Topic issue on new treatments in bladder cancer

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Image-guided surgery in oral cancer:toward improved margin control

Purpose of review The aim of this review is to discuss recent studies on the assessment of tumor extension and resection margins by different intraoperative techniques allowing for image-guided surgery of oral cancer. Recent findings There are different in-vivo and ex-vivo intraoperative techniques to improve margin control of which intraoperative ultrasound and targeted fluorescence-guided resections have high potential clinical value and are closest to clinical implementation. In oral cancer surgery, resection margins, particularly deep margins, are often inadequate. Intraoperative frozen section does not improve resection margin control sufficiently. Specimen-driven intraoperative assessment for gross analysis of suspected margins reduces the amount of positive resection margins substantially but leaves still room for improvement. Mucosal staining methods, optical coherence tomography and narrow band imaging can only be used for superficial (mucosal) resection margin control. Spectroscopy is under investigation, but clinical data are scarce. Intraoperative ex-vivo imaging of the resection specimen by magnetic resonance and PET/computed tomography may be used to assess resection margins but needs more research. Intraoperative in-vivo ad ex-vivo ultrasound and targeted fluorescence imaging have high potential clinical value to guide oral cancer resections and are closest to clinical implementation for improved margin control

Patient-specific finite element models of the human mandible:Lack of consensus on current set-ups

The use of finite element analysis (FEA) has increased rapidly over the last decennia and has become a popular tool to design implants, osteosynthesis plates and prostheses. With increasing computer capacity and the availability of software applications, it has become easier to employ the FEA. However, there seems to be no consensus on the input variables that should be applied to representative FEA models of the human mandible. This review aims to find a consensus on how to define the representative input factors for a FEA model of the human mandible. A literature search carried out in the PubMed and Embase database resulted in 137 matches. Seven papers were included in this current study. Within the search results, only a few FEA models had been validated. The material properties and FEA approaches varied considerably, and the available validations are not strong enough for a general consensus. Further validations are required, preferably using the same measuring workflow to obtain insight into the broad array of mandibular variations. A lot of work is still required to establish validated FEA settings and to prevent assumptions when it comes to FEA applications

Curcumin as Treatment for Bladder Cancer : A Preclinical Study of Cyclodextrin-Curcumin Complex and BCG as Intravesical Treatment in an Orthotopic Bladder Cancer Rat Model

Objective. To evaluate the antitumor effect of cyclodextrin-curcumin complex (CDC) on human and rat urothelial carcinoma cells in vitro and to evaluate the effect of intravesical instillations of CDC, BCG, and the combination in vivo in the AY-F344 orthotopic bladder cancer rat model. Curcumin has anticarcinogenic activity on urothelial carcinoma and is therefore under investigation for the treatment of non-muscle invasive bladder cancer. Curcumin and BCG share immunomodulating pathways against urothelial carcinoma. Methods. Curcumin was complexed with cyclodextrin to improve solubility. Four human urothelial carcinoma cell lines and the AY-27 rat cell line were exposed to various concentrations of CDC in vitro. For the in vivo experiment, the AY-27 orthotopic bladder cancer F344 rat model was used. Rats were treated with consecutive intravesical instillations of CDC, BCG, the combination of CDC+BCG, or NaCl as control. Results. CDC showed a dose-dependent antiproliferative effect on all human urothelial carcinoma cell lines tested and the rat AY-27 urothelial carcinoma cell line. Moreover, intravesical treatment with CDC and CDC+BCG results in a lower percentage of tumors (60% and 68%, respectively) compared to BCG (75%) or control (85%). This difference with placebo was not statistically significant (p=0.078 and 0.199, respectively). However, tumors present in the placebo and BCG-treated rats were generally of higher stage. Conclusions. Cyclodextrin-curcumin complex showed an antiproliferative effect on human and rat urothelial carcinoma cell lines in vitro. In the aggressive orthotopic bladder cancer rat model, we observed a promising effect of CDC treatment and CDC in combination with BCG.Peer reviewe

Intracutaneous and intravesical immunotherapy with keyhole limpet hemocyanin compared with intravesical mitomycin in patients with non-muscle-invasive bladder cancer: results from a prospective randomized phase III trial.

Contains fulltext : 108422.pdf (publisher's version ) (Open Access)PURPOSE: Despite current treatment after transurethral resection of a bladder tumor, recurrences and progression remain a problem. Keyhole limpet hemocyanin (KLH) was beneficial in earlier studies. In this study, safety and efficacy of KLH were compared with that of mitomycin (MM). PATIENTS AND METHODS: Patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) without carcinoma in situ were enrolled in a randomized phase III trial. In all, 283 patients were randomly assigned for 16 adjuvant intravesical instillations with KLH after preimmunization, and 270 patients were randomly assigned for 11 adjuvant intravesical instillations with MM. Primary outcome measurement was recurrence-free survival (RFS). Secondary outcome measurements were progression-free survival, adverse events (AEs), and the effect of delayed-type hypersensitivity (DTH) response on clinical outcome. RESULTS: There were significantly more pT1 tumors in the MM group (P = .01). In a log-rank test, univariate and multivariate Cox regression analysis, KLH was less effective than MM regarding RFS (all P < .001). Progression was uncommon (n = 20). In univariate Cox regression analyses, KLH tended to prevent progression more effectively than MM, but in multivariate Cox regression analyses, this could not be shown. AEs were common but mild. Fever, flu-like symptoms, and fatigue occurred significantly more after KLH treatment. Allergic reactions and other skin disorders occurred significantly more after MM treatment. Significantly more DTH-positive patients developed a recurrence than DTH-negative patients. CONCLUSION: KLH had a different safety profile and was inferior to MM in preventing NMIBC recurrences. KLH tended to be more effective than MM in preventing progression. More research is needed to clarify the immunologic effects of KLH and the effects of KLH on progression

Effects of on-farm hatching on short term stress indicators, weight gain, and cognitive ability in layer chicks

Layer chicks are usually transported early in life, experiencing immediate post-hatch food and water deprivation and various transport-related stressors with potentially negative long-term consequences for learning, cognition and welfare. In contrast, as chicks are only temporarily exposed to these stressors, the experienced stress could be sub-chronic which may improve cognitive flexibility. The aim of this exploratory study was therefore to investigate the acute and long-term effects of on-farm hatching (OFH) compared to conventional hatching. Dekalb White layer chicks were subjected to either OFH (n = 47) with ad libitum access to feed and water or temporary post-hatch resource deprivation and eight hour transport (RDT; n = 42). Physical and behavioural measures were collected to examine short-term effects of the treatment procedures. To determine longer term effects, treatment differences in learning and cognitive flexibility were assessed in a Y-maze using several paradigms (reversal, attentional-shift, extinction) between 4 and 12 weeks of age (WOA). Compared to OFH chicks, RDT had: greater corticosterone levels after transport (F1,19 =8.15, p = 0.01, RDT (16.24 ± 1.20 ng/mL) vs. OFH (8.13 ± 1.20 ng/mL) and post-recovery (F1,19 =4.93, p = 0.04; RDT (11.69 ± 1.35 ng/mL) vs. OFH (5.31 ± 1.37)), and lower body mass after resource deprivation and transport (F2258 =9.7, p < 0.001, RDT (33.14 ± 0.33 g) vs. OFH (37.62 ± 0.28 g)). Performance of activity behaviours (foraging, drinking, resting, wing-assisted running) after transport exhibited treatment by time interactions. Additionally, a tendency for OFH being heavier than RDT chicks was observed up to 11 WOA. The majority of birds learned the initial association in the Y-maze between a reward and location (77% of n = 19 RDT and n = 29 OFH chicks) or light stimulus (91% of n = 12 RDT and n = 11 OFH chicks). Subsequently, a number of chicks reached the learning criterion in the location reversal (24% of n = 13 RDT and n = 24 OFH chicks) and the light-to-location attentional-shift (47% of n = 11 RDT and n = 10 OFH chicks), and most of these chicks succeeded in the following extinction paradigm (80% of n = 3 RDT and n = 7 OFH chicks). No treatment effects were detected in any phase of cognitive testing. In conclusion, treatment affected behaviour and health parameters suggesting RDT animals were recovering from resource deprivation and transport. Continued treatment differences in body mass throughout rearing demonstrated long term effects as well although no effects on initial learning and cognitive flexibility were identified. Future work is needed to determine what mechanisms are responsible for the observed health and behavioural differences

Management strategy after diagnosis of Abernethy malformation: a case report

<p>Abstract</p> <p>Introduction</p> <p>The Abernethy malformation is a rare anomaly with a widely variable clinical presentation. Many diagnostic dilemmas have been reported. Nowadays, with the evolution of medical imaging, diagnosis can be made more easily, but management of patients with an Abernethy malformation is still open for discussion.</p> <p>Case presentation</p> <p>In this case study, we describe a 34-year-old Caucasian man who presented with a large hepatocellular carcinoma in the presence of an Abernethy malformation, which was complicated by the development of pulmonary arterial hypertension.</p> <p>Conclusion</p> <p>This case underlines the importance of regular examination of patients with an Abernethy malformation, even in older patients, to prevent complications and to detect liver lesions at an early stage.</p