BACKGROUND: En bloc resection of bladder tumor (ERBT) is an established surgical treatment method for patients with non-muscle invasive bladder cancer (NMIBC) in tumors less than 3 cm. Data regarding the efficacy and safety of ERBT on larger than 3 cm tumors are sparse and its efficacy compared to conventional transurethral resection (TURBT) remains unclear. The aim of this study was to prospectively compare the feasibility, safety and oncological outcomes of laser (Tm-fiber) ERBT and TURBT in patients with primary bladder lesions ≥3 cm. METHODS: A cohort of 45 patients who underwent surgery for primary NMIBC between February 2018 and March 2022 was collected prospectively. There was no randomization. All procedures were performed by two experienced surgeons. Inclusion criteria were as follows: age >18 years, primary Ta or T1 bladder tumor with a diameter of ≥3 cm, no more than 3 tumors and no history of upper tract urothelial carcinoma. Exclusion criteria were carcinoma in situ or invasion into muscle layer (≥T2). ERBT was performed with thulium fiber laser (IPG, Russia). Primary endpoints included efficacy with recurrence-free survival (RFS) at 3, 6 and 12 months. Secondary endpoints were safety parameters, perioperative data and specimen quality (the presence of muscle layer in specimens). RESULTS: Twenty-eight patients underwent laser ERBT and 17 conventional TURBT. The location and size of the tumors were comparable in both groups. The success rate was 93.3% in the ERBT group with two cases of conversion from ERBT to TURBT. Detrusor muscle was present in 92.8% patients in the ERBT group versus 70.5% in the TURBT group (P=0.04). Obturator nerve reflex was observed only in the TURBT group: 17.6% vs. 0.0% (P=0.02). The frequency of other complications was comparable between the two groups. RFS was not statistically different between the two methods at 3 (93.9% vs. 94.1%, P=0.87), 6 (89.3% vs. 82.3%, P=0.5) and 12 months (89.3% vs. 70.6%, P=0.11). CONCLUSIONS: Laser ERBT is a feasible and safe procedure to manage bladder tumors larger than 3 cm. While it seems safer than TURBT, its effect on efficacy remains to be assessed in larger trials.
- MeSH
- Cystectomy * methods MeSH
- Laser Therapy * methods adverse effects instrumentation MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms * surgery pathology radiotherapy MeSH
- Prospective Studies MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Tumor Burden MeSH
- Urethra surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Several plants have the potential to protect essential reproductive processes such as spermatogenesis or steroidogenesis, however, effective concentrations and main mechanisms of action are still unknown. This in vitro study was aimed to assess the effects of Apium graveolens L., Levisticum officinale, and Calendula officinalis L. extracts on the structural integrity, functional activity and gap junctional intercellular communication (GJIC) in mice Leydig cells. TM3 cells were grown in the presence of experimental extracts (37.5; 75; 150 and 300 μg/ml) for 24 h. For the present study, high-performance liquid chromatography analysis was used to quantify flavonoids or phenolic acids. Subsequently, Leydig cell viability was assessed by alamarBlue assay, while the cell membrane integrity was detected by 5-carboxyfluorescein diacetate-acetoxymethyl ester. The level of steroid hormones production was determined by enzyme-linked immunosorbent assay. Additionally, GJIC was assessed by scalpel loading/dye transfer assay. According to our results, Apium graveolens L. significantly increased the viability and cell membrane integrity at 75 μg/ml (109.0±4.3%) followed by a decline at 300 μg/ml (89.4±2.3%). In case of Levisticum officinale and Calendula officinalis L. was observed significant decrease at 150 μg/ml (88.8±11.66%; 87.4±6.0%) and 300 μg/ml (86.2±9.3%; 84.1±4.6%). Furthermore, Apium graveolens L. significantly increased the progesterone and testosterone production (75 and 150 μg/ml) however, Levisticum officinale and Calendula officinalis L. significantly reduced steroid hormones synthesis at 150 and 300 μg/ml. Finally, the disturbance of GJIC was significantly affected at 300 μg/ml of Levisticum officinale (82.5±7.7%) and Calendula officinalis L. (79.8±7.0%). The balanced concentration ratio may support the Leydig cell function, steroidogenesis as well as all essential parameters that may significantly improve reproductive functions.
- MeSH
- Apium * chemistry MeSH
- Cell Membrane drug effects pathology MeSH
- Cell Line MeSH
- Leydig Cells drug effects metabolism pathology MeSH
- Levisticum * chemistry MeSH
- Calendula * chemistry MeSH
- Gap Junctions drug effects metabolism pathology MeSH
- Cell Communication drug effects MeSH
- Mice, Inbred BALB C MeSH
- Gonadal Steroid Hormones biosynthesis MeSH
- Plant Extracts isolation & purification pharmacology MeSH
- Cell Survival drug effects MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
V podmínkách přístrojově i personálně vybaveného klinického pracoviště jsme chtěli prokázat racionalitu v provádění chirurgických výkonů na dolní skořepě u hypertrofické chronické rinitidy rezistentní ke konzervativní terapii a zároveň porovnat dosavadní standardně zavedené chirurgické techniky (klasická chirurgická parciální mukotomie/turbinoplastika a ambulantní laserová či radiofrekvenční turbinoplastika). Výsledkem je průkaz efektivity zdánlivě dražších moderních chirurgických postupů prováděných ambulantně, které významně zlepšují kvalitu života pacientů, ale současně také mohou snižovat finanční zatížení zdravotnického systému, a tím přinášet ve svém důsledku i větší socioekonomický efekt pro společnost (menší zatížení zdravotnického systému, kratší pracovní neschopnost atd.). Studie prokázala srovnatelně efektivní příznivý výsledný medicínský efekt všech výše uvedených technik provedení mukotomie/turbinoplastiky. Z hlediska lepší kvality života pacientů v časném pooperačním období dominují ambulantně prováděné výkony. Ekonomická analýza prokázala „životaschopnost“ jedné z nich (laserová turbinoplastika) i v podmínkách zdravotního systému v České republice, který dosud neumožňoval rozlišovat standardní a nadstandardní výkony v rámci zákonného zdravotního pojištění. Navíc v dnešní době zdravotními pojišťovnami preferovaný výkon (omezení mukotomie/turbinoplastiky na „výkon za hospitalizace“) poměrně jasně a zároveň nepochopitelně zatěžuje zdravotnický systém výdaji, které by bylo možné ušetřit (toto však již nebylo ani sledovaným cílem ani záměrem studie, může však posloužit jako příklad nehospodárnosti současného systému zdravotní péče). Podklady vyplývající ze závěrů ekonomické analýzy nicméně snad do budoucna alespoň teoreticky mohou přispět k podpoře tohoto cíle, tedy komplexní reformy zdravotnictví, včetně rozlišení výkonů standardních a nadstandardních v rámci zdravotního pojištění, případně zavedení privátního připojištění, které velmi dobře funguje i v tak sociálně vyspělých státech jako je sousední Německo či Rakousko a které znamenají benefit jak pro pacienta, tak i pro zdravotnický systém. Na rozdíl třeba od systému NHS ve Velké Británii se dvěma protipóly, kde stojí na jedné straně plně socialistické zdravotnictví (každý má nárok na vše, ale třeba až za jeden nebo dva roky při plánovaných operacích) a na straně druhé plně soukromá zdravotnická zařízení. Ale to je spíše námět na další článek.
In our setting of equipment of personnel of the clinical workplace we intended to prove rationality in performed surgical interventions on the inferior concha in hypertrophic chronic rhinitis which was resistant to conservative therapy and, at the same time, to compare so far used commonly introduced surgery (classical surgical partial mucotomy/turbinoplasty and outpatient laser or radiofrequency turbinoplasty. It has become obvious that the apparently more expensive modern surgical procedures performed in outpatient wards significantly improve quality of life of the patients, but they can simultaneously decrease financial cost for the public health system and in this way a higher social-economic effect for the society (lower demands for the public health system shorter working disability, etc.). The study demonstrated a comparatively effective favorable resulting medical effect of all above mentioned techniques of mucotomy/turbinoplasty. The outpatient interventions dominate the better quality of life of the patients in the early postoperative period. The economic analysis demonstrated viability of one of them (laser turbinoplasty) even in conditions of the public health system of the Czech Republic, which has been so far unable to differentiate between standard and above-standard interventions within the framework of legal (statutory) health insurance. Moreover, the presently public health insurance – preferred interventions (limiting mucotomy/turbinoplasty to intervention under hospitalization) rather clearly and simultaneously not understandably load the public health system by cost, which could be limited. This observation, however, was not the aim of the study, but it can serve as an example of the lack of economy of the present system of health care. The data following from the conclusions of the economic analysis, nevertheless, may in the future at least theoretically contribute to the support of this goal, specifically a complex reform of public health including differentiation of the standard and above-standard interventions within the framework of health insurance, or introduction of private additional insurance, which is functioning so well in socially developed countries such as Germany or Austria and which represent a benefit for the patient as well as for the public health system. In contrast to for example the N.H.S. system in Great Britain with two antipoles, where one of them represents a completely socialist public health (where everybody has the right for everything, but also after one or two years in the system of planned operation interventions) and the other fully private medical institutions. This is, however, a topic for another paper.
- Keywords
- standardní a nadstandardní výkony,
- MeSH
- Ambulatory Surgical Procedures economics MeSH
- Anesthesia economics methods MeSH
- Chronic Disease MeSH
- Length of Stay economics MeSH
- Financing, Organized MeSH
- Hospitalization economics MeSH
- Hypertrophy surgery pathology MeSH
- Catheter Ablation economics methods MeSH
- Quality of Life MeSH
- Laser Therapy economics methods MeSH
- Humans MeSH
- Health Care Costs statistics & numerical data MeSH
- Nasal Obstruction etiology surgery MeSH
- Turbinates surgery pathology MeSH
- Nasal Mucosa surgery pathology MeSH
- Otorhinolaryngologic Surgical Procedures * economics methods utilization MeSH
- Postoperative Complications MeSH
- Prospective Studies MeSH
- Rhinitis * surgery pathology MeSH
- Universal Health Insurance economics standards MeSH
- Outcome and Process Assessment, Health Care economics statistics & numerical data MeSH
- Insurance, Health MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
Background. The aim of the experiment was to compare the mechanical properties of intact spinal segment with impaired intervertebral disc and impaired intervertebral disc fixed by TSLP (Thoracolumbar Spine Locking Plate). Methods and results. Spinal specimens were taken from domestic swine. A total of 8 test mechanical states (intact, impaired and fixed) were modeled and the mechanical properties, expressed by the value of moment of couple necessary to twist the specimen at tensile force F = 200 N and the value of moments necessary for extension straining, were determined. The study was based on in vitro biomechanical testing of the TSLP plate used to stabilize the front thoracolumbar column of spinal segments taken from a pig. The plate was used for monosegmental fixation. The disc was cut by scalpel to simulate the Type A injury to front spinal column. In each state (intact, impaired or fixed), specimens were subjected to a tension load of prescribed force and, then, twisted by a given angle. Subsequently, extension load of intact, impaired and impaired & fixed segment was measured. Statistical evaluation verified the hypothesis of the different behavior of intact, impaired and fixed specimens – both for tension & torsion load and extension load. The analyses did not indicate different mechanical behavior of intact and fixed specimens. In other words, monosegmental fixation of both impaired and intact specimens by TSLP Synthes implant will lead to similar mechanical behavior of these specimens. Further, we found that intact and fixed specimens show non-symmetric behavior at positive and negative twisting angles. This was not observed for impaired specimens. Conclusion. Several stabilization systems were developed to stabilize the front thoracolumbar spinal column. Surgery of the anterior column of injured spine should restore the correct position of the spine, ensure decompression of vertebral canal when neural structures are compressed, and stabilize the spine to allow immediate loading and mobilization of the patient. The aim of this study was to compare mechanical properties of intact spinal segment, impaired spinal segment and impaired spinal segment stabilized by TSLP Synthes implant. The problems were solved by experimental modeling using a testing machine that simulated loads for several mechanical states of the spinal segment. Favorable mechanical properties of TSLP Synthes fixator were demonstrated. The experimental results will be used for subsequent computational modeling of the spinal segment in all experimentally solved states.
