Survival after radical cystectomy of non-bilharzial squamous cell carcinoma vs urothelial carcinoma: a competing-risks analysis

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? To date, there is controversy about the impact of histological subtype of bladder cancer (nonbilharzial squanous cell carcinoma vs. urothelial carcinoma) on cancer control outcomes. Our study shows that the histological subtype may have an impact on the stage of bladder cancer at presentation. However, after adjusting to stage, the histological subtype has no impact on cancer control outcomes.

OBJECTIVES

• ? To test the effect of histological subtype (NBSCC vs UC) on cancer‐specific mortality (CSM), after adjusting for other‐cause mortality (OCM).
• ? In Western countries, non‐bilharzial squamous cell carcinoma (NBSCC) is the second most common histological subtype in bladder cancer (BCa) after urothelial carcinoma (UC).

PATIENTS AND METHODS

• ? We identified 12 311 patients who were treated with radical cystectomy (RC) between 1988 and 2006, within 17 Surveillance, Epidemiology and End Results (SEER) registries.
• ? Univariable and multivariable competing‐risks analyses tested the relationship between histological subtype and CSM, after accounting for OCM.
• ? Covariates consisted of age, sex, year of surgery, race, pathological T and N stages, as well as tumour grade.

RESULTS

• ? Histological subtype was NBSCC in 614 (5%) patients vs UC in 11 697 (95%) patients.
• ? At RC, the rate of non‐organ confined (NOC) BCa was higher in NBSCC patients than in their UC counterparts (71.7% vs 52.2%; P < 0.001).
• ? After adjustment for OCM, The 5‐year cumulative CSM rates were 25.0% vs 19.8% (P= 0.2) for patients with NBSCC vs UC organ confined (OC) BCa, respectively. The same rates were 46.3% vs 49.3% in patients with NOC BCa (P= 0.1).
• ? In multivariable competing‐risks analyses, histological subtype (NBSCC vs UC) failed to achieve independent predictor status of CSM in patients with OC (hazard ratio, 1.2; P= 0.06) or NOC BCa (hazard ratio, 1.1; P= 0.1).

CONCLUSIONS

• ? At RC, the rate of NOC BCa is higher in NBSCC patients than in their UC counterparts.
• ? Despite a more advanced stage at surgery, NBSCC histological subtype is not associated with a less favourable CSM than UC histological subtype, after accounting for OCM and the extent of the disease (OC vs NOC).

     

Distraction osteogenesis using a longitudinal corticotomy

Purpose  

The purpose of this study was to evaluate whether the use of a longitudinal corticotomy (S-Z osteotomy) results in more rapid consolidation following distraction osteogenesis of short tibiae.     

Radiofrequency fulguration of␣the␣spleen under␣laparoscopy to␣stop iatrogenic hemorrhage

Background  

Iatrogenic splenic injury is a potentially serious complication of laparoscopic surgery associated with significant morbidity and mortality. It also has an impact on the prognosis of patients who undergo surgery for digestive cancer [1]. For iatrogenic splenic injury, splenic salvage is the ultimate goal. Various surgical techniques have been developed to achieve hemostasis of the spleen. Radiofrequency fulguration (RF) is reported to be a safe method in an animal trauma model [2, 3]. However, only three articles report RF for the control of splenic hemorrhage in human patients [4–6].     

Integrated view of genome structure and sequence of a single DNA molecule in a nanofluidic device

We show how a bird’s-eye view of genomic structure can be obtained at ∼1-kb resolution from long (∼2 Mb) DNA molecules extracted from whole chromosomes in a nanofluidic laboratory-on-a-chip. We use an improved single-molecule denaturation mapping approach to detect repetitive elements and known as well as unique structural variation. Following its mapping, a molecule of interest was rescued from the chip; amplified and localized to a chromosome by FISH; and interrogated down to 1-bp resolution with a commercial sequencer, thereby reconciling haplotype-phased chromosome substructure with sequence.Despite the sequencing of thousands of genomes (1), no human genome—reference or individual—has been described to completion (2): gaps remain in the genome reference sequence and there is a discontinuity between the resolution of next-generation sequencing and the resolution of cytogenetics. This gap leaves structure in the kilobase-to-megabase range partly unmapped. The nature and extent of highly repetitive regions—the centromeres, rDNA on the short arms of acrocentric chromosomes, the long arm of the Y chromosome—remain to be fully delineated, as do the sequences embedded in these regions. Sequencing of individual genomes (3) has also revealed that chromosome-scale amounts of sequence do not align to the human reference genome (4, 5), suggesting that substantial levels of sequence insertions are specific to individuals or subpopulations. Structural variation (SV) comprising rearrangement, loss, or gain of genomic regions is increasingly linked to phenotype and disease (6, 7). In cancer genomes, SV can be extreme (8) and difficult to deconvolve.All types and scales of SV pervade the human genome, but a single approach cannot capture them all (9). For example, though unbalanced SV can be readily ascertained by array technology, balanced SV cannot; a comprehensive analysis by paired-end sequencing is challenging and cost-prohibitive. Single-molecule optical mapping (10–13) facilitates assembly of genomes and detects SV, but haplotype phase is not preserved, because it requires construction of a consensus map from many molecules. These molecules cannot be recovered for further analysis, requiring larger amounts of sample for analysis, which may not be available, e.g., single-cell sequencing and clinical samples. An attempt to combine haplotyping and sequencing on Illumina flow cells was limited to sequencing only at the ends of short fragments (≤8 kb) (14).Microfluidic laboratory-on-a-chip devices have been used to separate individual chromosomes and extract genomic DNA (15, 16), enabling haplotype-phased genotype and sequence to be obtained. Meanwhile, laboratory-on-a-chip systems incorporating nanofluidics have been used to stretch and map DNA (17–19), but their application to detecting SV has remained theoretical due to technical limitations of the designs used. Existing platforms either do not stretch and hold DNA well enough to consistently produce accurate maps from a single molecule (20, 21), or they use inefficient labeling chemistry (22) and consequently cannot differentiate between poor matches and actual structural variation within a single molecule. These platforms also require purified input DNA, which is typically sheared during handling steps, cannot produce maps longer than a few hundred kilobases, and cannot readily recover the mapped DNA molecules to perform conventional genomic analysis. Finally, although confinement in nanochannels can provide high stretching under extreme buffer conditions (23), it is desirable to achieve full stretching independently of buffer composition.Here we describe a laboratory-on-a-chip design that overcomes these technical limitations and a procedure that offers an integrated view of human genome structure. By integrating a nanofluidic system with elongation flow into a laboratory-on-a-chip, (i) haplotype-phased chromosome substructures can be visualized on single megabase-scale molecules, (ii) structural variation ranging in size from a few kilobases to megabases can then be detected, (iii) our experimental maps can be compared with theoretical maps based on different genome assemblies, and variations can be detected, and (iv) interrogation of the same molecule can be zoomed out to the cytogenetic level and zoomed in to the sequence level.     

All about nasal valve collapse

For correcting collapsed alae, blunt dissection of the septal mucoperichondrium through the transfixion incision is extended on both sides up to the vault of the upper lateral cartilages, which are severed from their insertion. I remodel the lower lateral cartilage and secure the lateral crus together with the upper alar groove in a less concave position with mattress sutures in cases of anterior valvular disturbance. The upper lateral cartilages are also fixed in a more convex position, particularly in cases of posterior valvular disturbance. In both anomalies a slightly convex septal or auricular slice cartilage graft placed over the concerned cartilage helps to keep the valve more open and the lateral wall in proper position. If necessary, in extreme secondary cases, one needs the help of bilateral cartilaginous or bony supports embedded subperiostally at the nasal bones.     

Bilateral Z-flap pharyngoplasty in the treatment of rhinolalia

A technique using a bilateral Z-flap pharyngoplasty in the treatment of rhinolalia is reviewed. Also reviewed is the historical development of the surgical treatment of rhinolalia. Sixteen patients with rhinolalia and 3 patients with pharyngitis sicca who were treated by this technique have been followed for up to 16 years, and have shown marked improvement in speech.     

Yeast proteins enhance satiety in rats

This study was designed to characterize the suppressant effect of yeast protein and purified peptides on energy intake. For this purpose, 5 experiments were carried out using adult male Wistar rats. Rats that consumed ad libitum a standard yeast protein diet ate significantly less and were leaner over 21 d than rats that consumed ad libitum a standard milk protein diet (Expt. 1). Moreover, rats fed a high yeast protein load reduced their next meal and daily energy intake more than rats fed any other well-balanced, amino acid, high protein load (soy, total milk protein, or wheat gluten) and more than those fed a wheat starch diet (Expt. 2). Purified peptides from the yeast protein extract produced similar effects on subsequent energy intake (Expt. 3). Study of the behavioral satiety sequence showed that rats consuming P14-y or P55-y diets ad libitum did not acquire a conditioned food aversion (Expt. 4). Finally, a preliminary study of gastric emptying in rats fed yeast protein loads showed that yeast protein was emptied more rapidly through the pylorus than total milk protein during a meal, which may induce satiety (Expt. 5). Taken together, these experiments show that yeast proteins enhance satiety in rats more than other proteins.