Open radical cystectomy (ORC) has proven to be an important component in the treatment of high-risk bladder cancer (BCa). ORC surgical morbidity remains high; therefore, minimally invasive surgical ...techniques have been introduced in an attempt to improve patient outcomes.
To compare cancer outcomes in BCa patients managed with ORC or robotic-assisted radical cystectomy (RARC).
A prospective, randomized trial was completed between 2010 and 2013. Patients were randomized to ORC/pelvic lymphadenectomy (PLND) or RARC/PLND, with all undergoing open/extracorporeal urinary diversion. Median follow-up was 4.9 (IQR: 3.9–5.9) yr after surgery among surviving patients.
Secondary outcomes to the trial included recurrence-free, cancer-specific, and overall survival.
The trial randomized 118 patients who underwent RC/PLND and urinary diversion. Sixty were randomized to RARC and 58 to ORC. Four RARC-assigned patients refused randomization and received ORC; however, an intention to treat analysis was performed. No differences were observed in recurrence (hazard ratio HR: 1.27; 95% confidence interval CI: 0.69–2.36; p=0.4) or cancer-specific survival (p=0.4). No difference in overall survival was observed (p=0.8). However, the pattern of first recurrence demonstrated a nonstatistically significant increase in metastatic sites for those undergoing ORC (sub-HR sHR: 2.21; 95% CI: 0.96–5.12; p=0.064) and a greater number of local/abdominal sites in the RARC-treated patients (sHR: 0.34; 95% CI: 0.12–0.93; p=0.035). The major limitation to this study is that the trial was not powered to determine differences in cancer recurrences, survival outcomes, or patterns of recurrence.
The secondary outcomes from our randomized trial did not definitively demonstrate differences in cancer outcomes in patients treated with ORC or RARC. However, differences in observed patterns of first recurrence highlight the need for future studies.
Of 118 patients randomly assigned to undergo radical cystectomy/pelvic lymphadenectomy and urinary diversion, half were assigned to open surgery and half to robot-assisted techniques. We found no difference in risk of recurring or dying of bladder cancer between the two groups.
In this secondary analysis of cancer outcomes from our randomized controlled trial, we did not find a difference in overall recurrence rates and cancer-specific survival between open radical cystectomy and robot-assisted radical cystectomy for high-risk bladder cancer. Variations in patterns of recurrence require further study.
Purpose We review how the bacillus Calmette-Guerin vaccine evolved to become standard therapy for superficial bladder cancer. Materials and Methods We reviewed the historical literature describing ...the origin of the bacillus Calmette-Guerin vaccine as an anticancer agent and its singular success as the most effective immunotherapy used against a human neoplasm. Results The association between tuberculosis and cancer, and the demonstration that bacillus Calmette-Guerin invoked immunological reactivity, inhibiting tumor growth in experimental animal models, led to clinical trials showing that intravesical bacillus Calmette-Guerin eradicated and prevented recurrence of superficial bladder tumors. Conclusions For the last 3 decades bacillus Calmette-Guerin therapy has remained the most effective local therapy for superficial bladder cancer, an outstanding example of successful translational medicine in urology.
The Human Reference Atlas (HRA) aims to map all of the cells of the human body to advance biomedical research and clinical practice. This Perspective presents collaborative work by members of 16 ...international consortia on two essential and interlinked parts of the HRA: (1) three-dimensional representations of anatomy that are linked to (2) tables that name and interlink major anatomical structures, cell types, plus biomarkers (ASCT+B). We discuss four examples that demonstrate the practical utility of the HRA.
Abstract Background Open radical cystectomy (ORC) and urinary diversion in patients with bladder cancer (BCa) are associated with significant perioperative complication risk. Objective To compare ...perioperative complications between robot-assisted radical cystectomy (RARC) and ORC techniques. Design, setting, and participants A prospective randomized controlled trial was conducted during 2010 and 2013 in BCa patients scheduled for definitive treatment by radical cystectomy (RC), pelvic lymph node dissection (PLND), and urinary diversion. Patients were randomized to ORC/PLND or RARC/PLND, both with open urinary diversion. Patients were followed for 90 d postoperatively. Intervention Standard ORC or RARC with PLND; all urinary diversions were performed via an open approach. Outcome measurements and statistical analysis Primary outcomes were overall 90-d grade 2–5 complications defined by a modified Clavien system. Secondary outcomes included comparison of high-grade complications, estimated blood loss, operative time, pathologic outcomes, 3- and 6-mo patient-reported quality-of-life (QOL) outcomes, and total operative room and inpatient costs. Differences in binary outcomes were assessed with the chi-square test, with differences in continuous outcomes assessed by analysis of covariance with randomization group as covariate and, for QOL end points, baseline score. Results and limitations The trial enrolled 124 patients, of whom 118 were randomized and underwent RC/PLND. Sixty were randomized to RARC and 58 to ORC. At 90 d, grade 2–5 complications were observed in 62% and 66% of RARC and ORC patients, respectively (95% confidence interval for difference, −21% to −13%; p = 0.7). The similar rates of grade 2–5 complications at our mandated interim analysis met futility criteria; thus, early closure of the trial occurred. The RARC group had lower mean intraoperative blood loss ( p = 0.027) but significantly longer operative time than the ORC group ( p < 0.001). Pathologic variables including positive surgical margins and lymph node yields were similar. Mean hospital stay was 8 d in both arms (standard deviation, 3 and 5 d, respectively; p = 0.5). Three- and 6-mo QOL outcomes were similar between arms. Cost analysis demonstrated an advantage to ORC compared with RARC. A limitation is the setting at a single high-volume, referral center; our findings may not be generalizable to all settings. Conclusions This trial failed to identify a large advantage for robot-assisted techniques over standard open surgery for patients undergoing RC/PLND and urinary diversion. Similar 90-d complication rates, hospital stay, pathologic outcomes, and 3- and 6-mo QOL outcomes were observed regardless of surgical technique. Patient summary Of 118 patients with bladder cancer who underwent radical cystectomy, pelvic lymph node dissection, and urinary diversion, half were randomized to open surgery and half to robot-assisted laparoscopic surgery. We compared the rate of complications within 90 d after surgery for the open group versus the robotic group and found no significant difference between the two groups. Trial Registration ClinicalTrials.gov identifier NCT01076387 , www.clinicaltrials.gov.
We present a detailed theoretical analysis of the implementation of shortcut-to-adiabaticity protocols for the fast transport of neutral atoms with atom chips. The objective is to engineer transport ...ramps with durations not exceeding a few hundred milliseconds to provide metrologically relevant input states for an atomic sensor. Aided by numerical simulations of the classical and quantum dynamics, we study the behavior of a Bose-Einstein condensate in an atom chip setup with realistic anharmonic trapping. We detail the implementation of fast and controlled transports over large distances of several millimeters, i.e. distances 1000 times larger than the size of the atomic cloud. A subsequent optimized release and collimation step demonstrates the capability of our transport method to generate ensembles of quantum gases with expansion speeds in the picokelvin regime. The performance of this procedure is analyzed in terms of collective excitations reflected in residual center of mass and size oscillations of the condensate. We further evaluate the robustness of the protocol against experimental imperfections.
This study was an evaluation of whether restaging transurethral resection (TUR) of superficial bladder cancer improves the early response to bacillus Calmette-Guerin (BCG) therapy.
A total of 347 ...patients with high risk superficial bladder cancer (high grade Ta and T1 tumors associated with carcinoma in situ) underwent a single transurethral resection (TUR, 132 patients) or restaging TUR (215 patients) before receiving 6 weekly intravesical BCG treatments. The patients were evaluated for response (presence or absence of tumor) at first followup cystoscopy, at 6 and 12 months after treatment, and evaluated for disease stage progression within 3 years of followup.
Of the 132 patients who underwent a single TUR before BCG therapy, 75 (57%) had residual or recurrent tumor at the first cystoscopy and 45 (34%) later had progression, compared with 62 of 215 patients (29%) who had residual or recurrent tumors and 16 (7%) who had progression after undergoing restaging TUR (p = 0.001).
Restaging TUR of high risk superficial bladder cancer improves the initial response rate to BCG therapy, reduces the frequency of subsequent tumor recurrence and appears to delay early tumor progression.
In an era of climate change and increased environmental variability, breeders are looking for tools to maintain and increase genetic gain and overall efficiency. In recent years the field of high ...throughput phenotyping (HTP) has received increased attention as an option to meet this need. There are many platform options in HTP, but ground-based handheld and remote aerial systems are two popular options. While many HTP setups have similar specifications, it is not always clear if data from different systems can be treated interchangeably. In this research, we evaluated two handheld radiometer platforms, Cropscan MSR16R and Spectra Vista Corp (SVC) HR-1024i, as well as a UAS-based system with a Sentera Quad Multispectral Sensor. Each handheld radiometer was used for two years simultaneously with the unoccupied aircraft systems (UAS) in collecting winter wheat breeding trials between 2018-2021. Spectral reflectance indices (SRI) were calculated for each system. SRI heritability and correlation were analyzed in evaluating the platform and SRI usability for breeding applications. Correlations of SRIs were low against UAS SRI and grain yield while using the Cropscan system in 2018 and 2019. Dissimilarly, the SVC system in 2020 and 2021 produced moderate correlations across UAS SRI and grain yield. UAS SRI were consistently more heritable, with broad-sense heritability ranging from 0.58 to 0.80. Data standardization and collection windows are important to consider in ensuring reliable data. Furthermore, practical aspects and best practices for these HTP platforms, relative to applied breeding applications, are highlighted and discussed. The findings of this study can be a framework to build upon when considering the implementation of HTP technology in an applied breeding program.
Bose-Einstein Condensation in Microgravity van Zoest, T; Gaaloul, N; Singh, Y ...
Science (American Association for the Advancement of Science),
06/2010, Letnik:
328, Številka:
5985
Journal Article
Recenzirano
Albert Einstein's insight that it is impossible to distinguish a local experiment in a "freely falling elevator" from one in free space led to the development of the theory of general relativity. The ...wave nature of matter manifests itself in a striking way in Bose-Einstein condensates, where millions of atoms lose their identity and can be described by a single macroscopic wave function. We combine these two topics and report the preparation and observation of a Bose-Einstein condensate during free fall in a 146-meter-tall evacuated drop tower. During the expansion over 1 second, the atoms form a giant coherent matter wave that is delocalized on a millimeter scale, which represents a promising source for matter-wave interferometry to test the universality of free fall with quantum matter.
The current study evaluated lymph node staging and the outcome in patients with lymph node positive bladder cancer after radical cystectomy.
A total of 162 patients with lymph node positive bladder ...cancer were followed a median of 7.5 years after radical cystectomy and pelvic lymph node dissection for survival and local recurrence. Lymph node disease was stratified by pN stage, the number of positive lymph nodes and the number of positive lymph nodes in relation to the number removed (ratio based pN stage).
A median of 13 lymph nodes (range 2 to 32) was examined, showing an average of 3.3 positive lymph nodes per specimen. An increased number of lymph nodes correlated with the identification of lymph node positive cases. The ratio of the number of positive-to-total number of lymph nodes removed better defined surgical outcome than conventional lymph node staging.
Ratio based lymph node staging, which reflects the number of lymph nodes examined and the quality of lymph node dissection, was a significant prognostic variable for survival and local control in patients with lymph node positive bladder cancer after radical cystectomy.
Abstract Context Despite the effectiveness of bacillus Calmette-Guérin (BCG) therapy in non–muscle-invasive bladder cancer (NIMBC) to delay recurrence and disease progression, the evidence supporting ...maintenance treatment and its optimal duration is unkown. Objective The purposes of this paper are to critically review the evidence supporting the use of maintenance BCG after an initial series of induction instillations and to illustrate the factors contributing to current dilemmas in establishing the optimal duration of BCG treatment. Evidence acquisition The following terms were used in Medline database searches for original articles published before February 1, 2013: bladder cancer, urothelial cancer, bacillus Calmette-Guérin, maintenance , and induction. All randomized controlled trials and meta-analyses, including those based on indirect comparisons, were evaluated. Evidence synthesis Seven randomized studies compared induction BCG plus maintenance to induction alone, with or without retreatment with BCG on recurrence. All but one of these studies were underpowered and the largest study used a broad, composite end point: worsening-free survival. Seven meta-analyses have been conducted, three of which included data from observational cohort studies. They demonstrated the benefit of maintenance BCG to reduce disease recurrence and delay progression compared to various control groups; however, the analyses were based on suboptimal data. Although there is new evidence that 1 yr of maintenance BCG is sufficient treatment in intermediate-risk patients, the optimal duration of BCG maintenance remains unknown. A new randomized trial is proposed, which includes induction BCG with retreatment on recurrence as a control arm, to study this question. Conclusions The optimal duration of BCG treatment in patients with NMIBC remains unknown and should be the subject of further studies. We recommend that in addition to 3 yr of maintenance BCG, guideline panels also include 1 yr of therapy and induction BCG with retreatment on recurrence as a possible treatment options for patients with NMIBC, albeit with a lower level of evidence and grade of recommendation.
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