Sarcopenic Obesity and its Prognostic Impact on Urological Cancers: A Systematic Review.

PURPOSE: Sarcopenia, an age-related loss of muscle mass and function, may predict adverse outcomes for patients with urological cancers. However, the clinical implications and significance of sarcopenic obesity are not well understood. We systematically reviewed data on the prevalence and prognostic impact of sarcopenic obesity for patients with renal cell carcinoma, urothelial carcinoma and prostate cancer undergoing treatment. MATERIALS AND METHODS: We searched EMBASE®, PubMed®/MEDLINE® and Scopus® for relevant original articles and abstracts published between January 2010 and February 2021. Primary outcomes were overall survival (OS), cancer-specific survival (CSS) and progression-free survival. The secondary outcome was the prevalence of sarcopenic obesity. RESULTS: A total of 15 studies comprising 3,866 patients were included. Of the 10 studies that evaluated survival outcomes, the association between sarcopenic obesity and survival was mixed. One of 10 studies showed a significant association of sarcopenic obesity with OS (HR 0.7, 95% CI 0.51-0.98; p=0.04). One additional study showed reported a trend for shorter OS (p=0.05) associated with sarcopenic obesity. Others reported that it is an adverse prognostic factor for CSS (HR 5.0, 95% CI 1.4-16.7; p=0.01). All other studies did not demonstrate that sarcopenic obesity was of prognostic relevance with regard to OS, CSS and progression-free survival. Overall, its mean prevalence was 27% (range 11-63). CONCLUSIONS: There is considerable heterogeneity in methods used to define sarcopenic obesity in the literature, and current data are limited. Future studies are needed to further understand the relationship of obesity and sarcopenia on the clinical trajectory of patients with urological cancer.

Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance.

BACKGROUND: Central venous catheter (CVC) placement under ECG guidance in the left thoracocervical area can lead to catheter misplacement. The aim of this study was to identify the cause and quantify the magnitude of this error. METHODS: CVCs were sited in either the left or right internal jugular (IJ), subclavian (SC), or innominate (brachiocephalic) vein using the Seldinger technique and a total of 227 insertions were studied. The position of the catheter tip was confirmed with two different intra-atrial ECG monitoring methods (Seldinger's wire vs 10% saline solution). Measurements were compared between the two methods and correlated to the different access sites. RESULTS: All right-sided CVC had the line tip in the optimal position and both intra-atrial ECG recording by Seldinger's wire or 10% saline delivered correct results. For left-sided lines, however, the two methods gave significantly different results regarding the position of the line tip for each insertion site. When using the Seldinger wire as intravascular ECG lead, the results differed from the saline method by a mean of 21 mm for the IJ and 10 mm for the SC. CONCLUSIONS: CVC placement under ECG guidance is a reliable method to site the line tip at the optimal position. However, when using a left-sided thoracocervical access point, the Seldinger wire-conducted ECG delivered a constant error. This could be adjusted for by advancing the CVC 20 mm in addition to the wire-based measurement of the insertion depth at the left IJ vein and 10 mm at the left SC vein.

Platelet PD-L1 suppresses anti-cancer immune cell activity in PD-L1 negative tumors.

Strategies that interfere with the binding of the receptor programmed cell death protein-1 (PD-1) to programmed death ligand-1 (PD-L1) have shown marked efficacy against many advanced cancers, including those that are negative for PD-L1. Precisely why patients with PD-L1 negative tumors respond to PD-1/PD-L1 checkpoint inhibition remains unclear. Here, we show that platelet-derived PD-L1 regulates the growth of PD-L1 negative tumors and that interference with platelet binding to PD-L1 negative cancer cells promotes T cell-induced cancer cytotoxicity. These results suggest that the successful outcomes of PD-L1 based therapies in patients with PD-L1 negative tumors may be explained, in part, by the presence of intra-tumoral platelets. Altogether, our findings demonstrate the impact of non-cancer/non-immune cell sources of PD-L1 in the tumor microenvironment in the promotion of cancer cell immune evasion. Our study also provides a compelling rationale for future testing of PD-L1 checkpoint inhibitor therapies in combination with antiplatelet agents, in patients with PD-L1 negative tumors.

Chemical synthesis and NMR spectroscopy of long stable isotope labelled RNA.

We showcase the high potential of the 2'-cyanoethoxymethyl (CEM) methodology to synthesize RNAs with naturally occurring modified residues carrying stable isotope (SI) labels for NMR spectroscopic applications. The method was applied to synthesize RNAs with sizes ranging between 60 to 80 nucleotides. The presented approach gives the possibility to selectively modify larger RNAs (>60 nucleotides) with atom-specifically 13C/15N-labelled building blocks. The method harbors the unique potential to address structural as well as dynamic features of these RNAs with NMR spectroscopy but also using other biophysical methods, such as mass spectrometry (MS), or small angle neutron/X-ray scattering (SANS, SAXS).

Placement of endosteal implants in the zygoma after maxillectomy: a Cadaver study using surgical navigation.

Endosteal implants facilitate obturator prosthesis fixation in tumor patients after maxillectomy. Previous clinical studies have shown, however, that the survival of implants placed into available bone after maxillectomy is generally poor. Nevertheless, implants positioned optimally in residual zygomatic bone provide superior stability from a biomechanical point of view. In a pilot study, the authors assessed the precision of VISIT, a computer-aided surgical navigation system dedicated to the placement of endosteal implants in the maxillofacial area. Five cadaver specimens underwent hemimaxillectomy. The cadaver head was matched to a preoperative high-resolution computed tomograph by using implanted surgical microscrews as fiducial markers. The position of a surgical drill relative to the cadaver head was determined with an optical tracking system. Implants were placed into the zygomatic arch, where maximum bone volume was available. The results were assessed using tests for localization accuracy and postoperative computed tomographic scans of the cadaver specimens. The localization accuracy of landmarks on the bony skull was 0.6 +/- 0.3 mm (average +/- SD), as determined with a 5-df pointer probe; the localization accuracy of the tip of the implant burr was 1.7 +/- 0.4 mm. The accuracy of the implant position compared with the planned position was 1.3 +/- 0.8 mm for the external perforation of the zygoma and 1.7 +/-1.3 mm for the internal perforation. Eight of 10 implants were inserted with maximal contact to surrounding bone, and two implants were located unfavorably. Reliable placement of implants in this region is difficult to achieve. The technique described in this article may be very helpful in the management of patients after maxillary resection with poor support for obturator prostheses.

Computer-aided surgery in distraction osteogenesis of the maxilla and mandible.

When using unidirectional intraoral distraction devices, it is desirable to be able to determine the final position of the bone fragment after the distraction procedure. However, additional constraining forces from adjacent tissues render the prediction of the distraction direction difficult. We have utilised computer-aided surgery in three patients for intraoperative control of the distraction direction. In one cleft palate patient, suffering from maxillary hypoplasia and anterior open bite, a modified Le Fort I osteotomy and maxillary distraction was performed. Despite a ventrocaudal position of the distraction device, intraoperative computer visualisation showed an unfavourable caudal vector of distraction without any anterior movement. The final result confirmed the direction indicated by the computer. Maxillary advancement remained insufficient. In two patients suffering from mandibular hypoplasia, intraoperative assessment revealed a favourable direction of distraction. The distraction procedure led to a satisfactory result in both cases. Computer-aided surgery is helpful in assessing the vector of distraction intraoperatively, making the result of the distraction procedure more predictable and allowing instant correction by adequate reapplication of the device.

Comparison of six three-dimensional navigation systems during sinus surgery.

Three-dimensional (3D) navigation systems are routinely used in the fields of endoscopic skull base surgery, neurosurgery, maxillo-facial and endoscopic sinus surgery. The use of such systems is associated with the following advantages: a better 3D orientation: a more confident surgeon; a more precise surgical approach; and a reduced operation time. Six different brands of 3D navigation system were compared in order to find out if there are major differences in performance and whether the considerable financial investment required to purchase such a system would be justified by a noticeable improvement in surgical interventions and a realization of the above expectations. The 3D navigation systems were tested by performing endoscopic sinus surgery on 26 patients suffering from chronic sinusitis. The system accuracy, the confidence of the surgeon, the time of anaesthesia, the cost, the number of personnel required (and their skills), and the technical resources were compared. No major differences in performance of the different brands of 3D navigation system were noticed. All of the systems showed high, but varying, system precision, the surgeons felt more confident and the time of anaesthesia was prolonged by 5-15 min. A well-trained operating staff is required. Assuming that the initial costs are excluded and that data transfer occurs automatically, personnel costs and the extra time required still have to be considered.

Comparison of different 3D navigation systems by a clinical "user".

Three-dimensional navigation systems are routinely used in endoscopic skull base surgery, neurosurgery, maxillo-facial and endoscopic sinus surgery. Their precision can, however, change in the course of one experiment. We have compared five different 3D navigation systems and discuss here possible reasons for the limits of system precision. A plexiglass cube on which test points were marked served as a test-model. Two well-trained system users measured the distances between the test points in each of the five systems. The results were compared with reference data provided by the NUMEREX device at the Technical University of Vienna. The accuracy data shown by all these 3D navigation systems ranged from 0.0 mm to 6.67 mm. The accuracy data of a system calculated in advance did not always correspond with the system precision on the screen. The system precision in the center of the cube was higher than on its surface, which made us conclude that the angle between the tracker system and the pointing device touching the test point may be critical for system precision. Applying an automatic registration step did not result in greater system precision. Slice thickness and the angle of the pointing device seem to be responsible for system precision.

[Telenavigation and expert consultation using a stereotaxic surgical videoserver]. / Telenavigation und Expertenkonsultation mit Hilfe eines stereotaktischen Operationsvideoservers.

The exponential increase of medical information creates a need for new methods in the visualization of medical imaging modalities for diagnosis and therapy. In this sense, visualization includes the display of medical image data and image-guided stereotaxic navigation as well as the advice of an expert. The Artma Virtual Patient System enables a remote expert to observe the surgical procedure via the Internet and interactively modify the interoperative visualization from the remote location. The expert in the remote location receives the planning data almost in real time over TCP/IP from a stereotaxic videoserver. In addition to live video streaming, stereotaxic navigation data are sent over the network as rigid body coordinates. The expert modifies the surgical simulation on the remote computer and the modified operating plan is sent back to the operating site. By teleconsulting, the composite images and overlapping graphics--instruments, target structures, landmarks, contour--can be seen in affiliated clinics with the possibility of interactive graphical assistance. With this image fusion technology the knowledge of a remote expert is included in virtual data structures and visualized by the overlay with live video data (augmented reality) in real time during surgery.