A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background: Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.Methods/design: 200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/- the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.Discussion: The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group.Trial registration: ACTRN12611000661976

Do little embryos make big decisions? How maternal dietary protein restriction can permanently change an embryo's potential, affecting adult health

Periconceptional environment may influence embryo development, ultimately affecting adult health. Here, we review the rodent model of maternal low-protein diet specifically during the preimplantation period (Emb-LPD) with normal nutrition during subsequent gestation and postnatally. This model, studied mainly in the mouse, leads to cardiovascular, metabolic and behavioural disease in adult offspring, with females more susceptible. We evaluate the sequence of events from diet administration that may lead to adult disease. Emb-LPD changes maternal serum and/or uterine fluid metabolite composition, notably with reduced insulin and branched-chain amino acids. This is sensed by blastocysts through reduced mammalian target of rapamycin complex 1 signalling. Embryos respond by permanently changing the pattern of development of their extra-embryonic lineages, trophectoderm and primitive endoderm, to enhance maternal nutrient retrieval during subsequent gestation. These compensatory changes include stimulation in proliferation, endocytosis and cellular motility, and epigenetic mechanisms underlying them are being identified. Collectively, these responses act to protect fetal growth and likely contribute to offspring competitive fitness. However, the resulting growth adversely affects long-term health because perinatal weight positively correlates with adult disease risk. We argue that periconception environmental responses reflect developmental plasticity and 'decisions' made by embryos to optimise their own development, but with lasting consequences

Jefferson Medical College of Philadlephia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. N.M. Wilson

Session 1864-1865https://jdc.jefferson.edu/lecturetickets/2350/thumbnail.jp

Jefferson Medical College of Philadelphia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. N.M. Wilson

Session 1865-1866https://jdc.jefferson.edu/lecturetickets/2348/thumbnail.jp

Jefferson Medical College of Philadelphia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. N.M. Wilson (verso)

Session 1865-1866https://jdc.jefferson.edu/lecturetickets/2349/thumbnail.jp

Mr. N.M. Wilson of Pennsylvania has paid me for the Ticket of each Professor. Robley Dunglison, Dean. Nov. 9 1865 (verso)

Session 1865-1866https://jdc.jefferson.edu/lecturetickets/2359/thumbnail.jp

Jefferson Medical College of Philadelphia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. Samuel N. Troth (verso)

Session 1846-1847https://jdc.jefferson.edu/lecturetickets/1610/thumbnail.jp

Matriculation. Mr. N.M. Wilson Of the State of Pennsylvania is regularly Matriculated in the Jefferson Medical College, for the Ensuing Session. Philad.a Oct. 19 1864 Robley Dunglison Dean (verso)

Session 1864-1865https://jdc.jefferson.edu/lecturetickets/2361/thumbnail.jp

Jefferson Medical College of Philadelphia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. Samuel N. Troth (verso)

Session 1848-1849https://jdc.jefferson.edu/lecturetickets/1600/thumbnail.jp

Jefferson Medical College of Philadlephia. Lectures on Institutes of Medicine &c. By Professor Dunglison. Admit Mr. N.M. Wilson (verso)

Session 1864-1865https://jdc.jefferson.edu/lecturetickets/2351/thumbnail.jp