Recommendations for follow-up of muscle-invasive bladder cancer patients : A consensus by the international bladder cancer network

Rationale: Several guidelines exist that address treatment of patients with nonmetastatic muscle-invasive bladder cancer (MIBC). However, most only briefly mention follow-up strategies for patients and hence the treating physician is often left to infer on what the preferred follow-up schema would be for an individual patient. Herein, we aim to synthesize recommendations for follow-up of patients with MIBC for easy reference. Methods: A multidisciplinary MIBC expert panel from the International Bladder Cancer Network was assembled to critically assess currently available major guidelines on surveillance of MIBC patients. Recommendations for follow-up were extracted and critically evaluated. Important considerations for guideline assessment included both aspects of oncological and functional follow-up-frequency of visits, the use of different imaging modalities, the role of cytology and molecular markers, and the duration of follow-up. Outcome: An International Bladder Cancer Network expert consensus recommendation was constructed for the follow-up of patients with MIBC based on the currently available evidence-based data

Inicial experience with cinacalcet in Argentina

Introduction: Secondary Hyperparathyroidism is a frequent chronic renal disease complication. Cinacalcet, an allosteric modulator of the calcium sensing receptor, increases its sensitivity to activation by extracellular calcium ions, proved to be effective in reducing PTH levels. Objetive: To evaluate cinacalcet effectiveness in hemodialysis patients with HPTS. Methods: A retrospective, multicenter, observational study was carried out, on 76 patients who received Cinacalcet for at least 3 months, as a treatment for HPTS. Results: The median age was 51±16 years old, 61% were men. 67 months (43-109) was the median time in HD previous to starting with cinacalcet; 40.8% completed one year treatment. Basal PTH median was 1110 pg/ml (887-1477). PTH levels significantly decreased from first month of treatment 874 ( t< 0.0001) to the third 729 p< 0.0001 and to the sixth month 602 p< 0.0001. From the ninth month on, they remained stable, achieving PTH objective levels in 49% of patients that concluded one year treatment. FAL significantly decreased between months 3 and 6, remaining without changes afterwards. There was a significant decrease in calcemia (9.4mg/dl basal to 9 and 8.7 p< 0.0001) and phosphatemia (5.9 mg/dl basal to 5.5 and 5.3, p< 0.0001) in the first and the third month of treatment. Initial 30 mg cinacalcet dose was significantly increased in the 3 and 6 month (mean dose 50mg/day) but without modifications in 9 and 12 months. Conclusion: 50mg/day mean doses correct moderate SHPT but are insufficient for severe SHPT, pointing out the importance of an earlier treatment beginning, and dose tritation according to response

Impacts of hydromorphological degradation and disturbed sediment dynamics on ecological status. Deliverable 3.1 of REFORM (REstoring rivers FOR effective catchment Management), a collaborative project (large-scale integrating project) funded by the European Commission within the 7th Framework Programme under Grant Agreement 282656.

There is an acknowledged need among stakeholders that new hydromorphological metrics are required to facilitate site remediation and for reporting at national and European levels. Pressure/ impact data were assembled from across Europe. The task was challenging, but useful information was gathered. For each major hydromorphological pressure, the physical response gradients of rivers was summarised as diagnostic diagrams. For the first time we provide evidence that metrics indicating HYMO impact could be developed from monitoring data on fish and macrophytes. For the first time we demonstrate the potential to derive metrics sensitive to fine sediment. We provide evidence that phytobenthos (diatoms), invertebrates and macrophytes have the potential to be used in combined metrics. We found that many existing macroinvertebrate metrics lack specificity and can provide false positive responses to HYMO pressure, suggesting that disentanglement of multi-stressor responses is critical to good diagnosis. There is evidence that aquatic habitats protected under the Habitats Directive will be increasingly vulnerable to hydrological pressures with the changing climate. Frequently, overlooked topics such as sediment quality and groundwater issues ought to supplement or be included in HYMO assessments due to their potential for explaining variance in biological datasets. Land-use data on a spatial scale beyond the reach scale (corridor and catchment) relates to site-specific macroinvertebrate metrics and could be a more robust way of assessing impacts