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Radiotherapy Intensified by Increase of Fraction Size Using Three Dimensional Conformal Radiotherapy in Bladder Preservation Therapy

Radiotherapy Intensified by Increase of Fraction Size Using Three Dimensional Conformal Radiotherapy in Bladder Preservation Therapy

Five patients were died: 4 were MIBC patients and one was a superficial bladder cancer patient (Figure 1). Three of them received radical RT: one died of lung cancer with the bladder tumor controlled, another died of systemic metastases with local recurrence, and the remaining died of age (88 years) with local recurrence (cT1). The remaining two received palliative RT: one showed lymph-node metastasis with local disease control (cN1), and another with superficial bladder cancers eventually received total cystectomy, that showed sarcoma-changes. Tumor recurrence was identified in 10 patients, who were regarded as dead in the analysis of progression free survival. Rates of 3-year overall survival and 3-year progression free survival were 64% and 42%, respectively. Bladder preservation rate was 94%.
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Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy.

Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy.

Patients were recruited at UK NHS Trusts. All Trusts providing trial treatment had to provide details of surgical activity including morbidity and mortality rates for central review and confirmation of completion of a radiotherapy quality assurance program prior to activation. Randomisation was by telephone to the Clinical Trials and Statistics Unit, Institute of Cancer Research (ICR-CTSU). Participants were assigned 1:1 between selective bladder preservation and radical cystectomy using computer generated random permuted blocks (size 6 and 8), stratified by centre. Treatment allocation was not masked.
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Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience

Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience

Abstract: Background & objective: Bladder preservation therapy (BPT) using a trimodality approach represents an alternative option to cystectomy inmuscle-invasive bladder cancer (MIBC) patients, also a treatment option in non-cystectomy candidates. The objective of this study was to evaluate BPT using a trimodality approach composed of maximum TURBT, neoadjuvant chemotherapy, followed by chemoradiotherapy, regarding the overall survival (OS), progression free survival (PFS), locoregional progression free survival (LPFS) and treatment toxicity. Patients & methods: This prospective study involved 47 patients with pathologically proven MIBC (T2-T4a N0M0). The study involved muscle invasive bladder cancer patients who refused or were not cystectomycandidates. Patients enrolled received neoadjuvant 3cycles of Gemcitabine/Cisplatin, each cycle was every 21 days. Gemcitabine at 1000mg/m 2 on days 1&8 and cisplatin at 70mg/m 2 on day1, followed by Concurrent chemordiotherapy with cisplatin weekly (40mg/m 2 ). Radiation therapy included the whole bladder by 3D conformal planning to a dose of 64Gy/32Fxs. Results: Of the 47 patients, 25 (53.2%) patients expressed complete response (CR), while 22(46.8%) patients had incomplete response. The 4-year OS, PFS, and LPFS rates were 48%, 38%, and 42%, respectively. Acute genitourinary (GU) toxicity of Grade 1 and 2 occurs in 54% and 24%of patients, respectively, while acute gastrointestinal (GI) toxicity (colic &diarrhea) of Grade 1 and 2 occurs in 27.7% and 10.6 %of patients, respectively. Conclusion: For MIBC patients who are non-cystectomy candidates, or who are motivated to maintain their bladders, trimodality bladder preservation therapy (BPT) can be considered as an effective alternative to radical cystectomy.
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Gemcitabine Single Agent for Recurrent Post Bladder Preservation Therapy and in Metastatic Transitional Cell Carcinoma of Urinary Bladder in Elderly Patients with Renal Impairment

Gemcitabine Single Agent for Recurrent Post Bladder Preservation Therapy and in Metastatic Transitional Cell Carcinoma of Urinary Bladder in Elderly Patients with Renal Impairment

On another hand, regarding overall survival correlation, there is highly significant strong negative correlation between OS and age, (r=-849), and P= 0.000 as showing in the table (5). There is non-significant week negative correlation between OS and number of metastatic sites, (r = -0.476) and P=0.122 also there is non-significant week negative correlation between OS and sites of metastasis, (r = -0.476) and P=0.085. There is a significant strong negative correlation between OS and weight loss during treatment, (r = - .759) and P=0.002. Finally, there is significantly strong negative correlation between OS and elevated liver enzymes, (r = - 0.759) and P=0.002. There is no correlation between OS and WHO-performance state, (r= 0.016), and P= 0.957. There is no correlation between OS and grade of disease, (r= - 0.173), and P = 0.554. There is no correlation between OS and recurrent post-bladder preservation, (r = 0.399) and P=0.157. There is strong positive correlation between survival outcome and any types of response (CBR), (r= 0.788 , P=0.001 for PFS) and (r= 0.742 .P= 0.002 for OS) . Lastly, there is a strong positive correlation between PFS and OS, (r =0.921) and P= 0.000.
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Bladder preservation approach versus radical cystectomy for high grade non muscle invasive bladder cancer: a meta analysis of cohort studies

Bladder preservation approach versus radical cystectomy for high grade non muscle invasive bladder cancer: a meta analysis of cohort studies

Methods: We searched MEDLINE, The Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang database through 12 April 2018. Quality and publication bias were assessed using the Newcastle-Ottawa Scale and Begg ’ s/Egger ’ s test. We collected 2-year, 5-year, 10-year, and 15-year survival rate and hazard ratio (HR) for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Using the Review Manager 5.2 software, we used the odds ratio (OR) of specific years and HR for meta-analysis. Subgroup analysis was performed by the original tumor state, radical cystectomy timing, bladder preservation modality, and age. Results: In total, 11 cohorts with 1735 patients were selected for the meta-analysis. All OR of OS supported BP as a better treatment option; however, all OR of PFS had no significant differences. As for CSS, only the 15-year OR reflected a statistical significance preferring RC. Subgroup analysis showed that BP is more appropriate for patients older than 65 and G3 tumor. Limited data demonstrated that late RC (> 3 months) is more effective compared to early RC (< 3 months) and intravesical Bacillus Calmette – Guerin was not statistically different from that of RC. The mixed BP modalities were significantly better compared to RC in OS and worse in CSS, with both having a very low evidence strength.
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Biomarkers for Predicting Clinical Outcomes of Chemoradiation-Based Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Biomarkers for Predicting Clinical Outcomes of Chemoradiation-Based Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Bladder cancer is the second most common malignancy of the genitourinary tract after prostate cancer in the United States, with approximately 81,000 new cases and 17,000 deaths each year as of 2018 [1]. Approximately 75% of bladder cancer patients present with non-muscle-invasive bladder cancer confined to the mucosa and submucosa (Tis, Ta, and T1), while the rest present with muscle-invasive bladder cancer (MIBC) [2]. The reference standard of care for MIBC patients has long been radical cystectomy (RC) with urinary diversion and lymph node dissection. However, this surgical procedure is complex and invasive and could have long-term adverse effects on urinary, gastrointestinal, and sexual functions. A recent systematic review on surgical outcomes of robot-assisted laparoscopic RC demonstrated a 90-day overall
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The Patient Deficit Model Overturned: a qualitative study of patients' perceptions of invitation to participate in a randomized controlled trial comparing selective bladder preservation against surgery in muscle invasive bladder cancer (SPARE, CRUK/07/011

The Patient Deficit Model Overturned: a qualitative study of patients' perceptions of invitation to participate in a randomized controlled trial comparing selective bladder preservation against surgery in muscle invasive bladder cancer (SPARE, CRUK/07/011)

Of participants who had consented to SPARE, five were interviewed prior to definitive treatment (median of 13 days before (interquartile range (IQR) -36 to −8)), eight were interviewed following treatment (median of 51 days afterwards (IQR 31 to 57)). One patient was interviewed during radiotherapy treatment. Ethics approval was not sought to collect treatment details for patients refusing SPARE; however, the timing of the interview relative to treatment did not appear to differ for decliners. The majority were interviewed at home, across the United Kingdom. Patients’ characteristics are seen in Table 1. Patients were asked: ‘Please tell me about your bladder cancer experience’ and probed to cover the relevant topics while welcoming patients’ own comments.
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BLADDER CANCER AND DEBATE ON TRIMODAL THERAPY (TMT) FOR BLADDER PRESERVATION

BLADDER CANCER AND DEBATE ON TRIMODAL THERAPY (TMT) FOR BLADDER PRESERVATION

Abstract: Bladder Cancer is one of the most common types of malignant neoplasms that affects both men and women. The surgery considered standard for the treatment of invasive tumor is Radical Cystectomy, which causes undesirable morbidity in the postoperative period on affected patients. Radical Transurethral Resection (TRU), associated with Chemotherapy and Radiotherapy, together form the Trimodal Therapy (TTM), which can demonstrate satisfactory results in the approach of the patient with invasive tumor with lower morbidity and well-timed survival rate, in a short time.
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Organ Preservation in Bilharzial Bladder Cancer in Egypt: Single Institutional Experience

Organ Preservation in Bilharzial Bladder Cancer in Egypt: Single Institutional Experience

The most important points of this study were the higher incidence of CR and the tolerability to treatment. Eighty seven percent (26 of 30) patients achieved CR after che- mo-radiation. This is higher than previous results from our department (CR = 72%) [18] and also from other Egyptian result [19]. In the Massachusetts General Hos- pital series of 190 patients treated by tri-modality therapy between 1986 and 1998, 63% exhibited a CR [20]. In another series from Germany and Spain, CR was 80% and 89% respectively [21,22]. The radiotherapy oncology group (RTOG) trials demonstrated a CR rate after induc- tion in 75% and 59% of the patients [8,23]. RTOG twice daily protocol revealed 81% CR after induction phase [24]. Cisplatinum was the cornerstone of chemotherapy in most of these trials. Bladder preservation protocols depend on two phases of treatment with break to evaluate
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Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury

Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury

The bladder-specific instruments from the SCI-QoL measurement system and the NBSS are the outcome measures used for all aims of this study. The SCI-QoL measurement system is a validated, comprehensive patient-reported outcome measurement item bank panel, which consists of 19 item banks including two item banks related to complications and consequences of bladder management (“Bladder Complications”), as well as feelings about bladder related limitations and function (“Bladder Management Difficulties”) [14]. SCI- QoL instruments uses item response theory and com- puterized adaptive testing using the Assessment Center SM platform. Computer adaptive testing utilizes participant responses to guide the administration of only select, pertinent questions drawn from a larger item bank. For example, when chronically ill patients with limited functioning responds that they can’t get out of bed without help, they are not next asked if they can jog a mile. Instead the participant is asked more narrowed questions relevant to their mobility level, such as “Can you brush your hair or open a jar?” A final calibrated score is produced for each health domain to provide an individual’s QoL or function score. Computer adaptive testing minimizes floor and ceiling effects and allows ac- curate assessment over a wide range of function and symptoms while minimizing participant burden and maximizing patient relevance.
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Novel targeted bladder drug-delivery systems: a review

Novel targeted bladder drug-delivery systems: a review

facilitate transdermal drug transport. Recently, Goldfischer et al published the results of a Phase III trial that looked at the efficacy and safety of oxybutynin transdermal gel 3% (OTG3%) formulated with propylene glycol as permeation enhancer. OTG3% 84 mg and OTG3% 56 mg were compared with placebo gel in adults with urgency and/or mixed urinary incontinence (UI). In December 2011, the FDA approved the availability of OTG3% (84 mg/d) in a titratable pump dispenser, while the lower dose (56 mg/d) was not approved. Six hundred and twenty-six patients were randomized 1:1:1 in a double-blind, placebo-controlled, multicenter study. The primary efficacy end point was change from base- line to week 12 in weekly UI episodes recorded in 3-day bladder diaries. Secondary end points were change from baseline to week 12 in daily urinary frequency and change from baseline to week 12 in average urinary void volume. OTG3% 84 mg/d achieved significantly greater improve- ment vs placebo in weekly UI episodes (mean change from baseline: –20.4 vs –18.1, P,0.05), daily urinary frequency (–2.6 vs –1.9, P = 0.001), and urinary void volume (32.7 vs 9.8, P,0.0001). Dry mouth and application site erythema were more common with OTG3% 84 mg/d than with pla- cebo (12.1% vs 5.0%, P = 0.028, and 3.7% vs 1.0%, P = NS, respectively). Changes from baseline to week 12 of OTG3% 56 mg/d vs placebo were not significant for primary and secondary outcomes. 30
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Original Article SKIP expression is correlated with clinical prognosis in patients with bladder cancer

Original Article SKIP expression is correlated with clinical prognosis in patients with bladder cancer

Bladder cancer is the first and second most common malignancy of the urinary system in China and the USA, respectively [1]. Approximately 75% of patients with bladder cancer present as non-muscle invasive cancer (NMIBC) and the remaining 25% of BCs are muscle-invasive bladder cancer (MIBC) [2]. Although great progress has been made in the diagnosis and treatment of bladder cancer, tumor recurrence is still an annoying clinical problem. The reported recurrence rates of NMIBC after transurethral resection of bladder tumor (TUR-BT) are 10%~67% in 12 months [3, 4] and the cumulative 5-yr mortality rate is up to 30.2% [5]. Currently, there are no reliable biomarkers to predict the risk of recurrence and the prognosis of bladder cancer [6]. SKIP was originally found as a binding partner of the viral oncogene v-Ski in a yeast two-hybrid system. It was demonstrated to interact with a highly conserved region of Ski, which is thought to be important for Ski’s transforming activity [7]. Previous studies have shown that SKIP can combine with pRb to form a highly stable com- plex, which effectively inhibit pRb-induced tran-
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Scarlet Fever with Hydrops of the Gallbladder

Scarlet Fever with Hydrops of the Gallbladder

bladder disease in young subjects. The Gall Bladder. and Bile Ducts, ed. New York: William Wood and Company, 1904. : Call-bladder disease in young sub-[r]

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16localgovernment.pdf

16localgovernment.pdf

In this article, the evolution of Rochester's strong historic preservation movement is provided along with instructive sidelines for building.. an effective preservation coalition.[r]

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Exogenous overexpression of nerve growth factor in the urinary bladder produces bladder overactivity and altered micturition circuitry in the lumbosacral spinal cord

Exogenous overexpression of nerve growth factor in the urinary bladder produces bladder overactivity and altered micturition circuitry in the lumbosacral spinal cord

increased frequency of voiding (decreased intercontrac- tion interval). Suturing PE tubing directly into the bladder wall for a focused delivery likely contributed to the appearance of NVCs in 4/6 animals in both control and NGF groups. We do not normally observe NVCs in control rats with implanted intravesical catheters [3,9]. Despite the appearance of NVCs in both groups, the amplitude of the NVCs in the NGF-treated group was significantly greater. We also observed a small, but significant, increase in peak micturition pressure with NGF treatment but the reasons for this are not clear. An increase in peak micturi- tion pressure may result from changes in urethral outlet resistance resulting in increases in PVR. However, PVR was negligible in both NGF-treated and control rats. It should also be noted that NGF levels achieved in the present study were less than those achieved in the DRG [5] with intrathecal infusion of NGF at the identical dose and dura- tion used in the present study. Despite lower NGF tissue Effects of NGF on cystometry variables
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Total versus partial chordal preservation in mitral valve replacement: Early results

Total versus partial chordal preservation in mitral valve replacement: Early results

This is a retrospective study ,hence we did not emphasise on the stenotic or regurgitant lesions separately as these did not influence in picking up total, less or no chordal preservation strategies, which otherwise could have pronounced a significance in left ventricular function. At the time of surgery operating surgeon was the deciding factor for choice of procedure of chordal resection, posterior mitral valve preservation or total chordal preservation .Patient factors which influenced the strategy are severe subvalvular calcification and size of mitral valve annulus . Follow up of patients was restricted to six months because of remote access, poor transportation and low socioeconomic status. Multiple echocardiographers and echo machines were used during study. However, all the echocardiographers were certified cardiologists from the same department.
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Exogenous glycosaminoglycans coat damaged bladder surfaces in experimentally damaged mouse bladder

Exogenous glycosaminoglycans coat damaged bladder surfaces in experimentally damaged mouse bladder

We suggest that one possible mechanism for the symp- tom-relieving effect of this class of compounds is they may exclude urinary proteases rather than salts. Theoreti- cal calculations based on actual measurements of the amount of glycosaminoglycan found normally on the human bladder surface showed the presence of a dense layer of glycosaminoglycan will yield a bound water layer that reduces the concentration of salts at the bladder sur- face [20]. Lewis and Clausen earlier had demonstrated that urinary proteases degrade bladder ion channels [27], and Negrete and co-workers demonstrated the impermea- bility of rabbit bladder lay in the apical membrane [15]. Because the highly charged GAG layer with its attendant bound water layer would be a far more significant barrier for macromolecules than small, inorganic ions, we specu- late that the GAG layer may normally function to exclude macromolecules rather than salts. Therefore the therapeu- tic benefit of exogenous glycosaminoglycans may result
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Observation 9. Not all requirements are equally important and not all have to be precisely satisfied. To accommodate this, it is useful for a stakeholder to add an importance factor, as a measure of relative importance, and potentially a tolerance factor, as a measure of the tolerable degree of deviation from the specified value, with each requirement. For example, preserving the number of lines on a page might be less important than preserving the number of pages. During requirements evaluation of a preservation action the importance and tolerance factors can be combined into a weighted measure.
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Preserving the Past for the Present: Courthouse Preservation and Community Values in Thomas County, Georgia

Preserving the Past for the Present: Courthouse Preservation and Community Values in Thomas County, Georgia

Maintaining an inventory of resources allows the agency to better track where funding and protection may be needed most. This agency provides oversight for the 1973 law and helps to regulate and record any pending demolition or alteration and is a channel for alerting local authorities. The agency lacked a program for funding and lobbied Texas lawmakers, who provided legislation in 1999. The Texas Historic Courthouse Preservation Program (THCPP) was a separate program instituted in 1999 by legislation signed by Governor Bush. This program promotes the preservation and rehabilitation of courthouses which are currently functioning as courthouses and restricts funding to those which are publicly owned, not privately owned. This program has provided funding for the restoration of 44 of its 225 historic courthouses. Matched funding is provided through grants from county and state offices to courthouses which meet the needs for restoration and the requirements set forth by the guidelines of the THCPP
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Preservation of rhizobia

Preservation of rhizobia

Cryopreservation refers to the biological maintenance of living organisms at low temperature (–80°C or below) in a way that allows them to survive after thawing. Electric freezers allow storage at –80°C to –150°C. Because there are some reports that the viability of cultures maintained at –80°C decreases over time, the culture should ideally be checked every five years. For the preservation of bacteria, the OECD (2007) recommends they be stored at temperatures below –140°C.

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