfare beliefs and practices. Roger Paul, a member of the Passamaquoddy and Maliseet Tribes, was asked to discuss customary adoption. His wide-ranging narrative response illuminates past abuses and current strengths of tribal child welfare practice and belief. Two primary policy and practice implications emerge. They are (1) that cultural and institutional oppression continue to be embedded in current policy and practice and continue to have a detrimental impact on tribal children, families, and communities and (2) that little recognition of or support for the child welfare structure exists in tribal communities, as exemplified by the Wabanaki experience. Child welfare practices embedded in traditional tribal social structure can be trusted and effective. The recognition and acceptance of these practices will expand permanency resources for American Indian/Alaskan Native children and will improve relationships between tribal, state, and federal child welfare systems.

Therapeutic vaccination with an interleukin-2-interferon-gamma-secreting allogeneic tumor vaccine in patients with progressive castration-resistant prostate cancer: a phase I/II trial.

Immunotherapy with whole cell cancer vaccines has been tested in various tumor types. This study investigated the safety profile and antitumor activity of an allogeneic prostate carcinoma cell line, LNCaP, expressing recombinant human interleukin-2 and human interferon-gamma. Thirty HLA-A*0201-matched patients with progressive, castration-resistant prostate cancer received four intradermal injections on days 1, 15, 29, and 92, and then every 90 days, as long as no tumor progression occurred. Three patients received a dose level of 7.5 million cells, and 27 patients received 15 million cells per injection. The primary study criteria were safety and the difference in prostate-specific antigen doubling time (PSA-DT), determined in the pretreatment phase (before the start of vaccination) and in the trial treatment phase (during vaccination). No dose-limiting or autoimmune toxicity was seen. During vaccination there was a significant prolongation of the PSA-DT compared with the prevaccination period (prolongation from 63 to 114 days; p < 0.01; intention to treat). In addition, results showed a period of PSA stabilization of at least 12 weeks, together with stable bone scans in 12 of 30 patients, and 3 patients sustained a >50% decrease in PSA versus baseline. The median overall survival time from first vaccination was 32 months (mean value, 34 months). Immune monitoring revealed T cell stimulation in the majority of patients. This vaccine strategy was found to be safe and well tolerated and was accompanied by prolongation of PSA-DT. The results of this trial warrant clinical development of this vaccine.

Influence of body mass index on operability, morbidity and disease outcome following radical cystectomy.

INTRODUCTION: Obesity may influence postoperative outcome after tumor surgery. We evaluated the impact of patients' body mass index (BMI) on peri- and postoperative morbidity and outcome following radical cystectomy for bladder cancer. PATIENTS AND METHODS: 390 consecutive patients who underwent radical cystectomy due to bladder cancer from January 1986 to December 2004 were reviewed. According to WHO criteria, patients were divided into normal weight (NW, 45.6%), overweight (OW, 44.4%) and obese (10.0%) subgroups. The BMI of patients was associated to the time of surgery, amount of intraoperative blood units, TNM stage, postoperative complication rate as well as overall survival. RESULTS: The time of cystectomy increased with the degree of patients' obesity (NW, 330 min; OW, 355 min; p = 0.007). Between NW and OW patients no significant differences were noted in respect to intraoperative blood transfusion rate (NW, 3.0; OW, 2.0; p = 0.47), postoperative TNM stage (pTis-pT2b: 42.6 vs. 48.6%; pT3a-4: 38.2 vs. 27.2%; pN+: 20.2 vs. 24.2%) and postoperative complications, except for postoperative bleeding, which was more common in OW patients (p = 0.02). Mean overall survival times showed no significant differences between NW and OW patients receiving ileal conduits (5-year survival rate: 34.0 vs. 41.1%; p = 0.140) or ileal neobladders (5-year survival rate: 65.1 vs. 70.8%; p = 0.127). CONCLUSIONS: Increased BMI poses a greater challenge for surgical interventions such as radical cystectomy in bladder cancer patients. However, in our series, intra- and postoperative morbidity was not significantly elevated in OW patients. Overall survival was not reduced in OW compared to NW patients. Therefore, elevated BMI is not an exclusion criterion for radical cystectomy in bladder cancer patients.

Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings.

UNLABELLED: Lymph node involvement is a major prognostic factor in bladder cancer, but the accuracy of conventional imaging modalities for the prediction of regional and distant metastatic diseases is limited. This study was performed to compare the diagnostic accuracies of contrast-enhanced CT and PET with (11)C-choline for the staging of urothelial bladder cancer. METHODS: Twenty-seven patients (median age, 69.1 y) who had urothelial bladder cancer and who were referred for radical cystectomy and pelvic lymph node dissection (PLND) on the basis of a histologic evaluation after transurethral resection of bladder cancer (TURB) were studied. PET scanning, using 2 multiring whole-body tomographs, was performed 5 min after intravenous injection of approximately 370-500 MBq of (11)C-choline. In addition, conventional bone scintigraphy and contrast-enhanced CT were performed. After imaging, cystectomy and PLND were performed in all patients. Pathologic (11)C-choline uptake that could not be explained by intestinal activity was noted as a positive result. Node positivity was determined by size on CT: nodes measuring more than 1 cm in the long axis were described as being positive for tumor. Histopathologic findings were used as a reference. RESULTS: The presence of residual bladder cancer (pTa-pT4) was correctly detected in 21 of 25 histologically tumor-positive patients (84%) by CT and in 24 of 25 patients (96%) by (11)C-choline PET. Lymph node involvement was correctly detected in 4 of 8 patients (50%) by CT and in 5 of 8 patients (62%) by (11)C-choline PET. The median size of the 3 nodes with false-negative PET results was 9 mm (range, 6-21 mm), and the median size of the metastatic lesions within the lymph nodes was 3 mm (range, 1-15 mm). CT resulted in 6 (22%) false-positive lymph nodes, whereas none was demonstrated by (11)C-choline PET; these data indicated a significantly higher accuracy of PET than of CT (P < 0.01). Both modalities missed a small peritoneal metastasis verified by histologic evaluation. No positive results were obtained from bone scintigraphy. CONCLUSION: These preliminary data suggest that (11)C-choline PET is comparable to CT for detecting residual bladder cancer after TURB but appears to be superior to CT for the evaluation of potential additional lymph node metastases. (11)C-choline PET should be further evaluated for staging in patients who have bladder cancer and who are scheduled for radical cystectomy.

Influence of blood transfusions during radical retropubic prostatectomy on disease outcome.

OBJECTIVES: Blood transfusion in patients with malignant neoplasms may alter the disease outcome because of a theoretical immunomodulatory effect. This effect may reduce prostate-specific antigen (PSA)-free and disease-specific survival in patients with prostate cancer after radical prostatectomy. However, the results in published studies have been contradictory, and this effect has not yet been determined. METHODS: We evaluated 1412 patients after radical prostatectomy from 1984 to 2003 in a retrospective analysis, with a special focus on the rate and type of blood transfusions, specifically heterologous versus autologous blood. Univariate analysis and Cox regression analysis were performed to evaluate the impact of blood transfusions on disease outcome. RESULTS: The overall transfusion rate was 56.7%. The rate dropped from 88.9% in 1988 to 9.1% in 2002. PSA recurrence (greater than 0.5 ng/mL) was noted in 11.0% in patients without and in 26.0% with blood transfusions, which was not statistically significant on Kaplan-Meier analysis. Again, no difference was noted when patients were stratified according to the type (autologous versus heterologous) or the amount (2 U or less versus more than 2 U) of blood transfusion. Evaluating overall survival, again no differences were found. The established Cox regression model also proved that blood transfusions had no impact on disease outcome. CONCLUSIONS: Our retrospective analysis did not detect any effect of blood transfusions in patients with prostate cancer after radical prostatectomy. If a negative adverse effect occurs, this effect must be minimal. However, the infectious risk and the costs of blood transfusions should be reason enough to reduce blood loss and the transfusion rate further in patients with prostate cancer.

[Diagnostic work-up of the prostate carcinoma]. / Prostatadiagnostik von der rektalen Untersuchung bis zum Tumor-staging. Nichts ubersehen, Fehlalarm vermeiden.

The most important investigation in the diagnostic work-up of prostate carcinoma is the determination of the prostate-specific antigen (PSA) in the serum. The rate of increase in PSA (PSA velocity) may provide valuable additional information. The highest detection rate is achieved using the combination of digital rectal examination (DRE) and PSA determination. Transrectal ultrasound is of importance in particular in the context of biopsy-taking. Nomograms permit an estimation of the local tumor spread and lymph node status. The currently accepted most sensitive method for the detection of bone metastases is scintigraphy. The value of PET in the primary diagnostic work-up has yet to be established.