The effects of transurethral resection and cystoprostatectomy on dissemination of epithelial cells in the circulation of patients with bladder cancer

This study was undertaken to evaluate the risk of haematogenous dissemination of epithelial cells induced by endoscopic resection and/or cystoprostatectomy for transitional cell carcinoma of the bladder. Thirty-three patients were studied. Thirty-one had different stages and grades of bladder cancer and two patients had benign bladder conditions. Twenty-five cancer patients required transurethral resection of their bladder tumour. Of those, 20 had superficial disease (pTaG1–G2: n = 19; pT1G2: n = 1) and five had muscle invasive tumours (pT2G3: n = 2; pT3aG3: n = 1; pT4G3: n = 2). Five patients underwent radical cystoprostatectomy for muscle invasive cancers (pT2G3: n = 3; pT3bG3: n = 1; pT4G3: n = 1) and one man received chemotherapy for metastatic disease. Venous blood (10 ml) was obtained from the antecubital fossa in each patient, before and 1–2 h after completion of surgery, and prior to treatment in the metastatic patient. An indirect immunocytochemical technique was used to detect circulating epithelial cells after centrifugation on Ficoll gradient and fixation of mononuclear cells on slides, using a monoclonal antibody directed against three cytokeratins: CK8, CK18 and CK19. Circulating epithelial cells were detected only in the patient with metastatic disease. None of the other patients had evidence of epithelial circulating cells before or after surgery. The results suggest that irrespective of disease stage and grade, neither endoscopic nor open bladder surgery leads to detectable dissemination of urothelial cells in the peripheral circulation. These procedures are therefore unlikely to increase the risk of progression and metastasis in transitional cell carcinoma of the bladder. © 1999 Cancer Research Campaig

Prescribed burning impacts on ecosystem services in the British uplands: a methodological critique of the EMBER project

Due to its novelty and scale, the EMBER project is a key study within the prescribed burning evidence base. However, it has several significant but overlooked methodological flaws. In this paper, we outline and discuss these flaws. In doing so, we aim to highlight the current paucity of evidence relating to prescribed burning impacts on ecosystem services within the British uplands. We show that the results of the EMBER project are currently unreliable because: it used a correlative space‐for‐time approach; treatments were located within geographically separate and environmentally distinct sites; environmental differences between sites and treatments were not accounted for during statistical analysis; and, peat surface temperature results are suggestive of measurement error. Policy Implications. Given the importance of the EMBER project, our findings suggest that (a) government agencies and policymakers need to re‐examine the strengths and limitations of the prescribed burning evidence base; and, (b) future work needs to control for site‐specific differences so that prescribed burning impacts on ecosystem services can be reliably identified