Comparison between results of ileal conduit and continent ileal bladder (VIP), after radical cystectomy

OBJECTIVES: The aim of the present study is to analyze the results achieved with the ileal bladder according to the VIP (vescica ileale Padovana) procedure. METHODS/RESULTS: We compared the results obtained in 31 patients with invasive bladder cancer who underwent radical surgery (22 underwent the ileal conduit procedure and 9 were treated by orthotopic bladder substitution) and analyzed the early complications, long-term results and physiological data of the group submitted to the VIP procedure. In the patient group submitted to the VIP procedure, there was only one case who required removal of the new bladder due to an enteroneovesical fistula. Another case developed medium serrate anular stricture of the bulbar urethra about 8 months postoperatively and was treated by endoscopic urethrotomy. The uroradiologic and urodynamic evaluations confirmed urinary tract stability integrity of renal function and good adaptation of the new reservoir. The andrological studies showed complete sexual potency in 2 of 9 patients. CONCLUSIONS: The VIP procedure appears to be a good technique, with complications no greater than those of traditional urinary diversion, and improves the quality of life of patients undergoing radical surgery for invasive bladder cancer.     

Effect of topical anesthetic use on initial patient satisfaction and overall success with rigid gas permeable contact lenses

BACKGROUND: Rigid gas permeable (RGP) contact lenses have numerous benefits; however, RGP lens use is not increasing in the United States. An important factor for this trend has been initial comfort. Studies have demonstrated that how RGPs are presented to patients, in addition to lens design, can play an important role in the initial comfort process. Another important factor could be the use of a topical anesthetic during the fitting and dispensing visits. The purpose of this study was to use a multicenter format to determine if topical anesthetic use increased the likelihood of patient satisfaction and success. METHODS: A total of 80 subjects, with no previous rigid lens wear experience, was entered into this 1-month study, including 20 subjects from each of 4 institutions. Subjects were randomly divided into the following two groups: (A) anesthetic or (B) placebo, with the former group receiving one drop of a topical anesthetic before lens insertion at both the diagnostic fitting and dispensing visits, whereas the latter group received a placebo. Subjects completed a questionnaire on their perception of rigid lens wear both immediately before fitting and at the 1-month visit. After diagnostic fitting with rigid lenses, subjects completed an adaptation questionnaire after 15 min, 1 week, 2 weeks, and 1 month of lens wear. RESULTS: Seventy of the 80 subjects completed the study and, of the 10 subjects who discontinued, 8 were in the placebo group. In all categories evaluated, the anesthetic group experienced a more optimum adaptation experience at each visit vs. the placebo group. Specifically, overall comfort was rated significantly higher at both dispensing and 2 weeks. In addition, the anesthetic group exhibited significantly greater overall satisfaction with rigid lens wear at 2 and 4 weeks. Also, the anesthetic group perceived their adaptation, sensitivity, and adaptation time to be significantly better at the 1-month visit. There was no significant difference in corneal staining between these two groups at each visit, with the exception of a greater amount of staining in the central quadrant for the placebo group at the 1-month visit. CONCLUSIONS: The use of a topical anesthetic at the fitting and dispensing visits for first-time wearers of RGP lenses resulted in significantly fewer dropouts, improved initial comfort, an enhanced perception of the adaptation process, and greater overall satisfaction after 1 month of lens wear as compared to the use of a nonanesthetizing placebo at those visits. This result, in combination with both presenting RGP lenses in a nonthreatening manner and optimizing the lens design and fitting relationship, should result in a positive adaptation process and successful wear of RGP contact lenses.     

The hydrolytic polymerization of ε-caprolactone by triphenyltin acetate

The polymerization of ε-caprolactone (CL) using triphenyltin acetate has been investigated. Polymers with broad MWD were obtained in almost quantitative yield. After an initial induction period, the polymerization showed zero order kinetics with respect to monomer and nearly first order with respect to catalyst. The mechanism of the propagation reaction is proposed to proceed via an ester alcoholysis, with initiation by traces of water. The zero order kinetics are explained as follows: the tin catalyst is coordinated by the cyclic lactone, monomer addition to the polymer chain in the rate-determining step results in formation of an acyclic ester link, which is no longer a strong donor, and leads to a coordinatively unsaturated tin species.     

Early diagnosis of pulmonary embolism by means of scintigraphy

The occasions on which lung embolism is likely to occur and proceed with or without initial clinical symptoms are described. Lung scintiscanning technique, complemented by special expedients and personal experience, is explained. It is felt that the method helps in the early detection of suspect or clinically silent forms, as well as in the corroboration or ruling out of a clinical diagnosis as soon as this is possible. Scintiscanning is also of assistance in showing the anatomopathological features and extent of the process. The technique is simple and readily tolerated, even by patients with slight respiratory or circulatory disturbances. On the other hand, it is not competitive with conventional and well-tried angiopneumography.     

Middleware for the use of storage in communication

The Logistical Computing and Internetworking (LoCI) project is a reflection of the way that the next generation internetworking fundamentally changes our definition of high performance wide area computing. A key to achieving this aim is the development of middleware that can provide reliable, flexible, scalable, and cost-effective delivery of data with quality of service guarantees to support high performance applications of all types. The LoCI effort attacks this problem with a simple but innovative strategy. At the base of the LoCI project is a richer view of the use of storage in communication and information sharing.     

In vivo time-resolved reflectance spectroscopy of the human forehead

We present an in vivo broadband spectroscopic characterization of the human forehead. Absorption and scattering properties are measured on five healthy volunteers at five different interfiber distances, using time-resolved diffuse spectroscopy and interpreting data with a model of the diffusion equation for a homogeneous semi-infinite medium. A wavelength-tunable mode-locked laser and time-correlated single-photon counting detection are employed, enabling fully spectroscopic measurements in the range of 700-1000 nm. The results show a large variation in the absorption and scattering properties of the head depending on the subject, whereas intrasubject variations, assessed at different interfiber distances, appear less relevant, particularly for what concerns the absorption coefficient. The high intersubject variability observed indicates that a unique set of optical properties for modeling the human head cannot be used correctly. To better interpret the results of the analysis of in vivo measurements, we performed a set of four-layer model Monte Carlo simulations based on different data sets for the optical properties of the human head, partially derived from the literature. The analysis indicated that, when simulated time-resolved curves are fitted with a homogeneous model for the photon migration, the retrieved absorption and reduced scattering coefficients are much closer to superficial layer values (i.e., scalp and skull) than to deeper layer ones (white and gray matter). In particular, for the shorter interfiber distances, the recovered values can be assumed as a good estimate of the optical properties of the first layer.     

Extracellular Sphingosine-1-Phosphate Downstream of EGFR Increases Human Glioblastoma Cell Survival

Sphingosine-1-phosphate (S1P) is a crucial mediator involved in the progression of different cancers, including glioblastoma multiforme (GBM), the most frequent and deadly human brain tumor, characterized by extensive invasiveness and rapid cell growth. Most of GBMs overexpress the epidermal growth factor receptor (EGFR), and we investigated the possible link between S1P and EGFR signaling pathways, focusing on its role in GBM survival, using the U87MG human cell line overexpressing EGFR (EGFR+). We previously demonstrated that EGFR+ cells have higher levels of extracellular S1P and increased sphingosine kinase-1 (SK1) activity than empty vector expressing cells. Notably, we demonstrated that EGFR+ cells are resistant to temozolomide (TMZ), the standard chemotherapeutic drug in GBM treatment, and the inhibition of SK1 or S1P receptors made EGFR+ cells sensitive to TMZ; moreover, exogenous S1P reverted this effect, thus involving extracellular S1P as a survival signal in TMZ resistance in GBM cells. In addition, both PI3K/AKT and MAPK inhibitors markedly reduced cell survival, suggesting that the enhanced resistance to TMZ of EGFR+ cells is dependent on the increased S1P secretion, downstream of the EGFR-ERK-SK1-S1P pathway. Altogether, our study provides evidence of a functional link between S1P and EGFR signaling pathways enhancing the survival properties of GBM cells.