[Transurethral en bloc resection of non-muscle invasive bladder cancer. What is the state of the art?]

Bladder cancer of the urothelium is the second most common malignancy among urological tumors. In view of a worldwide aging population and the fact that increased incidence rates are associated with higher age, new socioeconomic challenges will appear. Even nowadays the treatment of bladder cancer bears the highest lifetime treatment costs per patient among all forms of cancer. In conjunction with higher comorbidity rates among older patients urologists are facing new challenges in the treatment and care of patients with bladder cancer. The standard treatment for non-muscle invasive bladder cancer (NMIBC) is monopolar transurethral resection using resection loops (TURB). Based on experience in the surgical treatment of benign prostatic hyperplasia, different concepts of en bloc resection of bladder tumors using alternative energy resources (e.g. holmium laser, thulium laser and the water-jet HybridKnife) have been developed. Goals of new treatment modalities are reduction of perioperative and postoperative comorbidities, better pathological work-up of the specimens and increased recurrence-free survival. Postulated advantages using laser devices are a more precise cutting line as well as better hemostasis. The evidential value of this review is limited due to the lack of randomized, prospective studies. However, there is a tendency towards a limitation of perioperative and postoperative morbidities as well as higher chance of well-preserved tissues for better pathohistological evaluation using en bloc resection methods. More studies with long-term follow-up periods and better randomization are needed to clarify whether en bloc strategies provide better long-term oncological survival.

Synthesis and in vitro cytotoxicity of cis,cis,trans-diamminedichloridodisuccinatoplatinum(IV)-peptide bioconjugates

The synthesis and characterization of four Pt(IV)-peptide conjugates, containing one or two peptides in the axial position, designed for the purpose of targeted drug delivery to tumor cells, are described. The precursor cis,cis,trans-diamminedichloridodisuccinatoplatinum(IV) was coupled in the last step of standard solid-phase peptide synthesis (SSPS) with an analogue of neurotensin (pseudo-neurotensin = Lys-Lys-Pro-Tyr-Ile-Leu) and with octreotate (D-Phe-Cys-Phe-D-Trp-Lys-Thr-Cys-Thr-OH), an analogue of somatostatin, respectively. For all peptides, the SSPS reactions afforded both mono- and diconjugated Pt-peptide species, which were separated and purified by RP-HPLC. The two couples of conjugates, together with the precursor, were tested as cytotoxic agents towards different cancer cell lines. In general all conjugates are good inhibitors of cellular proliferation when compared to a nontargeting platinum(IV) parent compound, so that its relatively low cytotoxicity is greatly improved by addition of the peptides.

Theoretical study of the O₂ interaction with a tetrahedral Al₄ cluster

Employing both multireference configuration interaction (MRCI) and density functional theory (DFT) methods, we have studied the interaction of O₂ with a tetrahedral Al₄ cluster in the total spin triplet state. For a parallel to the base approach of O₂ facing an apex of the pyramid, the O₂ adsorption is hindered by a barrier. Both the MRCI and the DFT calculations show that after a small barrier, there are two local energy minima: a shallow one just above the apex atom and another deeper one below the apex atom. The latter corresponds to dissociative O₂ adsorption. We discuss the implications of these findings for the understanding of O₂ adsorption on defect sites of Al surfaces.

Limits on neutrino emission from gamma-ray bursts with the 40 string IceCube detector

IceCube has become the first neutrino telescope with a sensitivity below the TeV neutrino flux predicted from gamma-ray bursts if gamma-ray bursts are responsible for the observed cosmic-ray flux above 10(18)  eV. Two separate analyses using the half-complete IceCube detector, one a dedicated search for neutrinos from pγ interactions in the prompt phase of the gamma-ray burst fireball and the other a generic search for any neutrino emission from these sources over a wide range of energies and emission times, produced no evidence for neutrino emission, excluding prevailing models at 90% confidence.

Differential localization of GABA(A) receptor subunits in relation to rat striatopallidal and pallidopallidal synapses

As a central integrator of basal ganglia function, the external segment of the globus pallidus (GP) plays a critical role in the control of voluntary movement. The GP is composed of a network of inhibitory GABA-containing projection neurons which receive GABAergic input from axons of the striatum (Str) and local collaterals of GP neurons. Here, using electrophysiological techniques and immunofluorescent labeling we have investigated the differential cellular distribution of α1, α2 and α3 GABA(A) receptor subunits in relation to striatopallidal (Str-GP) and pallidopallidal (GP-GP) synapses. Electrophysiological investigations showed that zolpidem (100 nm; selective for the α1 subunit) increased the amplitude and the decay time of both Str-GP and GP-GP IPSCs, indicating the presence of the α1 subunits at both synapses. However, the application of drugs selective for the α2, α3 and α5 subunits (zolpidem at 400 nm, L-838,417 and TP003) revealed differential effects on amplitude and decay time of IPSCs, suggesting the nonuniform distribution of non-α1 subunits. Immunofluorescence revealed widespread distribution of the α1 subunit at both soma and dendrites, while double- and triple-immunofluorescent labeling for parvalbumin, enkephalin, gephyrin and the γ2 subunit indicated strong immunoreactivity for GABA(A) α3 subunits in perisomatic synapses, a region mainly targeted by local axon collaterals. In contrast, immunoreactivity for synaptic GABA(A) α2 subunits was observed in dendritic compartments where striatal synapses are preferentially located. Due to the kinetic properties which each GABA(A) α subunit confers, this distribution is likely to contribute differentially to both physiological and pathological patterns of activity.

Microbial diversity and community composition in recirculating vertical flow constructed wetlands

Microorganisms constitute a central component of constructed wetlands (CWs), playing a major role in these systems' capacity for treating wastewater. The aim of this study was to determine the diversity and composition of the microbial community found in a recirculating vertical flow CW (RVFCW) bed fed with primarily settled domestic wastewater and its response to the presence of plants, season and location in the bed. The RVFCW removed 90-95% of TSS and BOD(5) to below 10 mg L(-1). The effluent quality was not significantly affected by seasonal temperature or the existence of plants in the bed. None of these factors had discernible effects on bacterial diversity, e.g. in the planted RVFCW, the richness (S') and Shannon-Weiner diversity (H') indices were 18.3 (±3.5) and 2.49 (±0.15), respectively, which are similar to the values of 19.4 (±3.5) and 2.57 (±0.18) in the unplanted RVFCW. However, there were indications that the structure of the microbial community underwent changes that were uncorrelated with the environmental factors tested and that did not affect the overall performance. The consistency in diversity and composition/structure of the bacterial community in the face of temporal and environmental influences possibly contributes to the robustness and high treatment capacity of the RVFCW system.

Quality of life of patients receiving platinum-based chemotherapy plus cetuximab first line for recurrent and/or metastatic squamous cell carcinoma of the head and neck

Background: A phase III trial demonstrated that cetuximab is the first agent in 30 years to improve survival when added to platinum-based chemotherapy (platinum-fluorouracil) first line for recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). This analysis of the trial assessed the impact of treatment on quality of life (QoL).

Patients and methods: The European Organisation for Research and Treatment of Cancer QoL Questionnaire-Core 30 (QLQ-C30) and QLQ-Head and Neck 35 (QLQ-H&N35) module were used to assess QoL.

Results: Of 442 patients randomly assigned, 291 (QLQ-C30) and 289 (QLQ-H&N35) patients completed at least one evaluable questionnaire. For QLQ-C30, cycle 3 and month 6 mean scores for platinum–fluorouracil plus cetuximab were not significantly worse than those for platinum–fluorouracil. Pattern-mixture analysis demonstrated a significant improvement in the global health status/QoL score in the cetuximab arm (P = 0.0415) but no treatment differences in the social functioning scale. For QLQ-H&N35, the mean score for the cetuximab arm was not significantly worse than that for the chemotherapy arm for all symptom scales at all post-baseline visits. At cycle 3, some symptom scores significantly favored the cetuximab arm (pain, swallowing, speech problems, and social eating).

Conclusion: Adding cetuximab to platinum–fluorouracil does not adversely affect the QoL of patients with recurrent and/or metastatic SCCHN.

[Sex reassignment surgery in transsexuals]

BACKGROUND

Rikshospitalet (The National Hospital) treats all transsexual patients in Norway. 50-70 patients are referred annually for assessment and about 20 of these are diagnosed as transsexual. Approximately 15 confirmed transsexuals, who have received hormone treatment, are referred to sex reassignment surgery per year. This article describes diagnosis and treatment of transsexualism with an emphasis on surgery.

MATERIAL AND METHODS

The article is based on a non-systematic review of the literature and our own clinical experience.

RESULTS

Patients are evaluated for sex reassignment surgery after at least one year of psychiatric evaluation and an additional year of endocrine treatment. Male-to-female patients are evaluated for breast augmentation if hormone therapy has given unsatisfactory results. Thereafter, genital surgery can be performed, i.e. the testis and corpus cavernosum are removed and a neovagina and neoclitoris are constructed. Female-to-male patients have the possibility to undergo breast reduction, hysterectomy, salpingoophorectomy and construction of a neopenis. If the patient responds well to male hormones, the clitoris can be straightened and reconstructed as a small neopenis with an erectile function (metaidoioplasty). Alternatively, phalloplasty is performed using the local groin flap or a microvascular free flap.

INTERPRETATION

Sex reassignment surgery mainly consists of operations on breasts and genitalia.

How are women with SUI-symptoms treated with duloxetine in real life practice? - preliminary results from a large observational study in Germany

BACKGROUND

Duloxetine was found safe and effective in the treatment of moderate to severe female stress urinary incontinence (SUI) in controlled clinical trials; complementary data from routine clinical practice are still wanted.

OBJECTIVES

To explore the use of various initial duloxetine doses by physicians in the treatment of female SUI in routine clinical practice and its implications on drug safety and patients' subjective impression of effectiveness.

METHODS

Adult women treated with duloxetine for SUI symptoms were documented as part of an ongoing large-scale observational study in Germany. Data collected at baseline, after 4 and 12 weeks, were evaluated by initial doses. Statistics were descriptive, 95% confidence intervals were calculated for adverse event (AE) rates.

RESULTS

A total of 7888 adult women were treated with duloxetine; their mean age was 61.4 years, body mass index 27 kg/m(2), incontinence episode frequency (IEF) 14.0 per week. Previous SUI treatments were observed in 52.2%, comorbidities in 60.4% of the patients. A total of 90.7% reported reduced frequency of SUI-episodes, 12.1% any AE; nausea (5.7%) and vertigo (1.6%) were reported most frequently. In all, 52.2% of patients were initiated on a duloxetine dose of 40 mg/day. Only minor differences in patient characteristics, effectiveness and tolerability were associated with varying initial duloxetine doses.

CONCLUSIONS

Many women received lower duloxetine doses than expected based on evidence-based dosing recommendations. Although SUI patients in this study had a higher health risk because of old age and multiple comorbidities than in previous controlled clinical trials, AE rates were lower, possibly because of the observational character of the study and/or the use of rather low doses. Similar AE rates for varying initial doses possibly reflect sensible dose-adjustment to individual needs.

Extending the search for neutrino point sources with IceCube above the horizon

Point source searches with the IceCube neutrino telescope have been restricted to one hemisphere, due to the exclusive selection of upward going events as a way of rejecting the atmospheric muon background. We show that the region above the horizon can be included by suppressing the background through energy-sensitive cuts. This improves the sensitivity above PeV energies, previously not accessible for declinations of more than a few degrees below the horizon due to the absorption of neutrinos in Earth. We present results based on data collected with 22 strings of IceCube, extending its field of view and energy reach for point source searches. No significant excess above the atmospheric background is observed in a sky scan and in tests of source candidates. Upper limits are reported, which for the first time cover point sources in the southern sky up to EeV energies.

Limits on a muon flux from neutralino annihilations in the sun with the IceCube 22-string detector

A search for muon neutrinos from neutralino annihilations in the Sun has been performed with the IceCube 22-string neutrino detector using data collected in 104.3 days of live time in 2007. No excess over the expected atmospheric background has been observed. Upper limits have been obtained on the annihilation rate of captured neutralinos in the Sun and converted to limits on the weakly interacting massive particle (WIMP) proton cross sections for WIMP masses in the range 250-5000 GeV. These results are the most stringent limits to date on neutralino annihilation in the Sun.

Quantum electron transport through ultrathin Si films: effects of interface passivation on Fermi-level pinning

We report first-principles calculations on electron transport through ultrathin silicon films between aluminum electrodes. The passivation of interface Si atoms at one side of the film with hydrogen makes the current-voltage characteristics asymmetric with quasirectifying properties. The low conductivity in this case can be explained by the weakened metal-induced gap states due to the passivation. We also demonstrate that the applied bias changes the strength of Fermi-level pinning for the passivated interface.

ENVIRO-HIRLAM: on-line coupled modelling of urban meteorology and air pollution

Abstract. The strategy of new generation integrated Meso-Meteorological (MetM) and Atmospheric Chemical Transport (ACT) models for predicting atmospheric composition, meteorology and climate change is discussed for the Enviro-HIRLAM (HIgh Resolution Limited Area Model) integrated system. Current progress in the Enviro-HIRLAM system development and its urban on-line coupled modelling applications is considered. Results of several sensitivity studies of the urban effects (urban albedo and roughness, anthropogenic heat flux, heat island, and urban aerosols) on meteorology and air pollution at different scales are presented. Several sensitivity tests of the off-line versus on-line coupling of MetM and ACT models in Enviro-HIRLAM as well as their verification versus the ETEX experiment are considered and results are discussed.