Evolution of the neobladder: A critical review of open and intracorporeal neobladder reconstruction techniques

Orthotopic neobladder is an attractive alternative to the ileal conduit following radical cystectomy. Robotic cystectomy is gaining popularity although the uptake of neobladder reconstruction is low, with the majority of cases being constructed extracorporeally via a mini-laparotomy. Minimally invasive cystectomy using the robotic platform facilitates intracorporeal neobladder reconstruction and several techniques have been described. This review discusses issues relating to patient selection, and describes existing techniques of open surgical neobladder reconstruction and their evolution to suit an intracorporeal approach. A Medline search for publications from January 1970 to September 2015 with the following keyword search criteria was performed: radical cystectomy, robotic cystectomy, intracorporeal, neobladder, orthotopic bladder reconstruction, surgical technique, patient selection and ureteric–ileal anastomosis

Minimum design requirements for a poroelastic mimic of articular cartilage

The exceptional functional performance of articular cartilage (load-bearing and lubrication) is attributed to its poroelastic structure and resulting interstitial fluid pressure. Despite this, there remains no engineered cartilage repair material capable of achieving physiologically relevant poroelasticity. In this work we develop in silico models to guide the design approach for poroelastic mimics of articular cartilage. We implement the constitutive models in FEBio, a PDE solver for multiphasic mechanics problems in biological and soft materials. We investigate the influence of strain rate, boundary conditions at the contact interface, and fiber modulus on the reaction force and load sharing between the solid and fluid phases. The results agree with the existing literature that when fibers are incorporated the fraction of load supported by fluid pressure is greatly amplified and increases with the fiber modulus. This result demonstrates that a stiff fibrous phase is a primary design requirement for poroelastic mimics of articular cartilage. The poroelastic model is fit to experimental stress-relaxation data from bovine and porcine cartilage to determine if sufficient design constraints have been identified. In addition, we fit experimental data from FiHy™, an engineered material which is claimed to be poroelastic. The fiber-reinforced poroelastic model was able to capture the primary physics of these materials and demonstrates that FiHy™ is beginning to approach a cartilage-like poroelastic response. We also develop a fiber-reinforced poroelastic model with a bonded interface (rigid contact) to fit stress relaxation data from an osteochondral explant and FiHy™ + bone substitute. The model fit quality is similar for both the chondral and osteochondral configurations and clearly captures the first order physics. Based on this, we propose that physiological poroelastic mimics of articular cartilage should be developed under a fiber-reinforced poroelastic framework

Correlation between plasma phospholipid transfer protein activity and low density lipoprotein subfractions pattern in subjects with type 2 diabetes mellitus

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Effects of angiotensin II receptor antagonist on endothelial vasomotor function and urinary albumin excretion in type 2 diabetic patients with microalbuminuria

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Novel urinary biomarkers for the detection of bladder cancer: A systematic review

BACKGROUND: Urinary biomarkers for the diagnosis of bladder cancer represents an area of considerable research which has been tested in both patients presenting with haematuria and non-muscle invasive bladder cancer patients requiring surveillance cystoscopy. In this systematic review, we identify and appraise the diagnostic sensitive and specificity of reported novel biomarkers of different 'omic' class and highlight promising biomarkers investigated to date. METHODS: A MEDLINE/Pubmed systematic search was performed between January 2013 and July 2017 using the following keywords: (bladder cancer OR transitional cell carcinoma OR urothelial cell carcinoma) AND (detection OR diagnosis) AND urine AND (biomarker OR assay). All studies had a minimum of 20 patients in both bladder cancer and control arms and reported sensitivity and/or specificity and/or receiver operating characteristics (ROC) curve. QUADAS-2 tool was used to assess risk of bias and applicability of studies. The search protocol was registered in the PROSPERO database (CRD42016049918). RESULTS: Systematic search yielded 115 reports were included for analysis. In single target biomarkers had a sensitivity of 2-94%, specificity of 46-100%, positive predictive value (PPV) of 47-100% and negative predictive value (NPV) of 21-94%. Multi-target biomarkers achieved a sensitivity of 24-100%, specificity of 48-100%, PPV of 42-95% and NPV of 32-100%. 50 studies achieved a sensitivity and specificity of ≥80%. Protein (n = 59) and transcriptomic (n = 21) biomarkers represents the most studied biomarkers. Multi-target biomarker panels had a better diagnostic accuracy compared to single biomarker targets. Urinary cytology with urinary biomarkers improved the diagnostic ability of the biomarker. The sensitivity and specificity of biomarkers were higher for primary diagnosis compared to patients in the surveillance setting. Most studies were case control studies and did not have a predefined threshold to determine a positive test result indicating a possible risk of bias. CONCLUSION: This comprehensive systematic review provides an update on urinary biomarkers of different 'omic' class and highlights promising biomarkers. Few biomarkers achieve a high sensitivity and negative predictive value. Such biomarkers will require external validation in a prospective observational setting before adoption in clinical practice

A woman with raised alkaline phosphatase and forearm deformity

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Correlation between serum C-reactive protein level and endothelial function in patients with type2 diabetes mellitus

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