MMC Group Research Articles

Employee Performance Evaluation Decision Support System with the SMART (Simple Multi-Attribute Rating Technique) Method

Every company needs an employee performance appraisal system, for the evaluation of its employees in terms of quality and responsibility for their work. In evaluating the performance of employees at PT. MMC Group is still manually so it takes a long time and the impact on decision making time also takes a long time. Besides evaluation only on aspects of the strengths and weaknesses of employees, so the results of decisions taken are not accurate and subjective. Therefore we need a decision support system that can do calculations quickly, precisely and accurately based on predetermined criteria. The calculation method used in this study is the SMART (Simple Multi Attribute Rating Technique) method. There are 5 assessment criteria used, namely quality of work, integrity, loyalty, discipline and personality, while for alternative data as many as 10 employees are taken by cluster random sampling. To test the performance of the SMART method calculation results using the Confusion Metrix method. The results of this study are an accuracy rate of 90%, a precission of 100%, a recall of 88.88% and a specificity of 94.12%.

Amylase concentration and activity in the amniotic fluid of fetal rats with retinoic acid induced myelomeningocele

Background In utero neurologic injury in myelomeningocele (MMC) occurs via a two-hit process: failed neural tube closure followed by neurodegeneration in utero. Meconium in the amniotic fluid contains pancreatic digestive enzymes and is neurotoxic in rat models of MMC. Objectives The objectives of this study were to demonstrate the neurotoxicity of α-amylase and to compare the enzyme concentration and activity in the amniotic fluid of rats with retinoic acid induced MMC to a healthy control population. Study design Timed pregnant Sprague Dawley rats were gavage fed all-trans retinoic acid (60 mg/kg) in olive oil on gestational day E10 to induce a MMC defect. Control rats received olive oil. Amniotic fluid was collected on embryonic days E15, E17, E19, and E21. The amniotic fluid amylase concentration and relative activity were measured at each gestational age, and levels were compared between the MMC and control groups using Wilcoxon Rank Sum and Kruskal–Wallis tests. In a subset of dams sacrificed on E10.5, neuroepithelial cells were isolated from control embryos and exposed to α-amylase in increasing concentrations. Percentage of cell survival was assessed with CellProfiler software. Results Amniotic fluid amylase activity for embryonic days E15, E17, E19, and E21 was determined for MMC and control pups. Amylase activity increased significantly from E15 to E21 in both control (p = 3.0 × 10−5) and MMC (p = 1.5 × 10−5) groups. Relative amylase activity was significantly increased in MMC pups compared to controls on E19 (247,792.8 versus 106,263.6; p = .0019) and E21 (772,645.8 versus 481,975.3; p = .021); no difference was detected on E15 (36,646.8 versus 40,179.3; p = .645) or E17 (121,617.5 versus 71,750; p = 1.000). In vitro, amylase demonstrated dose-dependent toxicity to fetal rat neuroepithelial cells. Conclusion Amylase concentration and activity level were higher in the amniotic fluid of rats with retinoic acid induced MMC compared to controls with advancing gestational age. As amylase is toxic to neural epithelial cells, the higher activity of this digestive enzyme in fetuses with MMC may be a contributor to neural tube damage in utero. Future research should focus on amylase and other digestive enzymes in human MMC, as they may serve as potential targets of in utero therapy.

Clinical Evaluation of Noncarious Cervical Lesions of Different Extensions Restored With Bulk-fill or Conventional Resin Composite: Preliminary Results of a Randomized Clinical Trial.

This randomized clinical trial evaluated the influence of the occlusogingival distance (OGD) of noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite. A total of 140 restorations were randomly placed in 77 participants by one operator. NCCLs were divided into four groups (n=35) according to OGD (1.5 mm±10% or 3 mm±10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]) used: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. A two-step self-etch adhesive (Clearfil SE Bond) was applied following manufacturer instructions in all restorative procedures. Restorations were polished 1 week after placement. Clinical evaluation was performed at baseline (7 days), 6 months, and 1 year by two calibrated examiners, according to the modified US Public Health Service criteria evaluating fractures/retention, marginal staining, marginal adaptation, recurrence of caries, anatomic form, postoperative sensitivity, and surface texture. The Kruskal-Wallis test was used for intergroup comparison in each follow-up; the Friedman analysis of variance, followed by the least significant difference test (multiple comparisons) was used for intragroup comparison between baseline and follow-up times (α=0.05). Two restorations were lost at 12 months (1 for 1.5 mm-B and 1 for 3 mm-B). The retention rates at 12 months were 100% for 1.5 mm-C, 97% for 1.5 mm-B, 100% for 3 mm-C; and 97% for 3 mm-B, with no statistical difference among the groups (p=0.570). At 12 months, a statistically significant difference was found among the follow-up times for the same group (1.5 mm-B, 1.5 mm-C, and 3 mm-B) regarding the marginal staining criterion; moreover, the 3 mm-C group showed a significant difference from 6 months. No significant difference was found for the other parameters. Both resin composites showed acceptable clinical performance, and the OGD of NCCLs did not influence the clinical performance of resin composite restorations after 12 months.

AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C.

PurposeTo evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT).Subjects and methodsA prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results.ResultsThe study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm2) was significantly lower than in no MMC group (92.4±17.3 mm2). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively.ConclusionThe treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.

Analysis of efficacy of intraoperative mitomycin C in external dacryocystorhinostomy

Analysis of efficacy of intraoperative mitomycin C in external dacryocystorhinostomy - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.081, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

The role of vitamin D replacement therapy in serum FGF23 concentration in children with myelomeningocele compared with healthy children - a preliminary study.

Background Fibroblast growth factor 23 (FGF23) is a recently discovered bone-derived regulator of vitamin D metabolism and phosphate homeostasis. It inhibits phosphate reabsorption and calcitriol production by the kidney. Myelomeningocele (MMC) remains the most severe form of neural tube defects involving serious locomotor disability, osteoporosis and pathologic fractures. We aimed to investigate the influence of vitamin D replacement therapy on serum FGF23 concentration in children with MMC and compare the results with healthy participants. Methods This prospective analysis was conducted on 16 children with MMC and 20 healthy children. Serum FGF23 levels were measured; for the studied group, before and after vitamin D replacement therapy with cholecalciferol (vitamin D3). The children's medical charts were analyzed to determine age, sex, anthropometric measurements, calcium and phosphate, cholecalciferol and renal function parameters. Results There were significant differences in vitamin D and FGF23 serum concentrations between the studied groups. The median vitamin D levels in the MMC group increased during replacement therapy (7 vs. 18.5 ng/mL, p = 0.29) in comparison to the median of 25.5 ng/mL in the control group. In MMC children we found a significant decrease in median serum FGF23 after vitamin D replacement therapy (from 42.1 to 0 RU/mL, p < 0.001). FGF23 correlated positively with albumin, serum and urine phosphate levels and negatively with alkaline phosphatase. Conclusions 1. Serum concentration of FGF-23 is increased in MMC children in comparison to a healthy control group. 2. Vitamin D replacement therapy decreases FGF23 concentrations in MMC children, although further studies are still warranted to gain detailed insight on the FGF23 in the MMC population. 3. Children with MMC present vitamin D deficiency. Nutrition supplemented with low doses of cholecalciferol (vitamin D3) (intakes reaching recommended daily allowances) was insufficient to correct 25(OH)-D level in that population of patients.

Neurosurgery Elective for Preclinical Medical Students With and Without a Home Neurosurgery Program

Abstract INTRODUCTION Early medical student exposure to neurosurgery through preclinical electives has been shown to improve recruitment, yet the effect on students without a home neurosurgery program is unknown. We conducted a preclinical neurosurgery elective in a mixed cohort of students with and without a neurosurgery program to 1) evaluate pre- and postelective neurosurgery perceptions, 2) discern differences between cohorts, and 3) identify important factors in those considering neurosurgery a career. METHODS A yearly neurosurgery elective was offered to students enrolled at the Vanderbilt University School of Medicine (VUSM; home program) or Meharry Medical College (MMC; no home program) from 2017 to 2018. Each class included three components: student-led presentation, faculty academic lecture, and faculty nonacademic discussion. Pre- and postcourse surveys were completed. RESULTS Thirty-two students completed the course. Postcourse surveys showed that both VUSM and MMC students felt more educated about the field/subspecialties, research, and practice settings. VUSM students showed no changes in perceptions of the field, whereas MMC students had multiple improved perceptions, including neurosurgery's future (P = .025), personalities and collegiality (P = .001), and achievability of family (P = .010). A total of 14 (44%) students showed a significant increase in considering neurosurgery as a career, 8 of which (57%) were in the MMC group. Students more likely to consider neurosurgery as a career showed a significant improvement in the level of emotional draining (P = .042), personalities and collegiality (P = .003), and achievability of family (P = .001), but not residency difficulty (P = .102) or financial security (P = .380). Those whose interest was neutral/decreased after the course showed no changes in these perceptions. CONCLUSION Early exposure to neurosurgery at medical schools without a home department may improve students' preconceived notions and attitudes about neurosurgery. Preclinical electives provide valuable, accurate information about the benefits and rigors of neurosurgery, allowing students to make informed decisions about pursuing the field further. This first-hand experience may broaden the net of residency recruitment.

Safety and efficacy of tacrolimus-coated silicone plates as an alternative to mitomycin C in a rabbit model of conjunctival fibrosis.

PurposeTo find safer and more effective drugs than mitomycin C to prevent conjunctival fibrosis in a rabbit model.MethodsTwenty-four rabbits were involved and randomly divided into four groups. Limbus-based peritomy was performed at the superior cornea, and normal saline (NS group), mitomycin C (MMC group), SR (SR group), or TC (TC group)-coated silicone plate was inserted at the sub-Tenon’s space in each group. Conjunctival congestion was evaluated at 1 and 4 weeks postoperatively. At 4 weeks, the numbers of inflammatory cells, fibroblasts, myofibroblasts, blood vessels, and goblet cells were counted in the conjunctiva and Tenon’s capsule around the silicone plate.ResultsAt 4 weeks, conjunctival congestion was significantly less than that observed at 1 week in the SR and TC groups (p < 0.05), whereas the number of myofibroblasts was significantly lower in the MMC and TC groups (p < 0.05). The conjunctiva was significantly less congested in the TC group versus the other groups at 1 week and 4 weeks (p < 0.05). The TC group had the lowest number of inflammatory cells and MMC group had the lowest number of goblet cells among all groups (p < 0.05).ConclusionsThe TC-coated silicone plate was more effective in inhibiting inflammation and fibrosis versus the MMC-coated silicone plate and was associated with fewer adverse effects in the rabbit model.

Nationwide survey of fetal myelomeningocele in Japan: Background for fetal surgery

Fetal surgery for myelomeningocele (MMC) has yet not been performed in Japan, and the clinical background of fetal MMC in Japan remains poorly described. We examined the prenatal characteristics and perinatal outcomes of fetal MMC to prepare for the introduction of fetal surgery. A nationwide questionnaire survey was conducted with regard to fetuses with MMC between January 2012 and December 2014 at perinatal centers in Japan. In 50 tertiary centers, 188 cases of MMC were identified, of which 126 (67%) were isolated cases. Only half of the cases involved referral to tertiary centers with a diagnosis of MMC. The median time point for a prenatal diagnosis was 26weeks' gestation (range, 12-38weeks); in 54% of cases the diagnosis occurred after 26 gestational weeks, which is over the limit for fetal surgery for MMC. Furthermore, in 22% of cases the diagnosis was made before 22 gestational weeks, and in three-quarters of these cases termination of pregnancy was selected. No fetal or neonatal deaths were observed in the isolated MMC group. MMC repair, ventriculoperitoneal shunt and clean intermittent catheterization were required after birth in 100%, 73% and 55% of isolated MMC cases, respectively. In total, 96% of the tertiary centers cared for <5 cases of fetal MMC per year. Gestational age at MMC diagnosis was late mid-gestation, therefore earlier detection is essential when considering fetal treatment of MMC in Japan. Although the survival rate was excellent, in three-quarters of isolated MMC cases ventriculoperitoneal shunt was required. Early detection and centralization of MMC cases at specialized centers should be considered.

Ologen implant versus mitomycin-C for trabeculectomy: A meta-analysis.

Aim:To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant.Methods:Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications.Results:A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was −3.69 (95% CI: −6.70 to −0.68) at 1 month, −2.69 (−5.17 to −0.21) at 3 months, −3.67 (−6.09 to −1.25)at 6 months, −3.24 (−6.08 to −0.41) at 12 months, 1.24 (−9.43 to 11.90) at 24 months, and 1.10 (−10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10–0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01).Conclusion:Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.

A randomized controlled trial of adjuvant mitomycin-c in endoscopic surgery for laryngotracheal stenosis.

Topical mitomycin-C (MMC) application is a commonly accepted adjuvant therapy in the surgical treatment for laryngotracheal stenosis (LTS). However, the efficacy of MMC has not been examined in a prospective, randomized clinical trial in humans. We aimed to examine the efficacy of MMC in the treatment of LTS patients as compared to a placebo-controlled group. Prospective, randomized, double-blind, placebo-controlled clinical trial. Fifteen patients with LTS were enrolled in a 24-month trial and randomized into one of two groups: 1) endoscopic surgical treatment with topical application of MMC or 2) endoscopic surgical treatment with topical application of saline. Postoperatively, patients were evaluated at standardized intervals with a symptom questionnaire and spirometry. Subsequent surgery was performed as needed based on relapse of stenosis on exam and patient-reported symptom severity. The average interval between surgical treatments was 17.9 months in the placebo group and 17.4 months in the MMC group (P = .95). There was no difference in magnitude of peak inspiratory flow (PIF) improvement between groups. The average magnitude of PIF change was 1.3 L/sec and 1.1 L/sec for the placebo and MMC groups, respectively (P = .64). Similarly, there was no difference in magnitude of symptom improvement or duration of symptom improvement between the two groups. This prospective, randomized. double-blind. placebo-controlled trial suggests that the use of MMC as a topical adjuvant therapy has no additional benefit in the endoscopic surgical management of LTS. Further study is needed. 1b Laryngoscope, 130:706-711, 2020.

Efficacy of Intraoperative Mitomycin-C in Vasovasostomy Procedure: A Randomized Clinical Trial.

BackgroundTwo-six percentage of vasectomized men will ultimately seek vasectomy reversal, which late stricture and obstruction after operation are relatively common. To find a method for improving vasovasostomy outcomes, we used intra-operative local mitomycin-C (MMC) preventing possible fibrosis and stricture.Materials and MethodsIn this randomized clinical trial, 44 patients were assigned to two groups randomly during a one-year study and the data of 40 patients were analyzed. The patients were followed up for 6 months after surgery. The case group (n=19) was treated by vasovasostomy with intra-operative local MMC. The control group (n=21) underwent standard vasovasostomy.ResultsMean sperm count in MMC group was significantly higher than the controls. The sperm count of more than 20 million/ml was respectively 53% and 14% in MMC and control groups. In a subgroup where the interval between vasectomy and reversal was 5-10 years, post-reversal azoospermia was absent in MMC group, but 50% of the controls were still azoospermic. In addition, 80% of MMC group had more than 20 million/ml sperms, but all of the controls had less than 20 million/ml sperms. No significant complication was seen.ConclusionIntra-operative local MMC in vasovasostomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Increase of sperm count is the main effect of local MMC applica- tion that is more prominent when the interval between vasectomy and reversal is 5-10 years (Registration number: IRCT2015092324166N1).

Assessment of corneal endothelial cell changes caused by mitomycin-C application during pterygium surgery

Background Topical Mitomycin-C (MMC) can have a deleterious effect onto corneal endothelium in some ophthalmic surgeries. Aim To evaluate safety of intraoperative topical MMC in pterygium surgeries onto corneal endothelium. Design Prospective comparative cohort study. Subjects and methods Forty-six patients were included in this study. Twenty-three patients underwent pterygium surgery with intraoperative MMC application (trial group) and equal number of patients underwent pterygium excision without MMC (control group) at the Suez Canal University Hospital. Corneal endothelial images were acquired with a specular microscope before surgery and at one week, one month, and three months following surgery. Results Mean preoperative endothelial cell counts were 2364±220 cells/mm2 in the pterygium excision without MMC group and 2411±227 cells/mm2 in the pterygium excision with MMC group (P=0.7). One week, one month and three months after surgery, the pterygium with MMC group showed a statistically insignificant endothelial cell loss (P=0.06) whereas the other group didn’t encounter any decrease in ECD (P=0.349), similar insignificant changes were found between the different measurements in the follow-up periods as compared to the preoperative measurements of central corneal thickness (CCT), cellular hexagonality, coefficient of variation and standard deviation of cell area as well as between patients of both groups. Conclusions A single intraoperative 0.02% MMC topical application using MMC solution-moistened cellulose sponges, onto the scleral bed under the conjunctiva with care not to touch the cornea has not resulted in a statistically-significant deleterious effect onto corneal endothelium.

Comparison of the clinical efficacy and safety of deep sclerectomy with mitomycin-c and trabeculectomy surgeries

Aim: Comparison of clinical efficacy and safety of trabeculectomy and deep sclerectomy with mitomycin-C (MMC) surgeries. Material and Methods: 58 eyes of 58 patients with glaucoma who underwent trabeculectomy or deep sclerectomy with MMC were evaluated retrospectively. The success criterion was regarded as follows; patients having intraocular pressure (IOP) less than 21 mmHg was regarded as complete success; patients with IOP less than 21 mmHg with medication was regarded as partial success; and patients with IOP higher than 21 mmHg with medication was regarded as un-success. Results: There was no statistically significant difference in IOP lowering effects between the two surgeries. Considering the success of the groups; complete success was achieved in 32 patients (91.4%) and partial success in 3 patients (8.6%) in the trabeculectomy group. Complete success was achieved in 20 patients (86.9%) and partial success in 3 patients (13.1%) in the deep sclerectomy with MMC group. In the deep sclerectomy with MMC group, hypotonia was detected in 2 patients (8.7%). In the trabeculectomy group, 5 patients (14.3%) had hypotonia, 2 patients (5.7%) had shallow anterior chamber and 1 patient (2.85%) had choroidal detachment. Conclusion: When IOP lowering effects of deep sclerectomy with MMC and trabeculectomy operations were compared, it was found that there was no statistically significant difference between the two techniques. When complication rates were compared, less complication was found in deep sclerectomy operations. It can be concluded that deep sclerectomy is safer than trabeculectomy and as effective as it is.

1000: Increased amylase activity in the amniotic fluid of fetal rats with retinoic acid induced myelomeningocele

Neurologic injury in myelomeningocele (MMC) occurs via a two-hit process: failed neural tube closure followed by neurodegeneration in utero. Meconium in the amniotic fluid causes neurotoxicity in rat models of MMC and contains digestive enzymes from the pancreas. The objective of this study is to measure the enzyme activity of amylase in the amniotic fluid of rats affected by retinoic acid induced MMC. We hypothesize that amylase activity will be present at increasing levels with advancing gestation and will be higher in the MMC group compared to a control population at all gestational ages. Timed pregnant Sprague Dawley rats were gavage fed all-trans Retinoic Acid (60 mg/kg) in olive oil on gestational day E10 to induce MMC defect (model previously described). Control rats received olive oil. Amniotic fluid was collected on embryonic days E15, E17, E19 and E21. MMC defect was confirmed visually. Amylase activity was assessed at each gestational age using the EnzChek Ultra Amylase Activity Assay Kit (Invitrogen, Carlsbad CA). Amniotic fluid samples were plated in triplicate on a 96 well microplate (N=8 per group). Amylase activity was detected via fluorescence at Ex 505nm/Em 512nm and read with a microplate reader (Glomax-Multi Promega, Madison, WI). Levels were compared between MMC and control groups at each gestational age using Wilcoxon Rank Sum and Kruskal-Wallis tests. Amylase activity for embryonic days E15, E17, E19 and E21 was determined for MMC and control pups. Amniotic fluid amylase activity increased significantly from E15 to E21 in both control (p=3.0 x 10-5) and MMC (p=1.5 x 10-5) groups. Amylase activity was significantly increased in MMC pups compared to controls on E19 (247,792.8 vs. 106,263.6; p=0.0019) and E21 (772,645.8 vs. 481,975.3; p=0.021); no difference was detected on E15 (36,646.8 vs. 40,179.3; p=0.645) or E17 (121,617.5 vs. 71,750; p=1.000). (Graph 1). Amylase activity level is higher in rats with retinoic acid induced MMC compared to controls with advancing gestational age. The higher activity of this digestive enzyme in fetuses with MMC may be a contributor to neural tube damage in utero. Future research should focus on amylase and other digestive enzymes as potential targets of in utero therapy in patients who are not candidates for antenatal MMC repair.

Results of Postoperative Instillation of Mitomycin C in Non Muscle Invasive Bladder Cancer after Complete Resection Versus BCG (Recurrence and Progression)

AbstractBackground: Intravesical immunotherapy or chemotherapy for non-muscle invasive bladder cancer is a well-established treatment for preventing or delaying tumour recurrence after tumour resection. However, up to 70% of patients may fail. New protocols and new intravesical agents with improved effectiveness are neededAim of Study: Is to evaluate the oncological outcome as regard progression, local recurrence and side effects of non-muscle invasive transitional cell carcinoma of the urinary bladder managed by complete resection followed by postop-erative intravesical instillation of Mitomycin C compared with BCG.Patients and Methods: This is a prospective study that included 51 patients with non-muscle invasive TCC bladder (Ta and T1) at Urology Department, Al-Azhar University hospitals between 2011 and 2015. Patients divided into two groups, the Mitomycin group received immediate MMC and periodic 6 doses of MMC and the other group, BCG received 6 doses of BCG one dose per week. Follow-up by cystoscope for two years at 3th, 6th, 9th, 12th, 18th, 24th month to detect the recurrence, progression and side effects.Results: The mean age of the patients was 60.58 (37 yrs. - 79 yrs.) in the MMC group and 61.76 (48 yrs-83 yrs) in the BCG group. The main comparison in this study is recurrence rate and progression rate of the tumor. Three patients (11.5%) had recurrence in the 1st year while four patients (15.4%) in the 2nd year with total recurrence seven patients (26.9%) in MMC group.In the BCG group, patients who had a recurrence in the 1st year were, two patients (8%) and three patients (12%) in the 2nd year with total recurrence, five patients (20%).The total progression in two years were 4 pts (15.38%) (One patient (3.8%) in the 1st year) (3 patients (11.5%) in the 2nd year) in the MMC group while were 4 pts (16%) (One patient (4%) in the 1st year) (year 3 patients (12%) in the 2nd year) in the BCG group.Conclusion: Our study confirmed the positive effect of immediate Mitomycin C intravesical instillation in patients who received periodic Mitomycin C instillation and either the positive effect of intravesical instillation of BCG in patients with non-muscle-invasive bladder tumors. Our present study showed that MMC and BCG equally reduced recurrence and progression in NMIBC patients while showed the superiority of MMC regarding to the adverse effects.

Pharmacologic Properties of the Carrier Solutions for Hyperthermic Intraperitoneal Chemotherapy: Comparative Analyses Between Water and Lipid Carrier Solutions in the Rat Model

BackgroundCarrier solutions play an important role in the distribution, plasma absorption, chemical stability, and solubility of anticancer agents during hyperthermic intraperitoneal chemotherapy (HIPEC). In the current study, lipophilic properties of carrier solutions were evaluated to determine whether they improved anticancer drug absorption rates using mitomycin-C (MMC) or oxaliplatin HIPEC as compared to hydrophilic carrier solutions.MethodsSprague-Dawley rats were divided into two groups: MMC and oxaliplatin treatment groups. Each group was then further subdivided by carrier solution: Dianeal® PD-2 peritoneal dialysis solution, 5% dextrose solution and 20% lipid solution (Lipision®). HIPEC was performed over 60 min at 41–42 °C using the anticancer drugs MMC (35 mg/m2) or oxaliplatin (460 mg/m2). The plasma area under the curve (AUC; AUCplasma), peritoneal AUC (AUCperitoneum), and peritoneal/plasma AUC ratios were compared among HIPEC carrier solutions.ResultsPlasma drug concentrations were significantly different among carrier solutions, varying by time. In contrast, peritoneal drug concentrations did not change with carrier solution. In the MMC group, the peritoneal/plasma AUC ratio of a lipid solution was three times higher than Dianeal® (p < 0.001). In the oxaliplatin group, the peritoneal/plasma AUC ratio was significantly different between carrier solutions (p = 0.046). Although the oxaliplatin AUCperitoneum did not vary (p = 0.941), the AUCplasma of a lipid solution was lower than that of 5% dextrose solution (p = 0.039).ConclusionsThe lipid carrier solution increases the peritoneal/plasma AUC ratio and decreases plasma absorption rates. However, further study is required before clinical uses, considering its pharmacologic properties and possible risks after HIPEC.

Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C.

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6months, 1 and 2year. Success rate was 100% at 3 and 6months follow-up in both the groups. At the end of 1year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure. Level of evidence Individual prospective cohort study, level 1b.

Experience in shunt management on revision free survival in infants with myelomeningocele.

Depending on the etiology of hydrocephalus in childhood, the shunt therapy still remains challenging due to frequent shunt complications leading to possible revisions such as shunt infection or shunt malfunction. In myelomeningocele (MMC) patients who often require shunt therapy, higher revisions rates were reported. In a single-center retrospective study, experiences on shunt regimen on hydrocephalus associated with MMC are presented. Data of 160 infant hydrocephalus cases younger than 1year of age at the time of implantation were retrospectively reviewed from the hospital database. These patients received an adjustable differential pressure valve with gravitational unit and antibiotic impregnated catheters as a primary or secondary implant during the time period of April 2007 to July 2015. The subgroup of infants cases with MMC (n = 44; age 50.6 ± 80.6days) were compared to the remaining cohort of other hydrocephalus etiology (control group). The shunt and valve revision free survival rates were recorded until July 2017. During the mean follow-up of 48.7 ± 19.2 (7-114) months, the shunt revision free survival was 87% at 1year and 49% at 60months in the MMC cohort. The control group showed a shunt survival rate of 68% at 1year and 39% at 60months. Similarly, the valve revision free survival rate showed a significant higher rate of 92% at 1year and 69% at 60months in the MMC group compared to the control group (75% at 1year and 51% at 60months; p < 0.05). During the entire follow-up period, 37% of the MMC infants underwent a revision operation in contrast to the control group of 40%. The presented shunt strategy showed improved revision free survival rates in infants with a MMC-related hydrocephalus in comparison to other etiologies of hydrocephalus in infants, which might relate to infection prophylaxis and high drainage resistance integrated in the shunt system.

Incidence of leukopenia and thrombocytopenia with cisplatin plus mitomycin-c versus melphalan in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Cytopenia after hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) has been reported in non-comparative studies with various chemotherapeutic regimens. This study compared the incidence of leukopenia and thrombocytopenia in patients who underwent CRS/HIPEC and received melphalan or cisplatin plus mitomycin-c (CIS + MMC). This retrospective study included patients who underwent CRS/HIPEC at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia from March 2011 to March 2017 and received melphalan 60mg/m2 or CIS 100mg/m2 combined with MMC 30mg/m2. Incidences and severity of leukopenia, neutropenia, thrombocytopenia, and anemia were compared between groups. This study included 46 patients who received CIS + MMC and 35 patients who received melphalan. The leukopenia incidence was 25.7% in the melphalan group and 17.3% in the CIS + MMC group (P = 0.362), with one patient (2.8%) in the melphalan group developed grade V leukopenia. The number of days to leukocyte nadir was 32.8 days for CIS + MMC group compared to 9.8 days for melphalan group(P = 0.035). Thrombocytopenia occurred at a similar rate in the melphalan (60%) and CIS + MMC (68.8%) groups (P = 0.4). Grade III thrombocytopenia developed in 3.2% and 5% of patients in the melphalan and the CIS + MMC groups, respectively. Neutropenia did not occur in any patient. In multivariate analysis, leukopenia predictors were female gender (P = 0.047) and baseline leukocyte counts (P = 0.029). Baseline platelet count predicted thrombocytopenia (P < 0.001). Melphalan and CIS + MMC regimens were associated with comparable incidences of leukopenia and thrombocytopenia. Severe leukopenia and severe thrombocytopenia were rare following CRS/HIPEC using both chemotherapy regimens.