Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients.

PURPOSE: Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS). METHODS: Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995-December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017-October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan-Meier method. RESULTS: In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5-8.9) versus 12.9 years (95% CI 11.7-14.0), respectively. CONCLUSION: Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments.

Intravesical ichthyosis: a rare case report.

BACKGROUND: Ichthyosis is a rare skin disorder, in which the shedding of squamous cells is altered. Intravesical ichthyosis is an extremely rare condition. There is evidence for an association with intravesical condylomata accuminata, caused by urogenital infections of the human papilloma virus. These lesions are generally benign but known to be of a carcinogenic potential and therefore should be treated immediately and followed-up closely. CASE PRESENTATION: We present the case of a 39-year-old woman who presented with recurrent urinary tract infections. During cystoscopy diffuse black pigmented flat bladder tumours were visualized. After transurethral resection the pathological report diagnosed an ichthyosis vesicae. CONCLUSION: We recommend a complete resection with frequent clinical and cystoscopic follow-up. Furthermore, testing for the human papilloma virus should be performed and a vaccination should be offered to the patient. As ichthyosis vesicae is a rare phenomenon, there is an evident lack of clinical data regarding therapy, prognosis and follow-up. With our report, we want to emphasize the need for further research.

Superior efficacy of neoadjuvant chemotherapy and radical cystectomy in cT3-4aN0M0 compared to cT2N0M0 bladder cancer.

In this study, we compared complete pathological downstaging (pCD, ≤(y)pT1N0) and overall survival (OS) in patients with cT2 versus cT3-4aN0M0 UC of the bladder undergoing radical cystectomy (RC) with or without neoadjuvant chemo- (NAC) or radiotherapy (NAR). A population-based sample of 5,517 patients, who underwent upfront RC versus NAC + RC or NAR + RC for cT2-4aN0M0 UC between 1995-2013, was identified from the Netherlands Cancer Registry. Data were retrieved from individual patient files and pathology reports. pCD-rates were compared using Chi-square tests and OS was estimated by Kaplan-Meier analyses. Multivariable analyses were conducted to determine odds (OR) and hazard ratios (HR) for pCD-status and OS, respectively. We included 4,504 (82%) patients with cT2 and 1,013 (18%) with cT3-4a UC. Median follow-up was 9.2 years. In cT2 UC, pCD-rate was 25% after upfront RC versus 43% (p < 0.001) and 33% (p = 0.130) after NAC + RC and NAR + RC, respectively. In cT3-4a UC, pCD-rate was 8% after upfront RC versus 37% (p < 0.001) and 16% (p = 0.281) after NAC + RC and NAR + RC, respectively. In cT2 UC, 5-year OS was 57% and 51% for NAC + RC and upfront RC, respectively (p = 0.135), whereas in cT3-4a UC, 5-year OS was 55% for NAC + RC versus 36% for upfront RC (p < 0.001). In multivariable analysis for OS, NAC was beneficial in cT3-4a UC (HR: 0.67, 95%CI 0.51-0.89) but not in cT2 UC (HR: 0.91, 95%CI 0.72-1.15). NAR did not influence OS. In conclusion, NAC + RC was associated with superior pCD compared to RC alone and NAR + RC. Superior OS for NAC + RC compared to RC alone was especially evident in cT3-4a disease.

Urogenital and Sexual Complaints in Female Club Cyclists-A Cross-Sectional Study.

INTRODUCTION: Cycling has gained increased popularity among women, but in contrast to men, literature on urogenital overuse injuries and sexual dysfunctions is scarce. AIM: To determine the prevalence and duration of urogenital overuse injuries and sexual dysfunctions in female cyclists of the largest female cycling association in The Netherlands. METHODS: A cross-sectional questionnaire survey was sent to 350 members of the largest female Dutch cycling association and 350 female members of a Dutch athletics association (runners). MAIN OUTCOME MEASURES: The prevalence and duration of urogenital overuse injuries and sexual complaints were assessed using predefined international definitions. RESULTS: Questionnaire results of 114 cyclists (32.6%) and 33 runners (9.4%) were analyzed. After at least 2 hours of cycling, dysuria, stranguria, genital numbness, and vulvar discomfort were present in 8.8%, 22.2%, 34.9%, and 40.0%, respectively (maximum duration 48 hours). These complaints are not present in the controls (P < .001). In multivariable logistic regression analysis, increased saddle width was significantly associated with the presence of dysuria and stranguria. Older age was significantly associated to the presence of vulvar discomfort. Of the cyclists, 50.9% has at least one urogenital overuse injury. Insertional dyspareunia was present in 40.0% of cyclists and lasted until 48 hours after the effort. The latter complaint was not present in runners (P < .001). Uni- or bilateral vulvar edema was reported by 35.1% of cyclists. As for general complaints, 18.4% of cyclists reported a change in sexual sensations and 12.8% reported difficulties in reaching orgasm owing to cycling-related complaints. Limitations include population size and the use of non-validated questionnaires. CONCLUSIONS: The results of this study suggest that urogenital overuse injuries and sexual complaints are highly prevalent in female cyclists who are active participants in riding groups.

Coupling heat and chemical tracer experiments for estimating heat transfer parameters in shallow alluvial aquifers.

Geothermal energy systems, closed or open, are increasingly considered for heating and/or cooling buildings. The efficiency of such systems depends on the thermal properties of the subsurface. Therefore, feasibility and impact studies performed prior to their installation should include a field characterization of thermal properties and a heat transfer model using parameter values measured in situ. However, there is a lack of in situ experiments and methodology for performing such a field characterization, especially for open systems. This study presents an in situ experiment designed for estimating heat transfer parameters in shallow alluvial aquifers with focus on the specific heat capacity. This experiment consists in simultaneously injecting hot water and a chemical tracer into the aquifer and monitoring the evolution of groundwater temperature and concentration in the recovery well (and possibly in other piezometers located down gradient). Temperature and concentrations are then used for estimating the specific heat capacity. The first method for estimating this parameter is based on a modeling in series of the chemical tracer and temperature breakthrough curves at the recovery well. The second method is based on an energy balance. The values of specific heat capacity estimated for both methods (2.30 and 2.54MJ/m(3)/K) for the experimental site in the alluvial aquifer of the Meuse River (Belgium) are almost identical and consistent with values found in the literature. Temperature breakthrough curves in other piezometers are not required for estimating the specific heat capacity. However, they highlight that heat transfer in the alluvial aquifer of the Meuse River is complex and contrasted with different dominant process depending on the depth leading to significant vertical heat exchange between upper and lower part of the aquifer. Furthermore, these temperature breakthrough curves could be included in the calibration of a complex heat transfer model for estimating the entire set of heat transfer parameters and their spatial distribution by inverse modeling.

Worlds apart 3: Botswana and Zambia. Secrets of success in southern Africa.

PIP: Botswana must close the gap between knowledge and practice if population growth is to be decreased. Community-based efforts have been partially successful, but obstacles are posed by cultural attitudes, misinformation and fear, teenage mistrust of family planning (FP) clinics, and slow FP service due to skilled labor shortages. The growth rate has declined from 3.5 in 1980 to 2.8, but population may still increase from 1.3 million in 1991 to 2.3 million by 2011. About 60% of the population is aged under 30 years. The increased population is expected to strain resources for social services, exacerbate employment absorption, and contribute to environmental degradation. Although fertility was still very high at 5.0 in 1991, the total fertility rate 10 years ago was 7.1. In 1988, 90% of women knew of a modern method, and contraceptive usage of a modern method increased to 33%. The government aimed to increase contraceptive prevalence to 40% between 1991 and 1997. Botswana, compared to the same-sized Zambia, has been able to rapidly reduce its fertility with only 33% of Zambia's arable land and lesser urbanization. The difference in these two countries may be in Botswana's work force, 33% of which is made up of women, and in the high female school enrollment. Government officials acted without an official population policy before voluntary FP associations were involved to encourage parents to space their children and use modern methods. The integration of maternal and child health and FP was responsible for much of the fertility decline. Family life education was initiated in school curriculums in the early 1980s. Male contraceptive use and parent education in communication with youth have received the attention of nongovernmental groups. 86% of the population lives within 15 km of a health center, and 73% lives within 8 km. Improvements are still needed in training health service staff to be sensitive to client concerns and to shorten waiting times. In 1987, the government approved dispensing of contraceptives to adolescents, who still fear clinics and reprisal from parents discovering their sexual activity or their contraceptive use.^ieng

Worlds apart 3: Botswana and Zambia. Zambian women's needs not being met.

PIP: Zambia has not been as successful as neighboring Botswana in reducing fertility. Zambian fertility only declined from 7.1 to 6.5 between 1972 and 1992. Only 15% use modern contraception, even though 87% have knowledge of modern contraception and a source of supply. A major obstacle to fertility decline is the lack of government endorsement of family planning (FP), even though the Planned Parenthood Association of Zambia has promoted FP since 1972. Contraception was feared and perceived as the persecution of Black Africans by White colonists. State hospitals did not begin accepting FP until the late 1970s, and foreign aid was directed to maternal and child health services. In 1989, a national population policy was adopted, and goals were set to attain 30% contraceptive prevalence by the year 2000. Health services lacked trained personnel to provide FP services. Teenagers were particularly unaware of contraception in a country where, in 1992, 66% of women were either mothers or pregnant by the age of 19 years. Unmet need was estimated at 33% of women who desired a delay in childbearing or no more children. Service accessibility was an obstacle, since many remote areas were 20-25 km from a health center. Other obstacles to good health were contaminated water supplies, lack of hygienic practices, and air pollution. 71% of the population lived in absolute poverty in 1990. Overcrowding in urban areas and lack of educational facilities contributed to the lack of social development. The tropical climate and shortages of arable land coupled with high fertility resulted in a difficult existence. Cultural support for a large family was still strong. Donor and government support is currently directed to contraceptive logistics, communications, contraceptive social marketing, community- and employment-based distribution, operations research, and safe abortions, which are legal but cumbersome because of bureaucratic procedures and the lack of an informed population.^ieng