Gender and cystectomy for bladder cancer: A high-volume tertiary urologic care center experience.

BACKGROUND: Differences have often been reported in the outcomes of bladder cancer (BC) patients according to gender. OBJECTIVE: This study aims to provide data on patients undergoing radical cystectomy (RC) in a high-volume tertiary urologic center and to assess whether gender discrepancies do exist in terms of surgical options and clinical outcomes. MATERIALS AND METHODS: Consecutive BC patients treated between 2016 and 2020 at a single center (Careggi University Hospital, Florence, Italy) were included in the study. The impact of gender on disease stage at diagnosis, overall survival (OS), and type of surgery was analyzed. RESULTS: The study series comprised 447 patients (85 females and 362 males). At a median follow-up of 28.3 months (IQR: 33.5), OS was 52.6% and cancer-specific survival was 67.6%. Significant differences in OS emerged for age, acute myocardial infarction (AMI), Charlson Comorbidity Index (CCI), pT, and pN. OS rates were higher in patients undergoing robot-assisted surgery and in those receiving open orthotopic neobladder (ONB) (p = 0.0001). No statistically significant differences were found between male and female patients regarding surgical offer in any age group, surgical time, early postoperative complications, pathologic stage, and OS. CONCLUSIONS: After adjustment for pathologic tumor stage and treatment modalities, female and male patients showed similar oncologic outcomes. Further studies should be undertaken to evaluate functional results in women subjected to RC.

Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review.

BACKGROUND: Inverted urothelial papilloma (IUP) of the upper urinary tract is an uncommon benign tumour that occasionally presents as a polypoid mass causing urinary obstruction. Histologically, IUP is characterised by a proliferating urothelium arranged in cords and trabeculae, in continuity with overlying intact epithelium, and extending into the lamina propria in a non-invasive, endophytic manner. Cytological atypia is minimal or absent. Top differential diagnoses include urothelial carcinoma with inverted growth pattern and florid ureteritis cystica. Although urothelial carcinomas of the upper urinary tract with prominent inverted growth pattern commonly harbour microsatellite instability, the role of the mutator phenotype pathway in IUP development is still unclear. The aim of this study was to describe two additional cases of IUP of the upper urinary tract, along with an extensive literature review. CASE PRESENTATION: We observed two polypoid tumours originating in the renal pelvis and the distal ureter, respectively. Both patients, a 76-year-old woman and a 56-year-old man, underwent surgery because of the increased likelihood of malignancy. Histology was consistent with IUP and patients are alive and asymptomatic after long-term follow-up (6 years for the renal pelvis lesion and 5 years for the ureter lesion). The tumours retained the expression of the mismatch-repair protein MLH1, MSH2, and PMS2 whereas loss of MSH6 was found in both cases. CONCLUSIONS: When completely resected, IUP does not require rigorous surveillance protocols, such as those for urothelial carcinoma and exophytic urothelial papilloma. It is therefore important for the surgical pathologist to be aware of this rare entity in order to ensure correct patient management.

Note: An analyzer for field detection of H2S by using cavity ring-down at 1.57 µm.

A prototype analyzer for the detection of hydrogen sulfide (H2S), based on cavity ring-down spectroscopy, is described. The device exploits, whenever possible, optical fibers, in order to simplify the alignment and to improve the stability. A trade-off between low detection level and simplicity has been pursued. The experimental results obtained during tests on different kinds of H2S samples are shown.

Mid-infrared frequency comb for broadband high precision and sensitivity molecular spectroscopy.

We report on the experimental demonstration of the metrological and spectroscopic performances of a mid-infrared comb generated by a nonlinear downconversion process from a Ti:sapphire-based near-infrared comb. A quantum cascade laser at 4330 nm was phase-locked to a single tooth of this mid-infrared comb and its frequency-noise power spectral density was measured. The mid-infrared comb itself was also used as a multifrequency highly coherent source to perform ambient air direct comb spectroscopy with the Vernier technique, by demultiplexing it with a high-finesse Fabry-Perot cavity.

High-coherence mid-infrared frequency comb.

We report on the generation of a frequency comb around 4330 nm with an unprecedented coherence of the single teeth. Generating the comb within a Ti:sapphire laser cavity by a difference-frequency process and using a phase-lock scheme based on direct digital synthesis, we achieve a tooth linewidth of 2.0 kHz in a 1-s timescale (750 Hz in 20 ms). The generated per-tooth power of 1 µW ranks this comb among the best ever realized in the mid-infrared in terms of power spectral density.

Subkilohertz linewidth room-temperature mid-infrared quantum cascade laser using a molecular sub-Doppler reference.

We report on the narrowing of a room-temperature mid-IR quantum cascade laser by frequency locking it to a CO2 sub-Doppler transition obtained by polarization spectroscopy. A locking bandwidth of 250 kHz has been achieved. The laser linewidth is narrowed by more than two orders of magnitude below 1 kHz, and its absolute frequency is stabilized at the same level.

Direct link of a mid-infrared QCL to a frequency comb by optical injection.

A narrow-linewidth comb-linked nonlinear source is used as master radiation to injection lock a room-temperature mid-infrared quantum cascade laser (QCL). This process leads to a direct lock of the QCL to the optical frequency comb, providing the unique features of narrow linewidth, absolute frequency, higher output power, and wide mode-hop-free tunability. The QCL reproduces the injected radiation within more than 94%, with a reduction of the frequency-noise spectral density by 3 to 4 orders of magnitude up to about 100 kHz, and a linewidth narrowing from a few MHz to 20 kHz.

Measuring frequency noise and intrinsic linewidth of a room-temperature DFB quantum cascade laser.

The frequency-noise power spectral density of a room-temperature distributed-feedback quantum cascade laser emitting at λ = 4.36 µm has been measured. An intrinsic linewidth value of 260 Hz is retrieved, in reasonable agreement with theoretical calculations. A noise reduction of about a factor 200 in most of the frequency interval is also found, with respect to a cryogenic laser at the same wavelength. A quantitative treatment shows that it can be explained by a temperature-dependent mechanism governing the transport processes in resonant tunnelling devices. This confirms the predominant effect of the heterostructure in determining shape and magnitude of the frequency noise spectrum in QCLs.

Molecular gas sensing below parts per trillion: radiocarbon-dioxide optical detection.

Radiocarbon ((14)C) concentrations at a 43 parts-per-quadrillion level are measured by using saturated-absorption cavity ringdown spectroscopy by exciting radiocarbon-dioxide ((14)C(16)O(2)) molecules at the 4.5 µm wavelength. The ultimate sensitivity limits of molecular trace gas sensing are pushed down to attobar pressures using a comb-assisted absorption spectroscopy setup. Such a result represents the lowest pressure ever detected for a gas of simple molecules. The unique sensitivity, the wide dynamic range, the compactness, and the relatively low cost of this table-top setup open new perspectives for ^{14}C-tracing applications, such as radiocarbon dating, biomedicine, or environmental and earth sciences. The detection of other very rare molecules can be pursued as well thanks to the wide and continuous mid-IR spectral coverage of the described setup.

Ti:sapphire laser intracavity difference-frequency generation of 30 mW cw radiation around 4.5 µm.

A cw mid-IR coherent source based on difference-frequency generation is designed and characterized. For mid-IR generation, a periodically poled MgO:LiNbO(3) crystal is placed inside a compact Ti:sapphire laser cavity. This provides high-power pump radiation for the nonlinear process. Optical injection by an external-cavity diode laser ensures single-frequency operation of the Ti:sapphire laser, while signal radiation is provided by a fiber-amplified Nd:YAG laser. Mid-IR radiation can be generated with 3850-4540 nm tuning range, narrow linewidth, Cs-standard traceability, and TEM(00) spatial mode. 30 mW power is obtained at 4510 nm.

Saturated-absorption cavity ring-down spectroscopy.

We report on a novel approach to cavity ring-down spectroscopy with the sample gas in saturated-absorption regime. This technique allows us to decouple and simultaneously retrieve the empty-cavity background and absorption signal, by means of a theoretical model that we developed and tested. The high sensitivity and frequency precision for spectroscopic applications are exploited to measure, for the first time, the hyperfine structure of an excited vibrational state of 17O12C16O in natural abundance with an accuracy of a few parts in 10{-11}.

Observing the intrinsic linewidth of a quantum-cascade laser: beyond the Schawlow-Townes limit.

A comprehensive investigation of the frequency-noise spectral density of a free-running midinfrared quantum-cascade laser is presented for the first time. It provides direct evidence of the leveling of this noise down to a white-noise plateau, corresponding to an intrinsic linewidth of a few hundred hertz. The experiment is in agreement with the most recent theory on the fundamental mechanism of line broadening in quantum-cascade lasers, which provides a new insight into the Schawlow-Townes formula and predicts a narrowing beyond the limit set by the radiative lifetime of the upper level.

Ultra-stable, widely tunable and absolutely linked mid-IR coherent source.

We report on a new coherent source that, using a phase-lock scheme to an optical frequency-comb synthesizer, achieves a 10-Hz intrinsic linewidth, is tunable from 4 to 4.5 microm with a presettable absolute frequency and, when coupled to a high-finesse cavity, can provide a short-term absorption sensitivity of 1.3 x 10(-11) cm(-1)Hz,(-1/2). These unique spectral features make this source a precise tool for molecular physics.

Lamb-dip-locked quantum cascade laser for comb-referenced IR absolute frequency measurements.

The frequency of a DFB quantum cascade laser (QCL) emitting at 4.3 microm has been long-term stabilized to the Lamb-dip center of a CO2 ro-vibrational transition by means of first-derivative locking to the saturated absorption signal. Thanks to the non-linear sum-frequency generation (SFG) process with a fiber-amplified Nd:YAG laser, the QCL mid-infrared (IR) radiation has been linked to an optical frequency-comb synthesizer (OFCS) and its absolute frequency counted with a kHz-level precision and an overall uncertainty of 75 kHz.

Animal performance and meat quality in cull cows with early weaned calves in Argentina.

Early weaning of calves (60 days old) is adopted in cow-calf operations for its high reproductive response. The objective of this research work was to find how age classes are related to beef quality in early weaning cull cows. Twenty four cows were grouped in four different age classes (teeth and number of calves produced) from two teeth and no calf produced, up to 12 years and 7 calves produced. All cows grazed a perennial pasture based on alfalfa and fescue. There were differences (P<0.05) in final weight (younger cows being lighter) but no other differences could be found during field conditions or in abattoir data (carcass weight and yield, top value hindquarter cuts weight and carcass percent). No differences (P>0.05) could be found in meat quality attributes except for moisture, protein and fat yellowness. Differences (P<0.05) in sensory attributes could only be found in connective tissue.

Frequency-comb-referenced quantum-cascade laser at 4.4 microm.

We report what we believe to be the first absolute frequency measurement performed using a quantum-cascade laser (QCL) referenced to an optical frequency comb synthesizer (OFCS). A QCL at 4.43 microm has been used for producing near-infrared radiation at 858 nm by means of sum-frequency generation with a Nd:YAG source in a periodically poled lithium niobate nonlinear crystal. The absolute frequency of the QCL source has been measured by detecting the beat note between the sum frequency and a diode laser at the same wavelength, while both the Nd:YAG and the diode laser were referenced to the OFCS. Doppler-broadened line profiles of (13)CO(2) molecular transitions have been recorded with such an absolute frequency reference.

Aerodynamic findings in esophageal voice.

OBJECTIVE: To define the perceptive and aerodynamic characteristics of esophageal voice in relation to different rehabilitation modalities. DESIGN: Cross-sectional study comparing perceptive and aerodynamic variables in 3 subject groups. SETTING: Referral center. SUBJECTS: A total of 19 subjects who underwent total laryngectomy were divided into groups A and B. Group A consisted of 13 subjects (who required speech therapy)-8 good speakers (subset A(1) who were >80% intelligible) and 5 mediocre speakers (subset A(2) who were <70% intelligible). Group B consisted of 6 subjects with a tracheoesophageal prosthesis (who were >90% intelligible). MAIN OUTCOME MEASURES: Perceptive variables included phonatory pauses and stomal noise. Aerodynamic variables included maximum phonation time, phonatory flow, phonatory volume, postphonatory volume, intensity, and articulatory pressure. RESULTS: Phonatory pauses and stomal noise statistically differentiated group A from group B and good speakers from mediocre speakers. Phonation time, phonatory volume, and phonatory flow were statistically higher in group B subjects compared with group A subjects. Postphonatory volume was significantly higher in group A. Intraoral pressure and postphonatory volume were statistically higher in subset A(2) subjects compared with subset A(1) subjects while maximum phonation time was significantly higher in subset A(1) subjects compared with subset A(2) subjects. CONCLUSIONS: In subset A(1) subjects a positive ratio between phonatory volume and phonatory flow was maintained with an adequate phonation time. In subset A(2) subjects a reduced phonatory volume was associated with a more rapid dispersion of phonatory flow, lower duration of phonation, and frequent pauses; stomal noise and consonant hyperarticulation worsened the voice performance in this group. In group B subjects the positive ratio between phonatory volume and phonatory flow represented the prerequisite of speech without frequent pauses.

MSSP, a protein binding to an origin of replication in the c-myc gene, interacts with a catalytic subunit of DNA polymerase alpha and stimulates its polymerase activity.

MSSP has been identified as a protein that binds to both single- and double-stranded sequences of a putative DNA replication origin sequence in the human c-myc gene. MSSP possesses versatile functions, including stimulation of DNA replication, transcriptional regulation, apoptosis induction, and cell transformation coordinated by c-Myc. MSSP contains two RNP domains, RNP1-A and RNP1-B, both of which are necessary for all of the functions of MSSP. In this study, we found that MSSP binds to the N-terminal region of a catalytic subunit of a human DNA polymerase alpha via its RNP domains both in vitro and in human cells. Furthermore, MSSP was released from the putative DNA replication origin of the c-myc gene after it complexed with DNA polymerase alpha, and MSSP stimulated DNA polymerase activity in vitro.

Paclitaxel efficacy and tolerability in second-line treatment of refractory and relapsed ovarian cancer patients.

Nineteen patients with recurrent or refractory ovarian carcinoma after a first-line platinum-based chemotherapy were treated with a 3-hour i.v. infusion of paclitaxel 175 mg/m2 every 3 weeks from November 1992 to October 1996. The major hematologic toxicity was neutropenia (63.2%). No febrile neutropenia was observed. Other hematologic effects were leukopenia (47.4%) and anemia (47.4%). The main non-hematologic toxicities were as follows: neuropathy (52.6%), nausea and vomiting (36.8%), myalgia (36.8%), cardiac toxicity (15.8%) and mucositis (10.5%). Alopecia was observed in the majority of cases. The overall response rate was 47.4%, with 5 (26.3%) complete responses (CRs) and 4 (21.1%) partial responses (PRs). The median duration of response was 7 months (range: 3-19), with a median follow-up of 17 months (range: 3-61). Quality of life of responding patients was good. Our results confirm that paclitaxel as second-line therapy in relapsed and refractory ovarian cancer patients is an acceptable treatment with a good safety profile, and can be safely administered at the dose of 175 mg/m2. In our study paclitaxel was more active in relapsed than in refractory patients. Consequently, further studies are needed to identify more effective drugs for the refractory subset.

The use of dynamic posturography to detect neurosensorial disorder in IDDM without clinical neuropathy.

The main aim was to evaluate the relative importance of sensory interactions for postural stability in 45 patients with insulin-dependent diabetes mellitus (IDDM) with and without peripheral neuropathy. All subjects had normal electronystagmography. Dynamic posturography provides functional, selective testing of three sensory modalities in maintenance of balance, i.e., vestibular, visual, and somatosensory. The Sensory Organization Test (SOT) includes six test conditions during which the subject tries to maintain an upright stance with as little sway as possible. The subject stands on a movable platform facing a square visual surrounding, which can be rotated independently. The test is performed first with the eyes open, then with the eyes closed. The second component of posturography testing consists of the Motor Control Test (MCT) concerning motor responses routinely used in balance maintenance. Compared to control subjects, IDDM patients with peripheral neuropathy but not patients without neuropathy showed lower scores for test conditions SOT 1 (analysis of variance, ANOVA F = 8.3; Scheffe test: p = 0.0007), SOT 2 (F = 6.6; p = 0.004), SOT 3 (F = 3.4; p = 0.04), and SOT 6 (F = 3.4; p = 0.04). The muscle response latencies in MCT were prolonged for small forward perturbations (F = 4.6; p = 0.02) in neuropathic patients (148.3+/-14.2 ms) with respect to control subjects, but not in non-neuropathic patients with respect to control subjects (135.2+/-13.3 ms). Sural (r = 0.2; p = 0.002) and peroneal (r = 0.12; p = 0.02) nerve conduction velocities showed significant correlations with muscle response latencies of MCT for small forward perturbations. Our results suggest a subclinical dysequilibrium in IDDM patients with peripheral neuropathy. The results of dynamic posturography may reflect the impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual modalities.