Translational research will fail without surgical leadership: SCOTRRCC a successful surgeon-led Nationwide translational research infrastructure in renal cancer.

BACKGROUND: High quality human biosamples with associated high quality clinical data are essential for successful translational research. Despite this, the traditional approach is for the surgeon to act as a technician in the tissue collection act. Biomarker research presents multiple challenges and the field is littered with failures. Tissue quality, poor clinical information, small sample numbers and lack of validation cohorts are just a few reasons for failure. It is clear that the surgeon involved in tissue acquisition must be fully engaged in the process of biosampling for a specific condition, as this will negate many of the issues for translational research failure due to an inadequate bioresource. APPROACH: In this Matter for Debate paper, the Scottish Collaboration On Translational Research into Renal Cell Cancer (SCOTRRCC) is discussed as an example of a urological surgery lead bioresource which has resulted in a National collection of renal cancer tissue and blood (from over 900 patients to date), negating all of the traditional issues with biobanks because of close enagagement and acknowledgement of urologists and uropathologists from seven centres around Scotland. SCOTRRCC has leveraged renal cancer research in Scotland resulting in several high impact publications and providing a springboard for future research in this disease in Scotland and beyond. CONCLUSIONS: The SCOTRRCC model presented here can be transferred to other surgical disciplines for success in translational research.

Efficacy of temsirolimus in metastatic chromophobe renal cell carcinoma.

BACKGROUND: Renal cell carcinoma (RCC) is a histopathologically and molecularly heterogeneous disease with the chromophobe subtype (chRCC) accounting for approximately 5% of all cases. The median overall survival of advanced RCC has improved significantly since the advent of tyrosine kinase inhibitors and mammalian target of rapamycin (mTOR) inhibitors. However, high-quality evidence for the use of new generation tyrosine kinase inhibitors in patients with advanced chRCC is lacking. Few published case reports have highlighted the use of temsirolimus in chRCC. CASE PRESENTATION: Here, we report the case of a 36-year-old Caucasian woman with metastatic chRCC with predominantly skeletal metastases who was refractory to sunitinib who demonstrated a durable clinical response to temsirolimus lasting 20 months. We review the available evidence pertaining to the use of new generation molecularly targeted agents, in particular mTOR inhibitors in chRCC and discuss their emerging role in the management of this disease which would aid the oncologists faced with the challenge of treating this rare type of RCC. CONCLUSION: Conducting randomised clinical trials in this rarer sub-group of patients would be challenging and our case report and the evidence reviewed would guide the physicians to make informed decision regarding the management of these patients.

Validation of the pulse rate over pressure evaluation index as a detector of early occult hemorrhage: a prospective observational study.

BACKGROUND: The aim of this study was to validate a calculation of pulse rate (PR) divided by pulse pressure (pulse rate over pressure evaluation [ROPE] index) as a method of predicting early hemorrhagic compensation in healthy patients donating blood. The ROPE index calculations were compared with shock index (PR divided by systolic blood pressure) calculations for the same donors. METHODS: This was a prospective serial observational study where blood donors received blood pressure and PR recordings immediately before and after donating 1 unit (470 mL) of blood over 20 minutes while in the supine position. ROPE and shock indices were calculated for each recording. The indices calculated before and after blood loss were analyzed to determine whether there was a significant change. RESULTS: One hundred sixteen donors were assessed; 78% and 73% experienced a significant decrease in systolic blood pressure and pulse pressure, respectively. There was no significant change in PR. Both the mean ROPE and shock indices increased significantly by 12.2% (p < 0.0001) and 6.9% (p < 0.0001), respectively. The ROPE index correlated well with the shock index in donors, both before and after blood loss (Pearson's correlation coefficients of 0.80 and 0.79, respectively). Changes in both indices had a similar but looser correlation (Pearson's correlation coefficient of 0.60). CONCLUSION: Loss of 1 unit of blood in adult donor causes a significant increase in a blood donor's ROPE and shock indices. This supports previous research which suggests that changes in the ROPE index have the potential to be an early indicator of blood loss. LEVEL OF EVIDENCE: Prognostic study, level II.