Bladder Sparing Approaches for Muscle-Invasive Bladder Cancers.

OPINION STATEMENT: Organ preservation has been increasingly utilised in the management of muscle-invasive bladder cancer. Multiple bladder preservation options exist, although the approach of maximal TURBT performed along with chemoradiation is the most favoured. Phase III trials have shown superiority of chemoradiotherapy compared to radiotherapy alone. Concurrent chemoradiotherapy gives local control outcomes comparable to those of radical surgery, but seemingly more superior when considering quality of life. Bladder-preserving techniques represent an alternative for patients who are unfit for cystectomy or decline major surgical intervention; however, these patients will need lifelong rigorous surveillance. It is important to emphasise to the patients opting for organ preservation the need for lifelong bladder surveillance as risk of recurrence remains even years after radical chemoradiotherapy treatment. No randomised control trials have yet directly compared radical cystectomy with bladder-preserving chemoradiation, leaving the age-old question of superiority of one modality over another unanswered. Radical cystectomy and chemoradiation, however, must be seen as complimentary treatments rather than competing treatments. Meticulous patient selection is vital in treatment modality selection with the success of recent trials within the field of bladder preservation only being possible through this application of meticulous selection criteria compared to previous decades. A multidisciplinary approach with radiation oncologists, medical oncologists, and urologists is needed to closely monitor patients who undergo bladder preservation in order to optimise outcomes

Priming food intake with weight control cues: systematic review with a meta-analysis

Background A growing number of studies suggest that exposure to cues which are associated with weight control can prime or prompt controlled food intake in tempting food environments. However, findings are mixed and understanding which types of cues and for whom such cues may be most effective is needed to inform subsequent research and societal applications. A systematic review and meta-analysis were conducted to evaluate the effects of exposure to weight control cues compared with control cues on food intake. Methods PsycINFO, Medline, Embase and Web of Science were searched using key terms. Hedge’s g was used to calculate effect sizes based on mean food intake, standard deviations and sample sizes extracted from relevant publications and, a random effects model was used for the meta-analysis. Results Twenty-five articles consisting of 26 studies were eligible. Data from 25 studies (31 effect sizes) were available for the meta-analysis. Overall, weight control cues reduced food intake, albeit to a trivial effect (ES: -0.149, 95% CI: -0.271 to − 0.027). Subgroup analyses when studies which induced negative affect were removed showed that for individuals with strong weight control goals the effect was small-to-moderate (ES: -0.440, 95% CI: -0.718 to − 0.163), whereas for individuals with weak weight control goals this effect was trivial and non-significant (ES: 0.014, 95% CI: -0.249 to 0.278). Cue type and level of engagement did not significantly moderate the effect; however, specific cues (low-calorie foods and thin models) and attended engagement yielded significant effects. Caution is needed interpreting these findings as most studies were rated with high risk of bias and a number of studies could not be included in the subgroup analyses. Conclusions Based on the data available, weight control cues reduce food intake in individuals with strong weight control goals. Further research is needed to explore longer term effects of cue exposure and confirm underlying mechanisms. PROSPERO registry#CRD42016052396

Image-guided radiation therapy for muscle-invasive bladder cancer.

International audienceOrgan preservation protocols that incorporate chemoradiotherapy have shown good efficacy in bladder cancer. Owing to changes in rectal filling, urinary inflow and subsequent bladder volume with bladder wall deformations, irradiation must take into account interfractional and intrafractional internal target motion. Growing evidence suggests that image guidance during irradiation is essential in order to appropriately treat bladder cancer in this way. We performed a literature search on the imaging techniques and margins used for radiation therapy planning in the context of whole-bladder and partial-bladder irradiation. The most common image-guided radiation therapy (IGRT) method was based on cone-beam CT using anisotropic margins. The role of cine-MRI for the prediction of intraindividual bladder changes, in association with cone-beam CT or ultrasonography, is promising. Drinking protocols, diet and laxatives were used in most cases to minimize large variations in bladder size and shape. IGRT is crucial for avoiding tumor undercoverage and undue toxicity during radiation therapy for bladder cancer. IGRT-based adaptive radiation therapy can be performed using cone-beam CT or ultrasonography: modeling of bladder changes with cine-MRI or other imaging techniques might also be useful for facilitating adaptive radiation therapy with personalized margins

The return of the Iberian lynx to Portugal: local voices

Abstract Background Ethnographic research can help to establish dialog between conservationists and local people in reintroduction areas. Considering that predator reintroductions may cause local resistance, we assessed attitudes of different key actor profiles to the return of the Iberian lynx (Lynx pardinus) to Portugal before reintroduction started in 2015. We aimed to characterize a social context from an ethnoecological perspective, including factors such as local knowledge, perceptions, emotions, and opinions. Methods We conducted semi-structured interviews (n = 131) in three different protected areas and observed practices and public meetings in order to describe reintroduction contestation, emotional involvement with the species, and local perceptions about conservation. Detailed content data analysis was undertaken and an open-ended codification of citations was performed with the support of ATLAS.ti. Besides the qualitative analyses, we further explored statistic associations between knowledge and opinions and compared different geographical areas and hunters with non-hunters among key actors. Results Local ecological knowledge encompassed the lynx but was not shared by the whole community. Both similarities and differences between local and scientific knowledge about the lynx were found. The discrepancies with scientific findings were not necessarily a predictor of negative attitudes towards reintroduction. Contestation issues around reintroduction differ between geographical areas but did not hinder an emotional attachment to the species and its identification as a territory emblem. Among local voices, financial compensation was significantly associated to hunters and nature tourism was cited the most frequent advantage of lynx presence. Materialistic discourses existed in parallel with non-economic factors and the existence of moral agreement with its protection. The considerable criticism and reference to restrictions by local actors concerning protected areas and conservation projects indicated the experience of an imposed model of nature conservation. Opinions about participation in the reintroduction process highlighted the need for a closer dialog between all actors and administration. Conclusions Local voices analyzed through an ethnoecological perspective provide several views on reintroduction and nature conservation. They follow two main global trends of environmental discourse: (1) nature becomes a commodified object to exploit while contestation about wildlife is centered on financial return and (2) emblematic wild species create an emotional attachment, become symbolic, and gather moral agreement for nature protection. Lynx reintroduction has been not only just a nature protection theme but also a negotiation process with administration. Western rural communities are not the “noble savages” and nature protectors as are other traditional groups, and actors tend to claim for benefits in a situation of reintroduction. Both parties comprehend a similar version of appropriated nature. Understanding complexity and diverse interests in local communities are useful in not oversimplifying local positions towards predator conservation. We recommend that professional conservation teams rethink their image among local populations and increase proximity with different types of key actors

Implicit bias in healthcare professionals: a systematic review

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients