Successful bladder-sparing partial cystectomy for muscle-invasive domal urothelial carcinoma with sarcomatoid differentiation: a case report.

High-grade (HG) urothelial carcinoma (UC) with variant histology has historically been managed conservatively. The presented case details a solitary lesion of muscle-invasive bladder cancer (MIBC) with sarcomatoid variant (SV) histology treated by partial cystectomy (PC) and adjuvant chemotherapy. A 71-year-old male with a 15-pack year smoking history presented after outside transurethral resection of bladder tumor (TURBT). Computerized tomography imaging was negative for pelvic lymphadenopathy, a 2 cm broad-based papillary tumor at the bladder dome was identified on office cystoscopy. Complete staging TURBT noted a final pathology of invasive HG UC with areas of spindle cell differentiation consistent with sarcomatous changes and no evidence of lymphovascular invasion. The patient was inclined toward bladder-preserving options. PC with a 2 cm margin and bilateral pelvic lymphadenectomy was performed. Final pathology revealed HG UC with sarcomatoid differentiation and invasion into the deep muscularis propria, consistent with pathologic T2bN0 disease, a negative margin, and no lymphovascular invasion. Subsequently, the patient pursued four doses of adjuvant doxorubicin though his treatment was complicated by hand-foot syndrome. At 21 months postoperatively, the patient developed a small (<1 cm) papillary lesion near but uninvolved with the left ureteral orifice. Blue light cystoscopy and TURBT revealed noninvasive low-grade Ta UC. To date, the patient has no evidence of HG UC recurrence; 8 years after PC. Patient maintains good bladder function and voiding every 3-4 h with a bladder capacity of around 350 ml. Surgical extirpation with PC followed by adjuvant chemotherapy may represent a durable solution for muscle invasive (pT2) UC with SV histology if tumor size and location are amenable. Due to the sparse nature of sarcomatous features within UC, large multicenter studies are required to further understand the clinical significance and optimal management options for this variant histology.

Calculating minimum safety distance against wildfires at the wildland-urban interface in Chile and Spain.

Wildfires in the urban-forest interface constitute a civil protection emergency, causing considerable personal injury and damage to properties. The potential impacts of wildfires on buildings can be minimized by reducing the surrounding fuel and the use of structural materials with low flammability. However, the costs associated with implementing these actions and the responsibility for maintenance usually present conflicts with the property owners. This study aimed to identify minimum safety distances in wildland-urban interfaces within priority areas. The priority areas were identified based on the integration of fire risk and fuel hazard. Radiant heat is a variable in the behavior of fire that directly influences the definition of safety distances. In this research the radiant heat transfer was calculated based on the potential fire behavior for each study area. A comparative study of the horizontal heat transfer method and the radiant heat flux model was carried out. The horizontal heat transfer method indicated the highest vegetation-free distances, ranging from 23 m to 32 m. Some safety distances were validated using experimental fires and wildfires. The findings from the experimental fires and wildfires emphasize the need for a progressive fuel load reduction to mitigate radiant heat transfer. This may include both the removal of surface fuel and removal of trees to mitigate against crown fires. Our findings provide relevant information for decision-making on the effectiveness and efficiency of safety distances at the wildland-urban interface.

Brachial artery responses in menopausal women using tibolone.

OBJECTIVE: To determine the effect of tibolone treatment on brachial artery pulsatility index (PI), resistance index (RI), and flux-mediated dilation (FMD) in postmenopausal Mexican women. METHOD: The FMD, PI, and RI of the right brachial artery were measured in 19 postmenopausal women before and after they received a hyperemic stimulus, first at baseline and then following a 6-month treatment with 2.5 mg of tibolone per day. Statistical analysis was performed using the t test. RESULTS: The mean+/-SD age was 52.2+/-3.9 years; time since menopause was 24.6+/-16.7 months; and treatment duration was 5.7+/-2.0 months. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in PI were observed at baseline. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in both PI and RI were observed post-treatment. CONCLUSION: Tibolone treatment had a favorable effect on brachial artery responses to hyperemic stimuli.