Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital.

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Seeding artificial habitats with native benthic species can prevent the occurrence of exotic organisms.

Seeding native species on pillars and platforms of marinas and harbors has been suggested to reduce space availability and prevent the colonization of exotic nuisance species, which are usually associated with coastal urbanization. The efficacy of seeding, however, has been tested mainly on the intertidal zone. To test how seeding native species in the subtidal zone affects the subsequent colonization and spread of exotic species and the community diversity, we deployed 10 PVC plates seeded with adults of the native sponge Mycale angulosa, 10 with the native ascidian Symplegma rubra, both covering about 6% of the available substrate, and 10 plates free of any intervention in a recreational marina from the Southwestern Atlantic Ocean. We then assessed the diversity and structure of the sessile community across treatments after eight months. Seeding the substrate with S. rubra resulted in no difference to unseeded communities, which were dominated by the exotic bryozoan Schizoporella errata (>66% of the substrate) and supported on average 16.9 ± 1.3 and 14.2 ± 2.0 morphospecies, respectively. However, seeding the substrate with M. angulosa resulted in a distinct community dominated by the seeded sponge (>97% of the substrate) and supporting only 3.2 ± 0.5 morphospecies. Besides, all 13 registered exotic species were reported from communities seeded with S. rubra, 11 from the unseeded communities, but only three were observed in those seeded with M. angulosa. While the consequences of the low diversity of the community seeded with M. angulosa must be addressed since poor communities are usually associated with low biotic resistance to invasion, seeding resulted in a high dominance of the native sponge, reducing the monopolization of resources by exotic species. These results suggest that seeding the substrate with native species should be implemented along with other interventions for managing artificial habitats in the coastal zone.

Beyond ba-ba and gu-gu: challenges and strategies in coding infant vocalizations.

Infant vocal behaviors are extremely complex. Consequently, coding these behaviors is difficult and is typically associated with low reliability across observers. Various difficulties that arise when dealing with prelinguistic vocalizations, especially in the first 6 months of life, are outlined here. A proposed database of digitized infant vocalizations that illustrates strategies used to deal with these difficulties is then described. These strategies are based on theoretical infraphonological constructs, empirical observations, and information about the nature of mature phonological systems. Furthermore, the strategies are open-ended and can be modified as new information becomes available regarding infant vocal behaviors. At present, a preliminary database is available on the Web that illustrates some of these strategies. As the database is expanded, it is expected to provide a general framework for observers to categorize infant vocalizations and thereby enhance observer reliability.

Soluble dietary fiber and cholesterol influence in vivo hepatic and intestinal cholesterol biosynthesis in rats.

Ninety-six male Sprague-Dawley rats were randomly assigned to eight dietary treatments. Rats were fed, with ad libitum access, diets containing 10% dietary fiber as cellulose (control), pectin, psyllium or oat bran with or without 0.3% added cholesterol for 3 wk. Among cholesterol-fed rats, liver total cholesterol was significantly lower in rats fed diets supplemented with either pectin or psyllium compared with those fed cellulose. In contrast, rats fed oat bran with cholesterol had significantly higher liver cholesterol concentrations compared with cellulose-fed animals. Liver total lipid concentrations were significantly lower in groups fed pectin and psyllium with or without dietary cholesterol compared with cellulose-fed controls. Pectin feeding with or without dietary cholesterol significantly lowered plasma total cholesterol compared with cellulose feeding. Oat bran had no effect on plasma total cholesterol compared with control diets. Hepatic sterol synthesis was significantly greater for animals fed soluble dietary fibers compared with those fed cellulose, but the effect on intestinal sterol synthesis was less pronounced.

Dietary soluble fiber and cholesterol affect serum cholesterol concentration, hepatic portal venous short-chain fatty acid concentrations and fecal sterol excretion in rats.

Sprague-Dawley rats were fed diets containing 7.5% dietary fiber as cellulose (control), pectin, psyllium or oat bran with or without 0.3% added cholesterol for 3 wk. Among rats fed cholesterol, liver total lipid and cholesterol concentrations were significantly lower in groups fed pectin, psyllium and oat bran compared with cellulose-fed controls. Cholesterol feeding resulted in significantly greater liver cholesterol in rats fed cellulose, psyllium and oat bran but not in those fed pectin. Among rats fed cholesterol, total serum cholesterol levels were significantly lower in those fed pectin than in those fed psyllium, oat bran or cellulose. When cholesterol was fed, the oat bran-fed group had significantly higher butyrate and the pectin-fed group had significantly higher propionate concentrations in the hepatic portal vein than did cellulose-fed controls. The groups fed psyllium, oat bran and pectin all had significantly higher fecal neutral sterols than did the cellulose-fed group when cholesterol was fed. Without dietary cholesterol only pectin-fed rats had significantly higher fecal excretion of neutral sterols than those fed cellulose. Dietary fiber did not influence fecal acidic sterol excretion. However, the addition of cholesterol to these fiber diets was accompanied by a significantly higher bile acid excretion than that of animals fed cellulose without cholesterol. The results of this study indicate that soluble dietary fibers may exert their hypocholesterolemic effect by increasing excretion of fecal neutral sterols.