Incidence of Bladder Cancer in Sri Lanka: Analysis of the Cancer Registry Data and Review of the Incidence of Bladder Cancer in the South Asian Population

PurposeTo investigate the incidence of bladder cancer (BC) in Sri Lanka and to compare risk factors and outcomes with those of other South Asian nations and South Asian migrants to the United Kingdom (UK) and the United States (US).Materials and MethodsThe incidence of BC in Sri Lanka was examined by using two separate cancer registry databases over a 5-year period. Smoking rates were compiled by using a population-based survey from 2001 to 2009 and the relative risk was calculated by using published data.ResultsA total of 637 new cases of BC were diagnosed over the 5-year period. Sri Lankan BC incidence increased from 1985 but remained low (1.36 and 0.3 per 100,000 in males and females) and was similar to the incidence in other South Asian countries. The incidence was lower, however, than in migrant populations in the US and the UK. In densely populated districts of Sri Lanka, these rates almost doubled. Urothelial carcinoma accounted for 72%. The prevalence of male smokers in Sri Lanka was 39%, whereas Pakistan had higher smoking rates with a 6-fold increase in BC.ConclusionsSri Lankan BC incidence was low, similar to other South Asian countries (apart from Pakistan), but the actual incidence is likely higher than the cancer registry rates. Smoking is likely to be the main risk factor for BC. Possible under-reporting in rural areas could account for the low rates of BC in Sri Lanka. Any genetic or environmental protective effects of BC in South Asians seem to be lost on migration to the UK or the US and with higher levels of smoking, as seen in Pakistan

Torsion of Wandering Gallbladder following Colonoscopy

Torsion of the gallbladder is an uncommon condition that may present as an acute abdomen. Its preoperative diagnosis can often be challenging due to its variable presentation, with specific sonographic signs seen infrequently. We describe, to our knowledge, the first case of torsion of a wandering gallbladder following a colonoscopy in a 69-year-old female who presented with acute abdominal pain after procedure. This was discovered intraoperatively, and after a subsequent cholecystectomy, she had an uncomplicated recovery

Effects of bariatric surgery on urinary and sexual function

Objective: To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function. Material and Methods: 653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires. Results: The pre-surgery body-mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ-SF (P= 0.0008) and Quality of Life (P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score (P= 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index (P= 0.005) and orgasmic function (P= 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post-LGB. Conclusions: Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight-loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing

Basal HIF1α protein expression, proliferation rates and migration/invasion rates in human PC cell lines. (

<p>A) Basal HIF1α protein concentrations in the human PC cell lines LNCaP, DU145 and PC3 under normoxic conditions were analyzed by Western blot. (B) Proliferation was assayed by cell counting after 24 and 48 hours. (C) Migration/invasion rates were measured by Transwell assays at 24 hours. Values in (A) and (C) are expressed as the fold increase compared to LNCaP cells, while the values in (B) are expressed as a percentage of the time 0 value. All values are the mean ± SEM of at least three separate treatments. (D) Survival rates of PC cells exposed to cytotoxic conditions. The survival of PC3 cells (which have higher basal HIF1α protein) when exposed to oxidative stress with hydrogen peroxide (H₂O₂) or chemotoxicity with 5-fluorouracil (5-FU) was compared to the survival of LNCaP cells (which have lower HIF1α expression). Survival was assessed by counting cell numbers at 24 hours. Values are expressed as a percentage of the untreated control and are the mean ± SEM of at least three separate treatments. #, P<0.05 versus treated LNCaP cells.</p

The translation efficiency of the HIF1α 5′UTR-luciferase reporter in prostate cancer cells.

<p>(A) <i>Firefly</i> and <i>Renilla</i> luciferase activities in prostate cancer cells following transfection of a HIF1α 5′UTR-luciferase construct and the pTK-Renilla control reporter vector were determined using a dual luciferase assay. (B) Real-time PCR (RT-PCR) analysis of luciferase mRNA in PC cells transfected with the HIF1α 5′UTR-luciferase construct. Following transfection, RNA was isolated, and luciferase mRNA expression detected by real time RT-PCR and normalized by 18S mRNA expression. (C) Translational efficiency represents the ratio of <i>Firefly</i>/<i>Renilla</i> luciferase activity, divided by the relative luciferase mRNA concentration in PC cells. The translational efficiency of luciferase mRNA driven by the 5′UTR region of HIF1α in PC3 cells is higher than in LNCaP cells. Values are the mean ± SEM of at least three separate experiments. *, P<0.05 versus treated LNCaP cells.</p

Knockdown of HIF1α expression in PC3 cells reduced both survival after cytotoxic treatments and migration rate.

<p>(A) HIF1α concentrations were reduced in 2 separate clones of PC3 cells following stable expression of HIF1α shRNA as assessed by Western blot. Values are the mean ± SEM of at least three separate experiments and are expressed as a percentage of wild-type PC3 cells. *, P<0.05 versus wild-type PC3 cells. (B) The survival of PC3 cells after exposure to oxidative stress (hydrogen peroxide (H₂O₂)) or chemotoxicity (5-fluorouracil (5-FU) for 24 hours was reduced following HIF1α knockdown compared to scrambled control vector-transfected PC3 cells. Values are the mean ± SEM of at least three separate experiments and are expressed as a percentage of untreated scrambled control vector-transfected PC3 cells. #, P<0.05 versus control. (C) HIF1α protein expression in PC3 cells transfected with control shRNA after treatment with 1% O₂, 300 µM CoCl₂, 100 µM H₂O₂, and 15 µM 5-FU. Cell lysates were electrophoresed on SDS-polyacrylamide gels and blotted with HIF1α antibody. GAPDH expression was used as loading control. The Western blots shown are representative of at least three separate experiments. Band densities were determined by densitometric analysis of HIF1α/GAPDH and are presented relative to the value for untreated cells. Data represent mean ± SEM; * p<0.05 vs. untreated PC3 cells. (D) Rates of migration/invasion in the HIF1α knockdown PC3 cells were reduced compared to the scrambled control vector-transfected PC3 cells as assessed by Transwell assay. Values are the mean ± SEM of at least three separate experiments and are expressed as a percentage of untreated scrambled control vector transfected PC3 cells. *, P<0.05 versus control. (E) Induction of HIF1α in LNCaP cells by hypoxia (dark grey bars) or by cobalt chloride (light grey bars) increased survival after exposure to oxidative stress with H₂O₂ or chemotoxicity with 5-FU for 24 hours when compared to control LNCaP cells (black bars). Values are the mean ± SEM of at least three separate treatments and are expressed as a percentage of the untreated LNCaP control. #, P<0.05 versus treated LNCaP cells. *, P<0.05 versus LNCaP cells treated with 1% O₂ and 5-FU. (F) HIF1α protein expression in LNCaP cells treated with 1% O₂ and 300 µM CoCl₂ in combination with either 100 µM H₂O₂ or 15 µM 5-FU. Cell lysates were electrophoresed on SDS-polyacrylamide gels and blotted with HIF1α antibody. GAPDH expression was used as loading control. The Western blots shown are representative of at least three separate experiments. Band densities were determined by densitometric analysis of HIF1α/GAPDH and are presented relative to the value for normoxic cells undergoing the same treatment. Data represent mean ± SEM; * p<0.05 vs. untreated control, 100 µM H₂O₂ or 15 µM 5-FU treated LNCaP cells.</p

Univariate and Multivariate Cox Regression analysis of the development of metastatic PC from the time of surgery and CRPC, prostate cancer specific death after starting androgen deprivation therapy.

a<p>13 patients excluded due to incomplete metastasis related data.</p>†<p>Cox regression with Firth’s penalized maximum likelihood method. CI denotes confidence interval.</p>‡<p>This group served as the reference group in the Cox regression analysis.</p>*<p>Pre-interventional PSA was defined as PSA immediately prior to obtaining the tissue sample.</p

Patient characteristics for the groups with Gleason score ≤7 or >7 and differences in HIF1α expression between the groups.

<p>The group with Gleason score ≤7 was comprised of Gleason score <6 (6), 6 (28) and 7 (4) and the group with Gleason score >7 was comprised of scores 8 (8), 9 (52) and 10 (2).</p>†<p>There were 17 patients with missing data for tumor stage in the group with Gleason score >7 and 16 of these patients were HIF1α positive.</p>¥<p>There was no significant association with HIF1α expression and Gleason scores when analyzed using Pearson’s Chi-squared test or Fisher’s exact test using two-by-two tables.</p>*<p>Pre-interventional PSA was defined as PSA immediately prior to obtaining the tissue sample.</p