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Prostate-Specific Antigen Density is a More Accurate Predictor of Prostate Cancer in Patients With Prostate-Specific Antigen Levels of 4-10 ng/mL and Normal Digital Rectal Examination Findings

Purpose: This study was conducted to identify the optimal predictor of prostate cancer among several prostate-specific antigen (tPSA) derivatives in prostate biopsies of patients with PSA levels of 4-10 ng/mL and normal digital rectal examination (DRE) findings. Materials and methods: We retrospectively assessed prostate biopsy specimens of 490 patients who underwent transrectal ultrasound-guided prostate biopsy in our hospital from January 2008 to June 2013. We excluded patients with abnormal DRE findings and serum tPSA levels of ＞10 ng/mL. Finally, 238 men with serum tPSA levels of 4-10 ng/mL and normal DRE findings were included in the statistical analysis. We performed receiver operating characteristic (ROC) curve analysis and assessed the predictive power of tPSA, percentage of free PSA (f/tPSA), and PSA density (PSAD) for detecting prostate cancer. Results: Overall, 47 (19.7%) of the 238 prostate biopsy specimens were positive for prostate cancer. Patients with positive and negative biopsy results had significant differences in the mean PSAD (0.306 and 0.156 ng/mL^2, respectively, p ＜ 0.001). The areas under the ROC curves for tPSA, f/tPSA, and PSAD were 59.8%, 36.6%, and 77.4%, respectively. Moreover, when PSAD was considered as a predictor at an optimal cutoff value of 0.16 ng/mL^2, the detection of prostate cancer was highly sensitive (72%) and specific (61%). The ROC curve analysis indicated that PSAD was a more accurate predictor of prostate cancer than was f/tPSA. Conclusion: The results suggest that PSAD improves the specificity of cancer detection in men with normal DRE findings and an intermediate PSA level.

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Prediction of impaired fasting glucose: a retrospective cohort study

Background: Impaired fasting glucose (IFG) is a condition of prediabetes. People with IFG have a 5- to 7-fold higher risk of diabetes mellitus than those with normoglycemia. People with prediabetes have higher risk of experiencing an adverse cardiovascular event and stroke. Objectives: The study investigates the risk factors of developing IFG. Methods: 1,018 participants receiving ≥2 health checkups were enrolled between 2003 and 2013. Clinical characteristics were obtained for the analysis of progression from normoglycemia to IFG. We used a Cox proportional hazard model to evaluate the risk of an IFG status. Results: The median follow-up period was 36 months. Two hundred nine people (20.5%) progressed to an IFG status with a median interval of 24 months (interquartile range, 12-48 months). Age ≥45 years old (hazard ratio [HR] = 2.04, p ＜ 0.001), overweight (HR = 1.46, p = 0.023) or obesity (HR = 1.83, p = 0.004), elevated blood pressure (BP)/hypertension (HR = 1.58, p = 0.003), regular alcohol consumption (HR = 2.145, p = 0.049), and initial fasting blood glucose (FBG) levels above 90 mg/dl (HR = 2.01, p ＜ 0.001) were independent risk factors predicting progression to IFG. People with ≥2 high-risk factors developed IFG earlier and more frequently than those with no or only one risk factor (5-year IFG-free survival rate, 60% vs. 88%, p ＜ 0.001). Conclusions: Age, body mass index, BP, random FBG sampling, and alcohol drinking status are feasible screening items to identify people with have a higher risk of developing IFG, which underscores the need for exercise, intensive BP control, and alcohol cessation in high-risk people.

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Synergic anti-tumor effect of pterostilbene, an inhibitor of type I insulin-like growth factor receptor, and trastuzumab against HER2-overexpressing bladder cancer cells

Background and purpose: Stilbene has been extensively investigated in varied fields including being anticancer agents. In this study, we proposed pterostilbene, a more potent compound of stilbenes, serve as a novel type I insulin-like growth factor receptor inhibitor (IGR- 1R inhibitor), and have synergic effect on bladder cancer cells. Methods: We treated bladder cancer cell lines with pterostilbene and utilized western blot analyses cell proliferation assays and flow cytometry to analyze the effect of pterostilbene on bladder cancer cell proliferation and cell cycle. We analyzed on perostilbene on IGF-1R of bladder cancer cell and also tried to explore the downward pathway. In addition, we used Chou and Talalay's combination index (CI) algorithm to exam the efficacy of pterostilbene in potentiating the effects of trastuzumab on Human epidermal growth factor receptor2-overexpressing (HER2) overexpressing bladder cancer cells. Results: Pterostilbene was shown to provoke a dose-dependent increase in the number of cells in G0/G1 phase of the cell cycle, and a decrease in the G2/M and S phases. Moreover, pterostilbene induced an increase in p27 expression, together with a decrease in p21 expression. Additionally, it led to a decrease in phosphorylated AKT levels in HER2-overexpressing T24 cells, and induced the apoptosis of T24 cells. A clear synergistic effect was obtained when the cells were treated with pterostilbene in combination with trastuzumab. Conclusion: Pterostilbene represents a novel IGF-1R inhibitor, which acts synergistically with trastuzumab, inhibiting the proliferation of HER2-overexpressing bladder cancer cells. These results demonstrate that anti-IGF-1R agent, such as pterostilbene, may be effectively combined with trastuzumab in order to achieve a more effective treatment of trastuzumab-resistant bladder cancers.

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Lumbar epidural angiolipoma: A rare case report

Spinal angiolipomas are rare benign tumors composed of mature fatty tissue and abnormal vascular elements. These lesions are most commonly found in the posterior spinal epidural space, especially within the mid-thoracic spine. However, case of lumbar epidural angiolipoma have been rarely reported in literature. Here, we report the case of a 50-year-old woman who presented with low back pain and left leg pain and in whom magnetic resonance imaging revealed a dumbbellshaped mass in the neural foramen around L1-L2 with root compression. The tumor was completely removed, and pathological examination confirmed the diagnosis of angiolipoma. We also reviewe the relevant literature.

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Ventricular Dysrhythmia and Unstable Hemodynamics during an Emergency Subdural Hemorrhage Operation in a Chronic Alcoholic Patient: Anesthetic Management of Hypokalemia and Metabolic Alkalosis

We report the anesthetic management of ventricular dysrhythmia and unstable hemodynamics in a chronic alcoholic patient with hypokalemia during an emergency subdural hemorrhage operation. We discuss the pathophysiology, clinical presentation, and possible causes of hypokalemia. Chronic alcoholism, head injury, or metabolic alkalosis might have caused hypokalemia in our patient. Methods to manage hypokalemia, namely monitoring, drug administration, and ventilation strategies, are also reviewed and discussed.

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The Role of Herbal Medication in Poor TACE Response Hepatocellular Carcinoma: Case Report

On principle, the treatment for hepatocellular carcinoma (HCC) generally involves surgeries. However, if patients are unfit or unwilling to undergo surgeries, medical personnel assess whether radiofrequency ablation is a viable option. If both of the aforementioned curative therapies are unsuitable, transarterial chemoembolization (TACE) may be considered. We report a patient who had undergone TACE and whose computed tomography (CT) scan during the 1-month follow-up showed unfavorable results, resulting in the patient deciding to withdraw from the treatment. After a discussion with the patient, 3 months of traditional Chinese medicine-based treatment were recommended. A follow-up CT scan indicated that the size of the tumor was reduced considerably, and that the application of TACE following the traditional Chinese medicine-based treatment yielded remarkable results. Thus, a combination of the two methods may be an option for patients whose liver cancer condition fails to improve after TACE.