[Early cystectomy-patient selection and technique]. / Indikationen und Technik der Frühzystektomie.

Early radical cystectomy (RC) is a therapeutic option for non-muscle invasive bladder cancer (NMIBC). The 15-year overall survival after early RC in NMIBC patients is about 70%. Nevertheless, RC is associated with significant morbidity and mortality and therefore requires careful patient selection. The aim of the following review is to assess the selection process for early RC in NMIBC. Especially, the new European Association of Urology (EAU) risk calculator identifying NMIBC patients with very high risk for disease progression is described in detail. Furthermore, the technical aspects of the procedure are evaluated. A review of the current literature (PubMed) and national and international guideline recommendations was also conducted.

Leaching losses from Kenyan maize cropland receiving different rates of nitrogen fertilizer.

Meeting food security requirements in sub-Saharan Africa (SSA) will require increasing fertilizer use to improve crop yields, however excess fertilization can cause environmental and public health problems in surface and groundwater. Determining the threshold of reasonable fertilizer application in SSA requires an understanding of flow dynamics and nutrient transport in under-studied, tropical soils experiencing seasonal rainfall. We estimated leaching flux in Yala, Kenya on a maize field that received from 0 to 200 kg ha-1 of nitrogen (N) fertilizer. Soil pore water concentration measurements during two growing seasons were coupled with results from a numerical fluid flow model to calculate the daily flux of nitrate-nitrogen (NO3 --N). Modeled NO3 --N losses to below 200 cm for 1 year ranged from 40 kg N ha-1 year-1 in the 75 kg N ha-1 year-1 treatment to 81 kg N ha-1 year-1 in the 200 kg N ha-1 treatment. The highest soil pore water NO3 --N concentrations and NO3 --N leaching fluxes occurred on the highest N application plots, however there was a poor correlation between N application rate and NO3 --N leaching for the remaining N application rates. The drought in the second study year resulted in higher pore water NO3 --N concentrations, while NO3 --N leaching was disproportionately smaller than the decrease in precipitation. The lack of a strong correlation between NO3 --N leaching and N application rate, and a large decrease in flux between 120 and 200 cm suggest processes that influence NO3 --N retention in soils below 200 cm will ultimately control NO3 --N leaching at the watershed scale.-the daily flux of nitrate-nitrogen (NO3 --N). The lack of a strong correlation between NO3 --N leaching and N application rate, and a large decrease in flux between 120 and 200 cm suggest processes that influence NO3 --N retention in soils below 200 cm will ultimately control NO3 --N leaching at the watershed scale.

A plasticizer released from IV drip chambers elevates calcium levels in neurosecretory terminals.

We report that intracellular calcium levels rise in mammalian neurosecretory terminals and in cultured pheochromocytoma cells during acute exposure to physiological medium incubated in IV drip chambers. The agent responsible for this effect is shown to be di(2-ethylhexyl)phthalate (DEHP). DEHP (800 nM) added to saline solution caused a rise in [Ca(2+)](i) similar to that elicited by the contaminant-containing solution. The extraction of this contaminant from the IV drip chamber, as measured by spectrophotometry, was time-dependent and was markedly accelerated by the presence of 50 mM ethanol in the solution. Larger [Ca(2+)](i) increases were observed in terminals exposed to solutions incubated in IV drip chambers for greater durations. The rise in calcium requires transmembrane calcium flux through membrane channels, as the response is blocked by either 100 microM cadmium or by lowering the extracellular free Ca(2+) concentration to 10 microM. Our results suggest that acute alterations in intracellular calcium should be considered in addition to long-term effects when determining the safety of phthalate-containing plastics and that laboratory researchers using plastic perfusion materials consider this potential source of artifactual results.

Sequences required for induction of neurotensin receptor gene expression during neuronal differentiation of N1E-115 neuroblastoma cells.

The promoter region of the mouse high affinity neurotensin receptor (Ntr-1) gene was characterized, and sequences required for expression in neuroblastoma cell lines that express high affinity NT-binding sites were characterized. Me(2)SO-induced neuronal differentiation of N1E-115 neuroblastoma cells increased both the expression of the endogenous Ntr-1 gene and reporter genes driven by NTR-1 promoter sequences by 3-4-fold. Deletion analysis revealed that an 83-base pair promoter region containing the transcriptional start site is required for Me(2)SO activation. Detailed mutational analysis of this region revealed that a CACCC box and the central region of a large GC-rich palindrome are the crucial cis-regulatory elements required for Me(2)SO induction. The CACCC box is bound by at least one factor that is induced upon Me(2)SO treatment of N1E-115 cells. The Me(2)SO effect was found to be both selective and cell type-restricted. Basal expression in the neuroblastoma cell lines required a distinct set of sequences, including an Sp1-like sequence, and a sequence resembling an NGFI-A-binding site; however, a more distal 5' sequence was found to repress basal activity in N1E-115 cells. These results provide evidence that Ntr-1 gene regulation involves both positive and negative regulatory elements located in the 5'-flanking region and that Ntr-1 gene activation involves the coordinate activation or induction of several factors, including a CACCC box binding complex.

Maximal expiratory pressures in spinal cord injury using two mouthpieces.

STUDY OBJECTIVE: A technique for assessing expiratory muscle strength is the measurement of maximal expiratory pressure (PEmax). Previous studies have shown that a tube-style mouthpiece yields greater PEmax values than a flange-style mouthpiece because the latter technique is limited by the strength of the buccal muscles. In individuals with weak muscles of exhalation, this limitation may not apply because the strength of their buccal muscles may exceed that of the respiratory muscles. DESIGN: A tube-style mouthpiece and flange-style mouthpiece were used to measure PEmax. The order of the mouthpiece used in testing was alternated between subjects and the greatest values obtained after three efforts were compared. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: Fifty subjects with chronic spinal cord injury without acute medical illnesses recruited from veterans and the community. RESULTS: The mean difference between PEmax(tube) and PEmax(flange) was 20.7+/-26.4 cm H2O (p = 0.0001). Differences were negligible in those with the weakest muscles of exhalation but were substantial even in some quadriplegic subjects. CONCLUSION: Even in individuals with neuromuscular disorders, errors in assessment of expiratory strength occur when a flange-style mouthpiece is used, and we recommend that this technique be abandoned in the measurement of PEmax.