Two Positive Nodes, A Significant Cut-off Value For Cancer Specific Survival In Patients With Node Positive Prostate Cancer

UroToday – The historical approach to radical prostatectomy (RP) with pelvic lymphadenectomy (PLND) was that positive lymph nodes dictated poor outcomes. More recent data suggests that combined with adjuvant therapies, RP with PLND can result in reasonable survival outcomes. The degree to which lymph nodes are involved was assessed in a large two institution study and reported in the online edition of European Urology.

Between 1988 and 203, 703 patients underwent RP with extended PLND (ePLND) at the Mayo Clinic, Rochester and Vita-Salute University, Milan. All patients received adjuvant therapy – androgen deprivation therapy (ADT) in 75.7% and ADT with adjuvant radiotherapy in 24.3%. The latter group had higher rates of locally advanced CaP, pathological Gleason score, rates of positive surgical margins and mean number of lymph nodes removed. Analysis identified the most-informative positive lymph-node cutoff in predicting CaP cancer specific survival (CSS) as 2. Less than 2 positive lymph nodes were found in 75.7% and more than 2 were found in 24.3%. Less than 2 positive lymph nodes correlated with patients who also had less adverse clinicopathological variables.

Mean follow-up was 113 months and 109 of 701 (15.5%) had died of CaP while 140 (19.9%) died from other causes. Biochemical recurrence free survival at 5, 8, 10, and 15 years was 71, 62, 58, and 49%, respectively. Overall survival at 5, 8, 10, and 15 years was 84, 74, 67, and 49%, respectively. CSS at 5, 8, 10, and 15 years was 90, 85, 82, and 78%, respectively. CSS for men with 2 positive lymph nodes. In multivariable analysis of clinicopathological factors, the 2 lymph node cutoff point remained significantly associated with CSS. A man with >2 positive lymph nodes had a 1.9-fold higher risk of dying from CaP than a man with 2 or less positive lymph nodes.

While the 1992 AJCC prostate cancer staging system stratified according to the number of positive lymph nodes, the 2002 version does not. The authors suggest that due to the significance of prognosis of >2 positive lymph nodes or

Telephone Support Helps Smokers Quit More Than Routine Medical Care, U Of M Reports

University of Minnesota Medical School and Minneapolis VA Medical Center research shows that smokers who receive support over the telephone when trying to quit are more successful in kicking the habit than those who receive help as part of routine medical care.

The research is published in the March 13, 2006, issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Lawrence C. An, M.D., assistant professor of medicine, and colleagues studied daily smokers who received care at five Veterans Affairs medical centers in the upper Midwest and were committed to quitting within one month.

“The findings suggest that health-care providers should consider adding telephone care to their smoking cessation programs,” An said. “With the telephone support, we are able to bring the service to the smokers instead of making them come to us to get help.”

The smokers in the study were divided into two groups: one received self-help materials in the mail and had continued access to smoking cessation services as part of routine medical care; the other group received counseling sessions using telephone care, which consisted of seven calls over a two-month period as well as mailing of smoking medications, as appropriate, directly to their homes.

After three months in the study, about 40 percent of the telephone-care group had not smoked in the previous seven days, compared with about 10 percent of the standard- care group. At the one-year mark, 13 percent of the telephone-care group and about 4 percent of the control group had abstained from smoking for the previous six months.

Additionally, compared to the group that received usual care, people who received telephone care were more likely to use other techniques to help them stop smoking, including smoking cessation counseling programs and medication, and made more attempts to quit.

“We were able to make a difference for people in this study because we helped smokers deal with both the habit and the addiction of smoking, and we did it in a way that was convenient for them.” An said.

From a national perspective, this study lends support to the idea of a national network of quit lines that would provide both phone counseling and access to free stop-smoking medications to smokers across the country.


Contact: Sara Buss
University of Minnesota

Small Amount Of Exercise Could Protect Against Memory Loss In Elderly, CU Study Suggests

A new University of Colorado Boulder study shows that a small amount of physical exercise could profoundly protect the elderly from long-term memory loss that can happen suddenly following infection, illnesses or injury in old age.

In the study, CU-Boulder Research Associate Ruth Barrientos and her colleagues showed that aging rats that ran just over half a kilometer each week were protected against infection-induced memory loss.

“Our research shows that a small amount of physical exercise by late middle-aged rats profoundly protects against exaggerated inflammation in the brain and long-lasting memory impairments that follow a serious bacterial infection,” said Barrientos of the psychology and neuroscience department.

The results of the study appears in the Aug. 10 edition of The Journal of Neuroscience.

“Strikingly, this small amount of running was sufficient to confer robust benefits for those that ran over those that did not run,” Barrientos said. “This is an important finding because those of advanced age are more vulnerable to memory impairments following immune challenges such as bacterial infections or surgery. With baby boomers currently at retirement age, the risk of diminished memory function in this population is of great concern. Thus, effective noninvasive therapies are of substantial clinical value.”

Past research has shown that exercise in humans protects against declines in cognitive function associated with aging and protects against dementia. Researchers also have shown that dementia is often preceded by bacterial infections, such as pneumonia, or other immune challenges.

“To the best of our knowledge, this is the first study to show that voluntary exercise in rats reduces aging-induced susceptibility to the cognitive impairments that follow a bacterial infection, and the processes thought to underlie these impairments,” Barrientos said.

In the study, the researchers found that rats infected with E. coli bacteria experienced detrimental effects on the hippocampus, an area of the brain that mediates learning and memory.

Previous research has shown that immune cells of the brain, called microglia, become more reactive with age. When the older rats in the study encountered a bacterial infection, these immune cells released inflammatory molecules called cytokines in an exaggerated and prolonged manner.

“In the current study we found that small amounts of voluntary exercise prevented the priming of microglia, the exaggerated inflammation in the brain, and the decrease of growth factors,” Barrientos said.

The next step of this research is to examine the role that stress hormones may play in sensitizing microglia, and whether physical exercise slows these hormones in older rats, she said.

Barrientos co-authored the paper with CU-Boulder professors of psychology and neuroscience Steven Maier, Linda Watkins, Serge Campeau, Heidi Day and Susan Patterson; and CU-Boulder psychology research assistants Timothy Chapman, Matthew Frank, Nicole Crysdale and Jared Ahrendsen.

The research was funded by the National Institute on Aging, which is part of the National Institutes of Health.

Smoking Teenagers Make Depressed Adults

A groundbreaking new study by researchers in the US suggests that teenagers who smoke could be setting themselves up to become depressed

Published pre-press as an early on line issue last month in the journal Neuropsychopharmacology, the research was the work of Florida State
University Psychology Professor Carlos A BolaГ±os-GuzmГЎn and colleagues.

In their background information BolaГ±os and colleagues said research has already established a strong link between tobacco consumption and mood
disorders, and while some might say smokers use tobacco to manage their moods, there is also evidence that tobacco consumption induces negative

For the study, BolaГ±os and colleagues used adolescent rats (their neurobiology is similar to that of humans) and showed that giving them nicotine
induced a depression-like state that left them less able to feel pleasure and more sensitive to stress in adulthood. The researchers suggested the same
might be true of humans.

As BolaГ±os explained, the finding is unique because:

“It is the first one to show that nicotine exposure early in life can have long-term neurobiological consequences evidenced in mood

He also said their research showed that even brief exposure to nicotine raised the risk of mood disorders later in life.

For the study, they injected adolescent rats twice a day with various doses of nicotine or a saline solution (the controls) for 15
days. At various times during and then after exposure finished the rats also underwent tests that examined their responses to stressful circumstances
and the offer of rewards. Separate groups of adult rats received a mid-range dose of nicotine to enable the researchers to rule out age-related

The results showed that:

Nicotine exposure during adolescence, but not adulthood, led to a depression-like state characterised by lower sensitivity to natural reward
(sucrose) and enhanced sensitivity to situations that raised anxiety and stress in later life.
Behavioural characteristics of depression can emerge 1 week after stopping nicotine exposure.
A single day of nicotine exposure during adolescence is enough to trigger a depression-like state in adulthood.
The depression behaviours went back to normal when the rats were given either nicotine or antidepressants (such as fluoxetine or bupropion) in

The adult rats that had not been exposed to nicotine as teenagers did not show the depression-like symptoms, although they underwent tests in parallel
with their teen-nicotine exposed counterparts.

Behaviours characteristic of depression and anxiety included repetitive grooming, less consumption of rewards like the sugary drinks they were
offered, and “freezing” in stressful situations instead of trying to escape them.

BolaГ±os and colleagues concluded that:

“These data suggest that adolescent exposure to nicotine results in a negative emotional state rendering the organism significantly more vulnerable to
the adverse effects of stress.”

“Within this context, our findings, together with others indicating that nicotine exposure during adolescence enhances risk for addiction later in life,
could serve as a potential model of comorbidity,” they added.

Talking about the research to the press, BolaГ±os said that:

“Some of the animals in our study were exposed to nicotine once and never saw the drug again,” but then it was “surprising to us to discover that a
single day of nicotine exposure could potentially have such long-term negative consequences.”

Speculating on the mechanisms that might underlie these findings, BolaГ±os said toxic effects in the brain could be responsible: effects which alter the
way that neurotransmitter circuits behave later in life. Perhaps these mechanisms are sensitive at particular stages of development, such as during the
teenage years. The researchers said this should be the focus of new studies.

In the meantime, the message to young people is:

“Don’t smoke and don’t even try it,” said BolaГ±os. They need to be made aware of the long term risks they are taking, even from having the occasional

The research was paid for by grants from the state of Florida’s James and Esther King Biomedical Research Program and the National Institute on
Drug Abuse. Funds also came from a McKnight Fellowship from the Florida Education Fund and Neuroscience Fellowships from Florida State

“Nicotine Exposure During Adolescence Induces a Depression-Like State in Adulthood.”
Sergio D IГ±iguez, Brandon L Warren, Eric M Parise, Lyonna F Alcantara, Brittney Schuh, Melissa L Maffeo, Zarko Manojlovic and Carlos A BolaГ±os
Neuropsychopharmacology advance online publication 17 December 2008.
doi: 10.1038/npp.2008.220

Click here for Abstract.

Sources: Journal Abstract, Florida State University.

: Catharine Paddock, PhD

Massachusetts Cuts Copayment Assistance Program For Seniors

More than 44,000 Massachusetts seniors must pay larger prescription drug copayments as a result of an $11 million cut to the state Prescription Advantage program, which provides copay assistance for seniors who meet an income-eligibility requirement, the Boston Globe reports. The cut, which was part of Gov. Deval Patrick’s (D) $1 billion state budget reduction in October 2008, could leave many seniors paying double or triple their copays, state officials said.

As of Jan. 1, state assistance for covered drugs is not available until Medicare and the beneficiary combined have spent $2,700. Deborah Banda, state director of AARP Massachusetts, said, “The pain will go away once they reach the $2,700, but it will be a heck of a lot of pain until then,” adding, “The vast majority of these people are on fixed incomes.”

Mary Sullivan, a pharmacist and director of the not-for-profit organization MassMedLine, said that many seniors are not picking up their prescriptions because they cannot afford the copays. In addition, despite a large outreach effort by advocacy groups in November and December, many seniors did not realize how they would be affected by the program cuts, according to the Globe. “They are calling us when they reach the pharmacy and realize their [prescription] plans are not what they expected,” Sullivan said.

In response, the Executive Office of Elder Affairs has been sending information to seniors notifying them about the changes. In addition, the state will be conducting “over 100 statewide informational seminars about the changes, as well as briefing senior centers, pharmacists and senior counselors,” according to Kristina Barry, a spokesperson for the Executive Office of Health and Human Services.

Banda said that with more budget cuts likely, “we just feel this program has taken the biggest hit it can right now without jeopardizing the health of some of our most vulnerable residents.” She added, “If people are cutting back because they can’t afford these costs, they may stop taking their prescriptions, and they may end up at emergency rooms all over the state” (Lazar, Boston Globe, 1/14).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Researchers Find Genetic Secrets To Common Kidney Cancer

By examining expression of every human gene in clear cell renal cell carcinoma (ccRCC) compared to normal kidney cells, researchers at Mayo Clinic’s campus in Florida have discovered gene signatures they say explain much of the biology of this common and difficult-to-treat kidney cancer.

In the May 18 issue of PLoS ONE, the researchers report they have discovered: a biological pathway signature of ccRCC for a group of altered genes that give this distinct cancer its “clear cell” appearance; other genes that confer stem cell-like properties to the cancer; and a set of master genes lost in ccRCC that they believe likely pushes initial development of the cancer.

“Understanding these genes and the pathways they regulate could provide valuable insight into how to treat ccRCC,” says hematologist/oncologist Han W. Tun, M.D., the study’s first author.

This cancer makes up 80 percent of all kidney cancer and is often resistant to both chemotherapy and radiation treatment, Dr. Tun says. It accounts for just 3 percent of all cancers in the United States, but is the sixth leading cause of cancer death.

“Up until this point, ccRCC was largely a mystery, but now we have new and exciting clues that seem to reveal the origin and development of this cancer,” says senior investigator John Copland, Ph.D., a cancer biologist.

The research team, which included scientists from the University of Texas Medical Branch in Galveston, used a comprehensive genome-wide gene expression analysis to look at expression of about 25,000 genes in the human genome. The gene chip measures the amount of messenger RNA (mRNA) that is transcribed from genes as part of the protein production process.

They used this tool to measure levels of mRNA for each gene in tissue samples taken from kidneys that were removed from 10 ccRCC patients. The kidneys were removed at the time of surgery and contained both normal tissue as well as tumor, so the scientists compared gene expression between the two to see what genes in the cancer were either over- or under-expressed, compared to normal cells.

Researchers found that 13,729 genes had altered expression in the cancer a figure Dr. Copland calls “just astounding, especially in trying to develop new treatments and in understanding the causes of kidney cancer.” They used novel software that grouped these genes into meaningful biological pathways which helped them discover master genes. Each of these master genes regulates hundreds of “downstream” genes.

Researchers confirmed these gene expression findings in 20 kidneys removed from other ccRCC patients. Then, they validated gene expression at the protein level in kidneys taken from a different group of 50 ccRCC patients. To provide biological relevance, researchers then grew live normal kidney and ccRCC cells in a culture mediuam and conducted experiments.

Among the research findings are:

– The top three biological pathways found included genes regulating normal kidney function and metabolic functions lost in ccRCC. Genes in immune pathways were also over-expressed.

– A gene expression signature responsible for adipogenesis, which is the accumulation of globules of fat inside cells that is the reason for the “clear” appearance of ccRCC. Using a novel cell culture technique, they turned ccRCC cell lines into fat-acquiring “clear cells,” mimicking what happens in patients. In patient-matched normal cells, fat is not produced.

– The loss of four developmental transcriptional factor genes in ccRCC that are important for normal kidney development. One of these genes, GATA3, controls many genes through transcriptional regulation of cell growth, immune function and inhibition of adipogenesis. Its loss is known to be critical to development of breast cancer. These four genes are known to control hundreds of other genes.

– That ccRCC cells behave like stem cells undifferentiated cells that have the ability to become any type of cell in the body. ccRCC, but not normal kidney cells, has the capacity to undergo development of fat-producing cells or bone-making cells, depending on which laboratory culture medium they are placed in.

– A gene expression signature for a biological process called epithelial-mesenchymal transition (EMT), a characteristic feature of invasive cancer and cells undergoing proliferation. EMT may be important for kidney cancer development.

The stem cell-like properties found in ccRCC may explain why this cancer is so resistant to treatment, says Dr. Tun. But it also suggests that newer classes of drugs designed to target stem cells may offer a new alternative to treatment for this cancer, he says.

Additionally, one of the study’s biggest surprises is that immune genes are being expressed in ccRCC cells, which may be the reason why ccRCC is one of the few cancers that responds to immunotherapy, says Dr. Tun. One such gene, TLR2, can help control the chronic inflammation that is integral to the disease process. Down-regulating these immune genes may therefore be another good strategy.

“Based on these findings, we propose a cancer model for the development of ccRCC,” says Dr. Copland. “Developmentally, kidneys are mesenchymal in origin and develop by biological processes, which include mesenchymal epithelial transition (MET). In our model, normal renal epithelial cells experience loss of normal renal function (dedifferentiation) and EMT as well as preferential adipogenic differentiation.

“We think that these processes turn normal kidney cells into cancer cells with stem cell-like qualities. Since our samples came from patients with early-stage ccRCC, it appears that EMT may play a prominent role in renal carcinogenesis,” he says.

The researchers are conducting experiments in which they knock out the four developmental genes from normal kidney cells, to see if cancer develops. They are also introducing these same genes into patient-derived ccRCC cell lines to see if cancer growth stops.

Other authors include Laura A. Marlow, Christina A. von Roemeling, Simon J. Cooper, Ph.D., Pamela Kreinest, Kevin Wu, M.D., Panos Z. Anastasiadis, Ph.D. all from Mayo Clinic; and Bruce A. Luxon, Ph.D., and Mala Sinha, Ph.D., from the University of Texas Medical Branch in Galveston.

The study was funded in part by a Sarah and James Kennedy Career Development Award to Dr. Tun, a gift from Susan A. Olde, The Scheidel Foundation, the David and Lois Stuhlberg Endowed Fund for Kidney Cancer and the National Cancer Institute. The authors declare no conflicts of interest.

About Mayo Clinic

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world’s leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients’ health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people.

Source: Mayo Clinic

Prescribing Inconsistencies In Prostate Cancer Treatment In The UK When Using LHRHAs

Eighty-four percent of GPs and 76 percent of specialists (uro-oncologists or urologists) agree that there is a significant legal risk associated with off-label prescribing in prostate cancer when there is a licensed alternative available, according to new survey data .[1] Despite this, 46 percent of specialists felt that primary care commonly changes the recommended Leutinising Hormone-Replacement Hormone agonist (LHRHa) when referring management of patients to the community.

The Need for a Data Driven Solution

The data show that nearly all (92 percent) specialists, GPs, oncology pharmacists and specialist urology nurses surveyed agree that patients should receive an LHRHa with supporting clinical evidence wherever possible. Zoladex (goserelin) is licensed for all stages of prostate cancer suitable for hormonal manipulation.[2] Also, it is the only LHRHa with a proven survival benefit in adjuvant treatment in high risk localised disease and in adjuvant treatment of locally advanced prostate cancer when compared to surgery or radiotherapy alone.[3],[4],[5] However, when asked to differentiate between goserelin and another LHRHa not licensed for all stages of prostate cancer suitable for hormone manipulation, 75 percent of GPs and 42 percent of specialists felt in their view that the clinical evidence was the same.

Commenting on the data, Dr Heather Payne, Consultant Clinical Oncologist in Urological Tumours, University College Hospital, London stated: “Prostate cancer is a complicated disease and can be treated in several different ways. Depending on the stage of the cancer, a clear understanding of the supporting clinical evidence for treatments should guide prescribing decisions. As healthcare professionals, we need to provide patients with the best evidence-based treatment and care at all times.”

Secondary and Primary Care Divide

Although 76 percent of GPs and 94 percent of specialists agree that prescribing decisions in prostate cancer should be left to specialist care, only 46 percent of specialists always recommend an LHRHa by specific molecule name and dose. In addition, only 24 percent of GPs would actually consult the specialist for further advice when they receive a referral / recommendation that indicate an LHRHa class only, indicating a need for improved communication between primary and secondary care in the management of patients with prostate cancer.

Although, only 38 percent of GPs said they would be confident in identifying the different stages of prostate cancer more than half (59 percent) said they felt comfortable prescribing LHRHa’s for patients with prostate cancer, even though not all LHRHa’s are licensed for all stages of prostate cancer.[6],[7],[8],[9],[10] Goserelin is the only LHRHa with the supporting clinical evidence and licensed indications for all stages of prostate cancer suitable for hormone manipulation.2 The data show more awareness of LHRHa clinical evidence and treatment licences is needed amongst healthcare professionals managing ongoing LHRHa treatment.

Continuity and consistency of prescribing in prostate cancer is important to maintain patient confidence and reduce patient anxiety with more than 73 percent of specialists, GPs, oncology pharmacists and specialist uro-oncology nurses agreed that changing the LHRHa in primary care from that referred / recommended in secondary care can be unsettling for patients. Although off-label prescribing is vital in some situations, the GMC requires that patients be informed when an unlicensed product is prescribed.[11] Dr. Payne additionally commented: “Results show that even though healthcare professionals agree that changing the LHRHa treatment could be unsettling for patients, it may occur in practice without informing the patient. It is clear from the data that we need to improve communication between secondary and primary care to ensure patients receive the most appropriate treatment at the right time. In this way, we can avoid unnecessarily unsettling the patient’s treatment routine.”


* Prostate cancer is the most common form of cancer in men in the UK with over 31,923 new cases diagnosed in 2002.[12] Off-label prescribing – refers to any prescription that is not within the strict terms approved by the Medicines and Healthcare Product Regulatory Agency (MHRA), which are based on the quality, safety and efficacy of the product.

* When the prostate cancer is confined to the area surrounding the original tumour, it is described as being “localised disease”.

* When the prostate cancer has spread into the capsule of the prostate or through the prostate into the surrounding tissue, it is described as being “locally advanced”.

* Goserelin, first introduced in 1987 in the UK, is a Luteinising Hormone-Releasing Hormone agonist (LHRHa) which reduces levels of sex hormones (testosterone in men and oestradiol in women) and is used in the treatment of prostate cancer in men and hormone-dependent breast cancer in pre- and peri-menopausal women.

* LHRHa’s work in prostate cancer by providing “medical castration” as opposed to surgical castration (orchidectomy). This avoids the physical and psychological morbidity associated with surgical castration.

About AstraZeneca:

AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world’s leading pharmaceutical companies with healthcare sales of $23.95 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.

“Zoladex” is a trademark of the AstraZeneca group of companies.


* LHRHa Prostate Cancer Prescribing Survey: Conducted in November 2006 by red kite for AstraZeneca UK Ltd.. Results on file

* Zoladex SmPC

* Pilepich MV, Winter K, Lawton C et al. Androgen suppression adjuvant to definitive radiotherapy in carcinoma of the prostate. International Journal of Radiation Oncology, Biology, Physics 2005; vol 61, No5, 1285-1290

* Bolla M, Collette L, Blank L, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002; 360(9327):103-108

* Messing EM, Manola J, Sarosdy M et al. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. LancetOncol. 2006 Jun ;7 (6): 472-9.

* Prostap SR SPC

* Decapeptyl SR 3mg SPC

* Prostap 3 SPC

* Decapeptyl SR 11.25mg

* Gonapeptyl SmPC

* General Medical Council (GMC) 2005. Good practice in prescribing medicines. London: General Medical Council)

* Cancer Research UK. Incidence Statistics for Males 2002. cancerresearch uk/cancerstats/incidence/males

Contact: Marianne Thrall

Hill and Knowlton

View drug information on Zoladex.

Ischemia training and low-resistance exercise increase muscle endurance

A new study demonstrates that a combination of ischemic training and low-resistance exercise increases leg extension exercise endurance.

Researchers examined whether repetitive, low-intensity leg extension exercise with reduced blood flow (ischemic training) increases leg extension endurance more than exercise without ischemia.

Ten participants performed pre- and post-training tests with each leg. This study shows that endurance training can be achieved with dynamic, low-intensity resistance exercise with superimposed ischemia.

Ischemic training may be applied in principle to other limb movements and larger muscle groups to benefit patients with chronic diseases and limited exercise capacity.

Journal of Rehabilitation Research & Development – pg 511

About the Journal

JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD’s mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community. For more information about JRRD, visit vard.

Judith LaVoie
VA Research Communications Service

Urology – Pros and Cons of Robot-Assisted Surgeries

Innovative technologies are now, more then ever, playing a prominent role in medicine. Robots are infiltrating hospitals
and the symbiotic relationship between man and machine is strengthening. But one question remains, “Are robots truly
beneficial?” The American Urological Association’s press briefing entitled Laparoscopic Prostatectomy moderated by Anthony
Smith, M.D., analyzes the pros and cons of robot-assisted surgeries by examining the cost analysis of the technology and
efficacy of the surgeries.

Early Complications and Surgical Margin Status Following Radical Retropubic Prostatectomy (RRP) Compared to Robot-Assisted
Laparoscopic Prostatectomy(RALP). David S. DiMarco, M.D. and his team used 18 months worth of data and compared the surgical
margins and early complications of RRP and RALP. They found comparable incidence and location of positive surgical margins
for both procedures, yet RALP yielded higher complication rates among patients but a smaller number of blood transfusion.

Cost-Profit Analysis of DaVinci Robotic Surgery: Is It Worth It?: Jean V. Joseph, M.D. and his team compared the costs of the
initial robot purchase, fixed and variable costs, average cost of reposables and disposables and the average cost for the
hospital for a radical prostatectomy. They found that without even accounting for the initial investment, repair and
maintenance cost of the robot, the average reimbursement of $8954.00 led to a net loss on every case. Until equipment costs
are decreased, using the DaVinci system is not a financially viable option for hospitals and physicians.

Man vs. Machine: Pure Laparoscopic Pyeloplasty vs. DaVinci Pyeloplasty: The question of choosing man or machine is prevalent
with the continuous introduction of new technologies in society. Sam B. Bhayani, M.D. and his team examine the issue of
efficacy as related to pyeloplasty in their abstract. According to the study, with proper experience in both techniques,
there is no advantage in applying DaVinci pyeloplasty over pure laparoscopic pyeloplasty. However, laparoscopic pyeloplasty
was found to be preferable from a surgical and hospital standpoint.

“I’m looking forward to moderating this discussion on innovative medical techniques,” said Dr. Smith. “The briefing will
delve into the world of medical technology and offer data on whether there is an advantage in implementing robotic surgery.”

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American
Urological Association, Inc. is the pre-eminent professional organization for urologists, with more than 13,000 members
throughout the world. An educational nonprofit 501(c)(3) organization, the AUA pursues its mission of fostering the highest
standards of urologic care by carrying out a wide variety of programs members and their patients, including
UrologyHealth, an award-winning on line patient education resource, and the American Urological Association Foundation,
Inc., formerly AFUD.

For full copies of abstracts, vist aua2005 or contact the
Press Room.

American Urological Association (AUA)
1000 Corporate Blvd.
Linthicum, MD 21040
United States

Forecasting Air Quality For China

With less than a month remaining before the Beijing Olympics, Chinese officials have introduced a series of measures to improve air quality for the Games. A new tool has been installed in the capital city to allow the Chinese to monitor the effectiveness of these efforts.

Poor air quality could pose problems for the Olympic athletes and hinder the performance of those competing outdoors in endurance sports, such as cycling and marathons.

Since the main source of air pollution in the Beijing urban area is vehicle emissions, restrictions on car traffic began on 20 July in order to take 50 percent of Beijing’s 3,5 million vehicles off the road.

From then until 20 September, private vehicles will only be allowed to drive on alternating days and cars with high emissions will be banned.

On behalf of ESA, CERC (Cambridge Environmental Research Consultants) installed a High Resolution Air Quality Forecasting System at the Beijing Municipal Environmental Protection Bureau (EPB) that allows Chinese authorities to monitor the effect these cuts have on street level air quality.

“We are delighted to have installed the system in Beijing and believe the detailed air quality forecast it provides will prove a valuable tool in predicting and understanding Beijing’s Air quality,” David Carruthers from CERC said.

“The system is highly flexible and can be adjusted rapidly, for example, to take account of the special emission reduction actions being implemented during July until after the Games.”

Thanks to this new tool, operational street scale air quality forecasts for Beijing have been generated since 8 July – exactly one month before the Games’ opening ceremony.

Three-day forecasts are posted daily and are accessible on the Beijing Air Quality website The forecasts are high-resolution pollution contour maps that predict levels of nitrogen dioxide, ozone, particles and sulphur dioxide for each of Beijing’s eight districts. Users can choose to view maps of each pollutant separately or to view the total health index with all pollutants combined.

“The final forecasts utilise a combination of air quality measurements, surface data and modelling. Regional modelling using Chimere is provided by the Royal Netherlands Meteorological Institute (KNMI) and detailed local modelling is done by CERC’s model, ADMS-Urban,” Carruthers explained.

Li Kunsheng, EPB Vice Director said he welcomed the installation of the new system and looked forward to it becoming an important tool for forecasting air quality in Beijing taking account of the effects of air pollution management measures including those being implemented for the Olympic Games.

The three-day advanced forecasts are made available as part of the Dragon-2 Programme, a joint undertaking between ESA and the Ministry of Science and Technology (MOST) of China designed to encourage increased exploitation of ESA and Chinese Earth Observation (EO) satellite data within China.


Satellite data from the SCIAMACHY and OMI instruments will be included into the regional model in the near future to improve further emission monitoring.

SCIAMACHY (Scanning Imaging Absorption Spectrometer for Atmospheric Chartography) is one of 10 instruments aboard ESA’s Envisat satellite.

OMI (Ozone Monitoring Instrument) was built by a team of European industry and scientists led by the Netherlands and supplied as an additional instrument to the NASA EOS-AURA mission.

Source: Claus Zehner

European Space Agency