Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience

Introduction:

The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation.

Materials and Methods:

Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates.

Results:

The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women.

Conclusions:

Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.

Phenotypic and genotypic diversity of dominant lactic acid bacteria isolated from traditional yoghurts produced by tribes of Iran

Morphological, biochemical and molecular characteristics were studied to identify dominant lactic acid bacteria (LAB), isolated from traditional yoghurts produced by tribes of Iran. From 60 yoghurt samples, a total of 137 LAB isolates were determined, in which 66 and 71 were identified as lactic acid cocci and bacilli, respectively. Biochemical tests showed the occurrence of 9.76% mesophilic homofermentative, 10.98% mesophilic hetrofermentative, 26.83% thermophilic homofermentative and 47.56% mesophilic homofermentative cocci. As for lactic acid bacilli, mesophilic facultative hetrofermentative (26%); thermophilic obligate homofermentative (56%); mesophilic obligate hetrofermentative (18%) were found. Genetically the presence of the following species were verified: E. faecium; E. faecalis; E. durans; L. lactis subsp. lactis; St. thermophilus; Lb. delbruecki subsp. bulgaricus; Lb. brevis; Lb. diolivorans; Lb. helveticus; Lb. jensenii; Lb. plantarum. 9% of the Lactobacillus isolates showed incompatible results between phenotypic and genotypic characteristics. From the cocci isolates, 38.46% showed identical results between phylogenetic characteristics. The current study constitutes the first step in the designing process of LAB starter cultures, to protect the typical organoleptic characteristics of traditional yoghurt. The results could also be used to introduce new starter cultures for commercial use.

Application of the Bayesian approach for derivation of PDFs for concentration ratio values

Concentration ratios (CRs) are used to derive activity concentrations in wild plants and animals. Usually, compilations of CR values encompass a wide range of element-organism combinations, extracted from different studies with statistical information reported at varying degrees of detail. To produce a more robust estimation of distribution parameters, data from different studies are normally pooled using classical statistical methods. However, there is inherent subjectivity involved in pooling CR data in the sense that there is a tacit assumption that the CRs under any arbitrarily defined biota category belong to the same population. Here, Bayesian inference has been introduced as an alternative way of making estimates of distribution parameters of CRs. This approach, in contrast to classical methods, is more flexible and also allows us to define the various assumptions required, when combining data, in a more explicit manner. Taking selected data from the recently compiled wildlife transfer database (http://www.wildlifetransferdatabase.org/) as a working example, attempts are made to refine the pooling approaches previously used and to consider situations when empirical data are limited.

Approaches to providing missing transfer parameter values in the ERICA Tool--how well do they work?

A required parameter for the ERICA Tool is the concentration ratio (CR), which is used to describe the transfer from environmental media to a range of organisms. For the original parameterisation of the ERICA Tool, 60% of these values were derived using a variety of extrapolation approaches, including the application of allometric models, the use of values for a similar organism or element with similar biogeochemical behaviour and the use of values from a different ecosystem. Although similar approaches are applied in other assessment systems, there has been little attempt to see how well these approaches perform. In this paper, CR values in the ERICA Tool derived using extrapolation approaches are compared to more recently available empirical data from the IAEA wildlife transfer database. The primary purpose of the default CR database in the ERICA Tool, and other models, is to enable the user to conduct conservative screening assessments. Conservatism was therefore introduced to the analyses by selecting the 95th percentile CR values for subsequent calculations. The extrapolation methodologies are not guaranteed to provide conservative estimates of empirical 95th percentile CRs. For the terrestrial ecosystem, the extrapolation methods provide underpredictions of empirical 95th percentiles as often as they produce overpredictions. In a few cases the underestimation of CR values, when considering all ecosystems, is substantial - by orders of magnitude - which is clearly unacceptable for a screening assessment. Thus, although extrapolation approaches will remain an essential component of screening assessments in the future, because data gaps will always be present, diligence is important in their application. Finally, by synthesizing the results from the current analyses and through other considerations, some recommendations are provided with regards to modifying the original guidance on use of extrapolation approaches in the ERICA Tool.

Assessment of the radiological impact of gamma and radon dose rates at former U mining sites in Tajikistan

An assessment of the radiological situation due to exposure to gamma radiation, radon ((222)Rn) and thoron ((220)Rn) was carried out at former uranium (U) mining and processing sites in Taboshar and at Digmai in Tajikistan. Gamma dose rate measurements were made using various field instruments. (222)Rn/(220)Rn measurements were carried out with field instruments for instantaneous measurements and then discriminative (222)Rn/(220)Rn solid state nuclear track detectors (SSNTD) were used for longer representative measurements. The detectors were exposed for an extended period of time in different outdoor and indoor public and residential environments at the selected U legacy sites. The results showed that gamma, (222)Rn and (220)Rn doses were in general low, which consequently implies a low to relatively low radiological risk. The radiation doses deriving from external radiation (gamma dose rate), indoor (222)Rn and (220)Rn with their short-lived progenies did not exceed national or international standards. At none of the sites investigated did the average individual annual effective doses exceed 10 mSv, the recommended threshold value for the general public. A radiation hazard could be associated with exceptional situations, such as elevated exposures to ionizing radiation at the Digmai tailings site and/or in industrial facilities, where gamma and (222)Rn/(220)Rn dose rates could reach values of several 10 mSv/a. Current doses of ionizing radiation do not represent a hazard to the health of the resident public, with the exception of some specific situations. These issues should be adequately addressed to further reduce needless exposure of the resident public to ionizing radiation.

Antiapoptotic effects of cerium oxide and yttrium oxide nanoparticles in isolated rat pancreatic islets

Type I diabetes mellitus is a metabolic disease caused by the impairment of pancreatic β-cells mainly mediated through oxidative stress and related apoptosis. Islets transplantation seems a promising treatment for these patients, but during islets transplant, various types of stresses related to the isolation and transplantation procedure compromise the function and viability of islets. We recently hypothesized that the combination of cerium oxide (CeO2) and yttrium oxide (Y2O3) nanoparticles with a potential free radical scavenger behavior should be useful to make isolated islets survive until transplanted. In the present study, oxidative stress-induced apoptosis in isolated rat pancreatic islets exposed to hydrogen peroxide (H2O2) and the protective effects of CeO2 and Y2O3 nanoparticles were investigated. Exposure of islets to H2O2 (50 µm, 2 h) increased intracellular oxidant formation such as reactive oxygen species and subsequently apoptosis and decreased viability, glucose-induced adenosine triphosphate (ATP) production and glucose-stimulated insulin secretion. Pretreatment with CeO2 and/or Y2O3 nanoparticles reduced the oxidant formation and apoptosis and increased viability, glucose-induced ATP production and glucose-stimulated insulin secretion. These results suggest that this combination may protect β-cell apoptosis by improving the oxidative stress-mediated apoptotic pathway.

Tissue distribution of infectious pancreatic necrosis virus serotype Sp in naturally infected cultured rainbow trout, Oncorhynchus mykiss (Walbaum): an immunohistochemical and nested-PCR study

This study investigates the occurrence and distribution pattern of infectious pancreatic necrosis virus (IPNV) within the pancreas, liver, kidney and spleen of naturally infected cultured rainbow trout, Oncorhynchus mykiss (Walbaum), using immunohistochemistry (IHC). A nested PCR was also employed to confirm the presence of the virus in the pooled tissues of the specimens. All the examined tissues except spleen were immunohistochemically positive for IPNV, but staining intensity and distribution pattern varied. The kidney tubules had the most intense and widespread staining by IHC, indicating a specific tissue tropism at least for this particular serotype. The nucleotide sequence had the greatest identity with the Sp serotype confirming the presence of the nucleic acid of IPNV in the pooled tissues. Based on the present findings, it could be concluded that the absence of lesions consistent with infectious pancreatic necrosis (IPN) disease in the H&E-stained sections cannot rule out the presence of the IPNV, and the use of an alternative rapid confirmatory method such as IHC with formalin-fixed, paraffin-embedded tissue sections is helpful for the final diagnosis of IPN in rainbow trout.

Radiographic examination of the greater sciatic notch in determining the sex among Iranian people

The distinctive morphology of the human innominate bone (os coxae) and its clear sexual dimorphism make it of interest from anatomical, anthropological and forensic points of view. The features of the greater sciatic notch of the coxae are characteristic and are commonly used to determine sex in unknown individuals. In this study, several measurements of the greater sciatic notch, e.g. width (AB), depth (OC) and width of the posterior segment (OB) were taken and indices I and II were calculated in 64 adult (32 men and 32 women) and side (right: left) coxae radiography (A-P view). Results indicated that out of all the parameters studied, width of the notch (right and left) (P < 0.001), posterior segment width (right and left) (P < 0.001), right (P = 0.036) and left (P = 0.008) index II of notch were found to be significantly greater in women as compared with men. Discriminant function analysis showed that the accuracy of sex determination varied from 100% in the men and 40% in the women groups to 70% for the total group. These results can be used as an aid to the identification of human skeletal remains in Iranian people.

Functional welfare – using biochemical and molecular technologies to understand better the welfare state of peripartal dairy cattle

Animal welfare is an important social construct showing that humans recognise the sentient nature of animals and manage them accordingly; however, because the concept differs depending on individual perceptions of the acceptability of different practices and appropriate endpoint measurements, objective evaluation of an animal’s welfare state is challenging. A good level of welfare, however, is not achieved merely by the absence of difficulties (e.g. pain, injury, disease, distress) but by the animal’s capacity to overcome them. Production-oriented (utilitarian) opinions contend that high production indicates good welfare, as an animal must be healthy and well nourished to achieve it. Although there is truth in this premise, high production can, in itself, result in stresses, with no obvious signs that potentially predispose animals to ill health. The focus of the present paper is on peripartal dairy cattle as it relates to development of better measures for an objective evaluation of welfare state. Advances in high-throughput metabolite (metabolomics) and gene expression (transcriptomics) analysis techniques have enabled the rapid identification of multiple biomarkers that, in combination, reflect the metabolic and immunocompetence functional capacity of the animal. With this knowledge, the effects of management, nutrition, physiological state, and their interactions can be evaluated for their effect on functional capacity. As the links between metabolism, immunology (immunometabolism) and mental state are elucidated, these techniques also offer a means to assess whether the animal also experiences feelings of malaise. Collectively, these measurements, thus, can indicate ‘functional welfare’, which encompasses biological function, physical state, and some components of mental state as part of animal welfare.

Quality of Life Assessment in Patients with Multiple Sclerosis Receiving Interferon Beta-1a: A Comparative Longitudinal Study of Avonex and Its Biosimilar CinnoVex

Background. Multiple sclerosis (MS) is an autoimmune inflammatory disease of central nervous system (CNS). MS affects quality of Life (QOL) due to physical disability and other associated problems. Disease-modifying agents like interferon beta (IFNB) have been widely utilized in this patient population; however, their frequency, route of administration, side effects, high cost, and also the question of whether they are truly beneficial for longer-term outcomes and QOL need to be further investigated. Objectives. To assess QOL in patients with multiple sclerosis receiving interferon beta-1a (Avonex or CinnoVex) and in order to compare QOL in groups receiving Avonex and CinnoVex, respectively, also, to evaluate whether the more cost-effective biosimilar form of IFNB (CinnoVex) has the same effect on QOL and can be substituted for Avonex. Methods. We conducted a 30-month, nonrandomized longitudinal study and recruited a total of 92 patients diagnosed with relapsing-remitting MS. The patients were distributed in Avonex and CinnoVex groups with 46 patients in each group. Quality of life was assessed by means of MSQOL-54 questionnaire, four times a year, at baseline and at months 4, 8, and 12 of the study. Results. Mean age ± SD was 30.5 ± 8.9 and 32.3 ± 9.0 years in Avonex and CinnoVex groups, respectively, and P value of gender was different (P value : 0.036). The physical health composite scores were 61.8 and 59.8 (P values 0.677 and 0.884) for Avonex and CinnoVex groups, in that order. The results of the study revealed no significant difference between the two groups with regard to physical health, health perception, energy, and role limitations due to physical problems, pain, sexual and social function, and physical health distress scores. Further, interferon therapy did not significantly impact patients' QOL after a year of treatment with either Avonex or CinnoVex. Conclusions. According to the present study, treatment with IFNB (Avonex or CinnoVex) did not affect QOL during a year of therapy. Further studies with longer follow-up periods are required to assess the value of interferons on long-term outcomes and patient's QOL.

Anteroposterior stability of the knee during the stance phase of gait after anterior cruciate ligament deficiency

Quadriceps avoidance and higher flexion strategies have been assumed as effects of ACL deficiency on knee joint function during gait. However, the effect of ACL deficiency on anteroposterior stability of the knee during gait is not well defined. In this study, 10 patients with unilateral acute ACL ruptures and the contralateral side intact performed gait on a treadmill. Flexion angles and anteroposterior translation of the ACL injured and the intact controlateral knees were measured at every 10% of the stance phase of the gait (from heel strike to toe-off) using a combined MRI and dual fluoroscopic imaging system (DFIS). The data indicated that during the stance phase of the gait, the ACL-deficient knees showed higher flexion angles compared to the intact contralateral side, consistent with the assumption of a higher flexion gait strategy. However, the data also revealed that the ACL-deficient knees had higher anterior tibial translation compared to the intact contralateral side during the stance phase of the gait. The higher flexion gait strategy was not shown to correlate to a reduction of the anterior tibial translation in ACL deficient knees. These data may provide indications for conservative treatment or surgical reconstruction of the ACL injured knees in restoration of the knee kinematics during daily walking activities.

Gene expression pattern of adiponectin and adiponectin receptors in dominant and atretic follicles and oocytes screened based on brilliant cresyl blue staining

Adiponectin and its receptors (AdipoR1 and AdipoR2) are novel endocrine systems that act at various levels to control male and female fertility. The aim of this study was to determine whether adiponectin and its receptors gene expression levels differ between dominant follicle (DF) and atretic follicle (AF) and also between oocytes which were stained positively and negatively with brilliant cresyl blue (BCB(+) and BCB(-)). Based on estradiol/progesterone ratio, follicles from ovaries were classified as AFs and DFs. The stages of estrous cycle (follicular or luteal phases) were defined by macroscopic observation of the ovaries and the uterus. Oocytes were stained with BCB for 90 min. The relative expression of adiponectin, AdipoR1 and AdipoR2 mRNA in theca and cumulus cells and oocytes of different follicles were determined by quantitative real time PCR. Adiponectin and its receptors genes were clearly expressed higher (P<0.05) in theca and cumulus cells and oocytes of DFs than those of AFs during the follicular and luteal phases. BCB(+) oocytes showed a higher (P<0.05) expression of adiponectin and its receptors compared with their BCB(-) counterparts. Positive correlation (r>0.725, P<0.001) was observed between adiponectin mRNA level in ovarian cells of DFs and follicular fluid E2 concentration in follicular phase. Adiponectin mRNA abundance in ovarian cells of AFs showed a significant negative correlation with follicular fluid progesterone concentration in follicular and luteal phases (r<-0.731, P<0.001). This work has revealed the novel association of adiponectin and its receptors genes with follicular dominance and oocyte competence, thereby opening several new avenues of research into the mechanisms of dominance and competence in animal and human.

Morphometric Study on Male Specimens of Hyalomma anatolicum (Acari: Ixodidae) in West of Iran

BACKGROUND

Hyalomma anatolicum is the well-known hard tick, which is one of the most important livestock and human pathogens vector, wide range in host and distributed in all over the Hyalomma geographic fauna as well as in Iran. Taxonomy of the Hyalomma ssp. is debatable whereas their identification is a problematic work. The reasons for this claim is time consuming Delpy's researches in Iran also Schulze School, Feldman-Muhsam and the Russian tick workers. We would like to understand morphometric variation in the field collected H. anatolicum in Iran also validating some morphologic quantitative and qualitative characters.

METHODS

A total 247 field-collected tick specimens from different geographical regions in west of Iran includes Khuzestan and Lorestan Provinces were studied. The morphologic characters of the ticks were measured by the calibrated stereomicroscope armed scaled lens. The measurements were analyzed using SPSS for windows, version 16 on an IBM PC, so varied shapes of species in different geographic regions were drawn by the aid of a drawing tube connected to a light stereomicroscope.

RESULTS

One way ANOVA test revealed significant differences among the quantitative parameters in five zones (P < 0.001) also each zone to other zone by Post Hoc Tests e.g. LSD. No significant differences in the lateral grooves length/conscutum length ratio parameter were found.

CONCLUSION

Morphometric variation in Hyalomma spp is poorly studied. The variation in range and quantity of the morphometric parameters of H.anatolicum underlies that the correct recognition and key construction for Hyalomma species dependes on a complement morphometric study on the other species.