Single early instillation of mitomycin C and urinary alkalinization in low-risk non-muscle-invasive bladder cancer: a preliminary study

Mathematical model of MMC chemotherapy for non-invasive bladder cancer treatment

Mitomycin-C (MMC) chemotherapy is a well-established anti-cancer treatment for non-muscle-invasive bladder cancer (NMIBC). However, despite comprehensive biological research, the complete mechanism of action and an ideal regimen of MMC have not been elucidated. In this study, we present a theoretical investigation of NMIBC growth and its treatment by continuous administration of MMC chemotherapy. Using temporal ordinary differential equations (ODEs) to describe cell populations and drug molecules, we formulated the first mathematical model of tumor-immune interactions in the treatment of MMC for NMIBC, based on biological sources. Several hypothetical scenarios for NMIBC under the assumption that tumor size correlates with cell count are presented, depicting the evolution of tumors classified as small, medium, and large. These scenarios align qualitatively with clinical observations of lower recurrence rates for tumor size ≤ 30[mm] with MMC treatment, demonstrating that cure appears up to a theoretical x[mm] tumor size threshold, given specific parameters within a feasible biological range. The unique use of mole units allows to introduce a new method for theoretical pre-treatment assessments by determining MMC drug doses required for a cure. In this way, our approach provides initial steps toward personalized MMC chemotherapy for NMIBC patients, offering the possibility of new insights and potentially holding the key to unlocking some of its mysteries.

[Prophylaxis of recurrence in low-to-intermediate risk non-muscle invasive bladder cancer (NMIBC)]

BACKGROUND

Low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC) is characterized by a relatively high risk of recurrence and adjuvant instillation therapy is considered standard of treatment for the majority of patients.

OBJECTIVES

To provide a current and in-depth review on the role of adjuvant therapy in low-to-intermediate risk NMIBC.

METHODS

A PubMed-based search focusing on specific keywords (BCG, EORTC, early instillation, intermediate-risk, low-risk, mitomycin, NMIBC, recurrence) was conducted to identify studies published between 2000 and 2021. The corresponding publications were assessed based on their clinical relevance to the question at hand and their pro/retrospective approach.

RESULTS

The EORTC risk tables are most frequently used to determine the risk of recurrence. In low-risk NMIBC, transurethral bladder tumor resection (TURBT) followed by early instillation is considered standard of treatment. In intermediate-risk NMIBC, TUR-BT is followed by adjuvant instillations with either chemoinstillation or BCG.

CONCLUSIONS

Consequent use of adjuvant instillation therapy is necessary to reduce the risk of recurrence. New agents and modes of drug delivery (i.e. chemoablation) on the horizon have the potential to further improve outcomes.

Pediatric Nurses' Information and Applications Related To Ethical Codes

Background:

Ethics is defined as the entirety of moral principles that form the basis of individuals’ behavior; it can also be defined as “moral theory” or “theoretical ethics”.

Objectives:

To determinate information and applications related to ethical codes of pediatric nurses.

Patients and Methods:

Participants were nurses attending the Neonatal Intensive Care Unit Nursing Course and the Pediatric Nursing Course conducted in Istanbul between September 2011 and December 2012. A total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis. Data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics.

Results

140 nurses participated in this study. Information and applications were related to ethical codes of nurses including four categories; autonomy, beneficence, nonmaleficence, justice. The principle of confidentiality/keeping secrets. Exactly 64.3% of nurses reported having heard of nursing ethical codes. The best-known ethical code was the principle of justice. Furthermore, while the rates were generally low, some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances.

Conclusions:

We conclude that most nurses working in pediatric clinics act in compliance with ethical codes. We also found that the majority of nurses wanted to learn about ethical codes. For this reason, we recommended that nurses working in clinics and future nurses in training be informed of the appropriate ethical behavior and codes.

Risk factors associated with ineligibility of adjuvant cisplatin-based chemotherapy after nephroureterectomy

PURPOSE

Radical nephroureterectomy (RNU) is a standard treatment for upper urinary tract urothelial carcinoma. However, RNU can result in decreased renal function and cannot be treated with adjuvant chemotherapy. We performed a risk group stratification analysis to determine the preoperative factors that are predictive of diminished renal function after RNU.

MATERIALS AND METHODS

We retrospectively evaluated the medical records of all patients who underwent nephroureterectomy for upper urinary tract urothelial carcinoma at the Chang Gung Memorial Hospital from 2001 to 2008. We analyzed the association between perioperative glomerular filtration rate and preoperative parameters including cancer characteristics, serum creatinine level, and kidney size measured on computed tomographic images.

RESULTS

A total of 242 patients fulfilled the inclusion criteria. The average decrease in renal function 1 month after RNU was 19.7%. Using 60 mL/min/1.73 m(2) as the eligibility cutoff for cisplatin-based chemotherapy, 42.1% of the population was eligible prior to nephroureterectomy, whereas following surgery only 15.2% remained eligible. Using a cutoff of 45 mL/min/1.73 m(2), 59.9% of the cohort was eligible for fractionated cisplatin dosing preoperatively, whereas only 32.6% remained above the cutoff postoperatively. The most significant predictors of poor postoperative renal function were body mass index >25 kg/m(2), age >65 years, contralateral kidney length less than 10 cm, and absence of ipsilateral hydronephrosis.

CONCLUSION

Our results suggest that older age, higher body mass index, smaller contralateral renal length, and absence of ipsilateral hydronephrosis are predictive of decreased renal function after RNU.