Peter Black Research Articles

MP75-09 THE NATURAL HISTORY OF RENAL FUNCTION AFTER SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA: RESULTS FROM THE CANADIAN KIDNEY CANCER INFORMATION SYSTEM

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-09 THE NATURAL HISTORY OF RENAL FUNCTION AFTER SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA: RESULTS FROM THE CANADIAN KIDNEY CANCER INFORMATION SYSTEM Ross Mason, Anil Kapoor, Zhihui Liu, Olli Saarela, SImon Tanguay, Michael Jewett, Antonio Finelli, Louis Lacombe, Jun Kawakami, Ronald Moore, Chris Morash, Peter Black, and Ricardo Rendon Ross MasonRoss Mason More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Zhihui LiuZhihui Liu More articles by this author , Olli SaarelaOlli Saarela More articles by this author , SImon TanguaySImon Tanguay More articles by this author , Michael JewettMichael Jewett More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Louis LacombeLouis Lacombe More articles by this author , Jun KawakamiJun Kawakami More articles by this author , Ronald MooreRonald Moore More articles by this author , Chris MorashChris Morash More articles by this author , Peter BlackPeter Black More articles by this author , and Ricardo RendonRicardo Rendon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1727AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients who undergo surgical management of renal cell carcinoma (RCC) are at risk for chronic kidney disease due to loss of nephrons and intraoperative ischemic injury. This decrease in renal function is associated with both increased morbidity and mortality. This study explored factors associated with decreased renal function in patients undergoing partial or radical nephrectomy. METHODS Patients who underwent partial or radical nephrectomy were identified from the Canadian Kidney Cancer Information System (CKCIS), a large multiinstitutional prospectively maintained database. Univariable and multivariable logistic regression were used to determine the association between post-operative estimated glomerular filtration rate (eGFR) and type or surgery (radical versus partial), duration of ischemia, ischemia type (warm versus cold), and tumor size. RESULTS With a median follow-up of 26 months, 1379 patients were identified from the CKCIS database including 665 and 714 who underwent partial and radical nephrectomy, respectively. Patients undergoing radical nephrectomy had a lower eGFR at 3, 12, and 24 months post-operatively with the mean eGFR at 3 months being 19 ml/min/1.73m2 lower than those undergoing partial nephrectomy (p<0.001). A lower pre-operative eGFR and increasing age were also associated with a lower eGFR post-operatively (p<0.01) in both the entire cohort and among patients undergoing partial nephrectomy. Severe renal failure (Stage 4 or 5) developed post-operatively in 31.0%, 5.4%, and 1.1% of patients with pre-operative stage 1, 2, or 3 chronic kidney disease. Among patients undergoing partial nephrectomy, ischemia type and duration were not predictive of post-operative decline in eGFR at all time intervals. CONCLUSIONS Patients undergoing radical nephrectomy have a greater long-term reduction in renal function compared with those undergoing partial nephrectomy. In this modern series with generally short ischemia durations, ischemia duration and type were not predictive of post-operative renal function. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e981-e982 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ross Mason More articles by this author Anil Kapoor More articles by this author Zhihui Liu More articles by this author Olli Saarela More articles by this author SImon Tanguay More articles by this author Michael Jewett More articles by this author Antonio Finelli More articles by this author Louis Lacombe More articles by this author Jun Kawakami More articles by this author Ronald Moore More articles by this author Chris Morash More articles by this author Peter Black More articles by this author Ricardo Rendon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP13-20 SECOND-GENERATION ANTISENSE OLIGONUCLEOTIDE - HSP27 A NEW INTRAVESICAL TREATMENT FOR BLADDER CANCER: PHASE 1CLINICAL TRIAL.

You have accessJournal of UrologyBladder Cancer: Non-Invasive I1 Apr 2016MP13-20 SECOND-GENERATION ANTISENSE OLIGONUCLEOTIDE - HSP27 A NEW INTRAVESICAL TREATMENT FOR BLADDER CANCER: PHASE 1CLINICAL TRIAL. Sebastian Frees, Eliana Beraldi, Kim Chi, Ladan Fazli, Peter Black, Martin Gleave, and Alan So Sebastian FreesSebastian Frees More articles by this author , Eliana BeraldiEliana Beraldi More articles by this author , Kim ChiKim Chi More articles by this author , Ladan FazliLadan Fazli More articles by this author , Peter BlackPeter Black More articles by this author , Martin GleaveMartin Gleave More articles by this author , and Alan SoAlan So More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment options to prevent recurrence and progression in patients with non-muscle invasive bladder cancer (NMIBC) are limited. Heat Shock Protein 27 (Hsp27) is a cytoprotective protein that has been linked to therapeutic resistance and disease progression in many malignancies, including bladder cancer (BCa). OGX-427 is a 2nd generation (2′-MOE) antisense oligonucleotide that potently inhibits Hsp27 expression in vitro and in vivo. A phase I clinical study was performed to assess the safety, pharmacodynamic (pd) and biologic effects of intravesical treatments of OGX-427 using a presurgical dose-escalating design for patients with BCa. METHODS Eligible patients include patients with Ta, T1 or carcinoma-in-situ and candidates for transurethral resection of the bladder tumour (TURBT), or patients with muscle invasive BCa (>cT2) and candidates for radical cystectomy (RC). Patients were treated with intravesical OGX-427 on days 1, 3, 5 and 8 and then underwent surgery on day 9-12. Dose was escalated after tolerability and safety assessment for each cohort at 20uM, 50 uM, 100uM, 250uM, 500uM, and 750uM. Dose limiting toxicities (DLTs) and adverse events (AEs) were assessed. Pharmacodynamic properties of OGX-427 was determined through assessment of knockdown of Hsp27 by immunohistochemistry of tumours after treatment. Anti-tumour activity was measured by response to treatment 9-12 days after OGX-427 intravesical administration by a secondary TURBT for patients with NMIBC and RC patients with muscle invasive disease compared to baseline histology. RESULTS Twenty-four patients were enrolled. 23 patients had NMIBC and one had cT2 disease treated by TURBT and RC, respectively. OGX-427 decreased expression of Hsp27 in tumours assessed after treatment when compared to pre-treatment. Pathological staging of surgical specimens revealed that eight patients had initial complete responses (p0). The remaining NMIBC patients had pTa tumours that ranged from G1-G2; the sole patient undergoing RC had pT2aG3 bladder cancer. No significant drug-related adverse events were reported; no dose limiting toxicity was observed CONCLUSIONS OGX-427 was well tolerated intravesically with minimal toxicity. Our results indicate early evidence for activity of OGX-427 treatment in NIMBC that requires confirmation in phase II/III studies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e142 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sebastian Frees More articles by this author Eliana Beraldi More articles by this author Kim Chi More articles by this author Ladan Fazli More articles by this author Peter Black More articles by this author Martin Gleave More articles by this author Alan So More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP49-01 NEXT GENERATION SEQUENCING OF CELL FREE DNA REVEALS GENOMIC ABERRATIONS IN METASTATIC UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2016MP49-01 NEXT GENERATION SEQUENCING OF CELL FREE DNA REVEALS GENOMIC ABERRATIONS IN METASTATIC UROTHELIAL CARCINOMA Tilman Todenhöfer, Stanislav Volik, Bernie Eigl, Scott North, Sonal Brahmbhatt, Anne Haegert, Johannes Mischinger, Arnulf Stenzl, Stephane LeBihan, Alexander Wyatt, Colin Collins, and Peter Black Tilman TodenhöferTilman Todenhöfer More articles by this author , Stanislav VolikStanislav Volik More articles by this author , Bernie EiglBernie Eigl More articles by this author , Scott NorthScott North More articles by this author , Sonal BrahmbhattSonal Brahmbhatt More articles by this author , Anne HaegertAnne Haegert More articles by this author , Johannes MischingerJohannes Mischinger More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Stephane LeBihanStephane LeBihan More articles by this author , Alexander WyattAlexander Wyatt More articles by this author , Colin CollinsColin Collins More articles by this author , and Peter BlackPeter Black More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.414AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, only limited data is available on genomic alterations present in metastatic lesions of patients with metastatic urothelial carcinoma (mUC). The constant release of circulating cell free DNA (cfDNA) from tumor cells into the peripheral blood stream may provide a valuable source for detection of cancer associated somatic copy number variations and mutations. The value of next-generation sequencing (NGS) of cfDNA to identify unknown genomic mutations in patients with bladder cancer has not been addressed. The aim of the present pilot study was to evaluate the feasibility of analysis of somatic mutations and copy number variations in plasma cfDNA of patients with mUC. METHODS Peripheral blood (20ml) was collected from 8 patients with mUC before chemotherapy. Plasma cfDNA was isolated using the QIAAmp Circulating Nucleic Acid Kit. DNA was extracted from peripheral blood mononuclear cells (PBMCs) using the DNEasy Kit (Qiagen) for assessment of germ-line DNA alterations. Library construction was performed using the Ampliseq Comprehensive Cancer Panel (ThermoFisher). NGS was done on an ION Proton platform (ThermoFisher). Copy number variations and mutations were compared to publically available datasets from UC tissue. RESULTS The median amount of cfDNA extracted was 202.2 ng (range 42.3-530.4). We detected strong mutation candidates in 6/8 patients (Table 1) and copy number changes consistent with previously reported alterations in UC. Common copy number variations included gain of 1p (5/8 patients), 7p (5/8 patients), and 17q (3/8 patients including one with high-level focal amplification of ERBB2) and loss of 6q (6/8 patients). CONCLUSIONS Non-invasive characterization of genomic changes in peripheral blood of patients with mUC using NGS of plasma cfDNA is feasible and detects copy number changes and mutations in a high proportion of patients. Analysis of cfDNA might therefore provide an improved understanding of genomic changes in mUC that could enable the personalized use of targeted therapies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e664 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tilman Todenhöfer More articles by this author Stanislav Volik More articles by this author Bernie Eigl More articles by this author Scott North More articles by this author Sonal Brahmbhatt More articles by this author Anne Haegert More articles by this author Johannes Mischinger More articles by this author Arnulf Stenzl More articles by this author Stephane LeBihan More articles by this author Alexander Wyatt More articles by this author Colin Collins More articles by this author Peter Black More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD03-06 RADICAL PROSTATECTOMY FOLLOWING ACTIVE SURVEILLANCE IS ASSOCIATED WITH INCREASED RATES OF UNFAVOURABLE PATHOLOGY

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2016PD03-06 RADICAL PROSTATECTOMY FOLLOWING ACTIVE SURVEILLANCE IS ASSOCIATED WITH INCREASED RATES OF UNFAVOURABLE PATHOLOGY Richard Savdie, Robert Bell, Jonathan Anning, Alan So, Martin Gleave, Peter Black, and Larry Goldenberg Richard SavdieRichard Savdie More articles by this author , Robert BellRobert Bell More articles by this author , Jonathan AnningJonathan Anning More articles by this author , Alan SoAlan So More articles by this author , Martin GleaveMartin Gleave More articles by this author , Peter BlackPeter Black More articles by this author , and Larry GoldenbergLarry Goldenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2094AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our centre has offered AS to men with very low to low-tier intermediate risk PCa based on patient and physician accepted balance of competing risks. We aimed to analyse the rates of unfavourable pathology in those undergoing radical prostatectomy (RP) following AS and compare these with a contemporary immediate RP group. METHODS Patients were stratified into very low risk (Epstein), low and intermediate NCCN risk groups. Rates of unfavourable pathology (predominant Gleason pattern 4 or ≥pT3 disease) and PSA failure following radical prostatectomy were analysed. A 2:1 propensity score matched analysis was performed using age, pre-treatment PSA, biopsy Gleason score and clinical T stage with a cohort of immediate RP patients from the same time period. RESULTS 651 men had AS (including 144 Intermediate Risk) with a median follow-up of 4.5 years (range 0.6-19.1). 203 patients had radical prostatectomy after AS (AS+RP) with an overall rate of unfavourable pathology of 34.9%. 195 AS+RP were matched to 390 immediate RP (IRP) with excellent correlation between covariates. The median time to surgery was 1.59 years for the AS+RP group vs 0.3 years for the IRP group ( p<0.001). There were slightly higher rates of EPE in AS+RP vs IRP group but this was not statistically significant (20% v 17%, p=0.5). Predominant Gleason pattern 4 was seen in significantly more men who had delayed RP compared to their matched counterparts (24.6% vs 12%, p<0.001). There was no difference in unfavourable pathology in the very low risk AS+RP vs IRP group (p=0.17). Despite differences in unfavourable pathology, there was no difference in the PSA failure free survival between the two groups at 3 years (Log Rank, p=0.47). CONCLUSIONS Active surveillance carries an increased risk of unfavourable pathology at the time of delayed RP in low and intermediate but not very low risk groups. Early data suggests that PSA recurrence rates are similar following RP despite delay in treatment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e58 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Richard Savdie More articles by this author Robert Bell More articles by this author Jonathan Anning More articles by this author Alan So More articles by this author Martin Gleave More articles by this author Peter Black More articles by this author Larry Goldenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP45-04 PATERNALLY EXPRESSED GENE-10 PROMOTES CELL GROWTH AND INVASION OF BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Basic Research & Pathophysiology I1 Apr 2016MP45-04 PATERNALLY EXPRESSED GENE-10 PROMOTES CELL GROWTH AND INVASION OF BLADDER CANCER Yoshihisa Kawai, Shusuke Akamatsu, Tetsutaro Hayashi, Eliana Beraldi, Fan Zhang, Roland Seiler, Jeffrey Leong, Htoo Oo, Igor Moskalev, Ladan Fazli, Hideyasu Matsuyama, Peter Black, Colin Collins, and Martin Gleave Yoshihisa KawaiYoshihisa Kawai More articles by this author , Shusuke AkamatsuShusuke Akamatsu More articles by this author , Tetsutaro HayashiTetsutaro Hayashi More articles by this author , Eliana BeraldiEliana Beraldi More articles by this author , Fan ZhangFan Zhang More articles by this author , Roland SeilerRoland Seiler More articles by this author , Jeffrey LeongJeffrey Leong More articles by this author , Htoo OoHtoo Oo More articles by this author , Igor MoskalevIgor Moskalev More articles by this author , Ladan FazliLadan Fazli More articles by this author , Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author , Peter BlackPeter Black More articles by this author , Colin CollinsColin Collins More articles by this author , and Martin GleaveMartin Gleave More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.281AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have recently identified that paternally expressed gene-10 (PEG10) promotes cell cycle progression in the context of TP53 and RB1 loss in neuroendocrine prostate cancer. Based on the evidence that TP53 mutations and RB1 inactivation are more prevalent in muscle invasive bladder cancer (MIBC), it is possible that PEG10 may contribute to the progression and prognosis of MIBC. To test this hypothesis, we characterized PEG10 function in bladder cancer and evaluated if PEG10 can be a novel therapeutic target for these cancers. METHODS PEG10 gene expression of tumor samples was analyzed using the cancer genome atlas (TCGA) cohort. The PEG10 expression in several bladder cancer cell lines was assessed by Western blot analysis and quantitative reverse transcription-PCR (qRT-PCR). Silencing of PEG10 in vitro was achieved using siRNA. The in vivo effect of PEG10 antisense oligonucleotide (ASO) treatment was assessed in the T24 orthotopic bladder cancer model. RESULTS Higher mRNA level of PEG10 was significantly associated with poorer disease-free survival after cystectomy in 131 patients in the TCGA, Nature 2014 cohort. We examined PEG10 expression in a panel of 12 bladder cancer cell lines by Western blot. UM-UC14 showed the highest PEG10 expression, and T24 showed higher PEG10 expression than the other bladder cancer cell lines. Similar results were confirmed by qRT-PCR. PEG10 transient knockdown using two independent siRNAs resulted in significant growth suppression in UM-UC14 (RB1inactivatedTP53mut) and T24 (RB1wtTP53mut) cells. PEG10 knockdown induced higher expression of key cell cycle dependent kinase inhibitors p21 and p27 than observed in the control cells. Conversely, forced PEG10 RF1b/2 isoform over-expression induced cell growth in UC14 and T24 cells. Furthermore, UM-UC14 cell invasion was significantly decreased with PEG10 transient knockdown. Using BrdU incorporation assay after cell cycle synchronization by double-thymidine block, we found that PEG10 drove cell cycle progression from G0/G1. In the orthotopic bladder cancer model, systemic PEG10-ASO administration to athymic nude mice delayed tumor progression in T24 cells. CONCLUSIONS We have demonstrated that PEG10 promotes bladder cancer progression. Inhibition of PEG10 may be a novel treatment strategy for a subset of bladder cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e608 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yoshihisa Kawai More articles by this author Shusuke Akamatsu More articles by this author Tetsutaro Hayashi More articles by this author Eliana Beraldi More articles by this author Fan Zhang More articles by this author Roland Seiler More articles by this author Jeffrey Leong More articles by this author Htoo Oo More articles by this author Igor Moskalev More articles by this author Ladan Fazli More articles by this author Hideyasu Matsuyama More articles by this author Peter Black More articles by this author Colin Collins More articles by this author Martin Gleave More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Rembrandt and the Passion, written by Peter Black, with Erma Hermens

Rembrandt and the Passion, written by Peter Black, with Erma Hermens

Ferenc A. Jolesz (1946-2014).

Ferenc A. Jolesz (1946-2014).

MP49-13 LIM-SH3 DOMAIN PROTEIN 1 KNOCKDOWN INHIBITS CELL GROWTH AND ENHANCES ACTIVITY OF CISPLATIN IN BLADDER CANCER.

You have accessJournal of UrologyBladder Cancer: Basic Research III1 Apr 2015MP49-13 LIM-SH3 DOMAIN PROTEIN 1 KNOCKDOWN INHIBITS CELL GROWTH AND ENHANCES ACTIVITY OF CISPLATIN IN BLADDER CANCER. Takashi Dejima, Ario Takeuchi, Tetsutaro Hayashi, Jeffrey Leong, Tabitha Tombe, Kevin Tam, Htoo Oo, Peter Black, Seiji Naito, Martin Gleave, and Christopher Ong Takashi DejimaTakashi Dejima More articles by this author , Ario TakeuchiArio Takeuchi More articles by this author , Tetsutaro HayashiTetsutaro Hayashi More articles by this author , Jeffrey LeongJeffrey Leong More articles by this author , Tabitha TombeTabitha Tombe More articles by this author , Kevin TamKevin Tam More articles by this author , Htoo OoHtoo Oo More articles by this author , Peter BlackPeter Black More articles by this author , Seiji NaitoSeiji Naito More articles by this author , Martin GleaveMartin Gleave More articles by this author , and Christopher OngChristopher Ong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.517AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer is the 6th most common cancer in the USA. The current standard therapy for the first line of metastatic or local advanced bladder cancer is combination therapy with cisplatin (CDDP) and gemcitabine (GEM). However 5-years survival is still below 50%; therefore additional therapy is needed. LIM-SH3 domain protein 1 (LASP1), identified from cDNA library of metastatic axillary lymph nodes of breast cancer, has been shown to promote cancer progression and invasion in several malignancies. In bladder cancer, LASP1 expression associates with cell invasion and can be used for detecting bladder cancer. However, the anti-tumor effects of LASP1 knockdown in vivo as well as combination therapy with chemotherapy remain unclear. In this study, we investigated the anti-cancer activity of LASP1 knockdown in bladder cancer. METHODS LASP1 gene expression of tumor samples is analyzed using the Affymetrix Exon Array. The LASP1 expression in several bladder cancer cell lines was assessed by Western blot analysis and quantitative reverse transcription-PCR. Silencing of LASP1 in vitro was achieved using siRNA. The In vivo effect of LASP1 antisense oligonucleotide (ASO) treatment was assessed in the T24 CDDP-R (cisplatin-resistant) orthotopic bladder cancer model. RESULTS High LASP1 expression correlated with recurrence rate between patients receiving adjuvant chemotherapy or not. This difference is increased in patients after adjuvant chemotherapy. The LASP1 expression is higher in UC1 and UC15 cells than in UC13 and UC6 cells. Knockdown of LASP1 using siRNA inhibited cell growth, and was accompanied by an increase in p21 and p27. Conversely, stable LASP1 overexpression drove cell growth with increase of cyclinD1 in UC13 and UC6 cells. The treatment of CDDP and GEM induced LASP1 expression in vitro. Combination treatment with LASP1 knockdown using siRNA and CDDP inhibited cell growth in UC1 cells. Furthermore, compared with parental cell line, LASP1 is higher in T24 CDDP-R and RT112 CDDP-R cells than in parental cells. In the orthotopic bladder cancer model, systemic LASP1 ASO administration to athymic nude mice delayed tumor progression in T24 CDDP-R cells. CONCLUSIONS These data revealed that LASP1 inhibition might be as a promising novel therapeutics modality in the treatment of bladder cancer, as well as a possible synergy with chemotherapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e607-e608 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takashi Dejima More articles by this author Ario Takeuchi More articles by this author Tetsutaro Hayashi More articles by this author Jeffrey Leong More articles by this author Tabitha Tombe More articles by this author Kevin Tam More articles by this author Htoo Oo More articles by this author Peter Black More articles by this author Seiji Naito More articles by this author Martin Gleave More articles by this author Christopher Ong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP1-07 ENRICHMENT OF CIRCULATING TUMOR CELLS IN PATIENTS WITH LOCALIZED PROSTATE CANCER USING A MICROFLUIDIC DEVICE

You have accessJournal of UrologyProstate Cancer: Markers I1 Apr 2015MP1-07 ENRICHMENT OF CIRCULATING TUMOR CELLS IN PATIENTS WITH LOCALIZED PROSTATE CANCER USING A MICROFLUIDIC DEVICE Tilman Todenhöfer, Emily Park, Hamid Abdi, Alex Li, Richard Ross, Xiaoyan Deng, Chao Jin, Simon Duffy, Martin Gleave, Hongshen Ma, and Peter Black Tilman TodenhöferTilman Todenhöfer More articles by this author , Emily ParkEmily Park More articles by this author , Hamid AbdiHamid Abdi More articles by this author , Alex LiAlex Li More articles by this author , Richard RossRichard Ross More articles by this author , Xiaoyan DengXiaoyan Deng More articles by this author , Chao JinChao Jin More articles by this author , Simon DuffySimon Duffy More articles by this author , Martin GleaveMartin Gleave More articles by this author , Hongshen MaHongshen Ma More articles by this author , and Peter BlackPeter Black More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Circulating tumor cells have proven prognostic value in patients with advanced prostate cancer (PC) but have been identified only infrequently in patients with localized PC using current standard techniques which are dependent on cell surface expression of epithelial cell adhesion molecule (EpCAM). However, evidence suggests that a proportion of CTCs likely do not express EpCAM. We developed a microfluidic system enabling antigen-independent enrichment of circulating tumor cells based on cell size and deformability. The aim of the present study was to evaluate presence of CTCs detected by this platform in patients with clinically localized PC. METHODS We included 58 consecutive patients undergoing radical prostatectomy and pelvic lymphadenectomy for localized PC. As control, we included 7 healthy men. Peripheral blood was collected preoperatively and processed by a microfluidic device for CTC enrichment. This device uses the deformation of single cells through layers of funnel shaped constrictions with openings smaller than the cell diameter in order to selectively transport cells based on size and deformability. Effluent cells were stained for pancytokeratin, CD45 and the androgen receptor (AR), and were identified by spectral analysis on the Zeiss LSM 780 confocal microscope. Cells positive for CK and negative for CD45 were considered to be CTCs. CTC counts were correlated to clinicopathologic parameters. RESULTS One or more CTCs were detected in 0/7 healthy controls and 35/58 (60.3%) patients with PC. The proportions of patients with ≥5 and ≥20 CTCs per ml were 41.4% and 24.1%, and the maximum CTC count was 527 CTCs/ml. We observed no correlation of CTC counts with tumor stage, nodal stage, Gleason score and serum PSA. CTCs were positive for AR-expression. CONCLUSIONS Circulating tumor cells can be detected in a considerable proportion of patients with localized prostate cancer using an EpCAM-independent system. CTC counts in our study were clearly higher than in other cohorts using EpCAM-dependent detection. The expression of AR in cytokeratin positive CTCs confirms their prostatic origin. The prognostic value of CTCs in peripheral blood before and after prostatectomy remains to be defined. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e3 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tilman Todenhöfer More articles by this author Emily Park More articles by this author Hamid Abdi More articles by this author Alex Li More articles by this author Richard Ross More articles by this author Xiaoyan Deng More articles by this author Chao Jin More articles by this author Simon Duffy More articles by this author Martin Gleave More articles by this author Hongshen Ma More articles by this author Peter Black More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Raising our profile

Dental Nursing June 2014 Vol 10 No 6 315 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Arissa Ames arissa.ames@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Managing Director Jon Benson Chief Executive Officer Ben Allen

MP37-17 INTRAOPERATIVE REGISTERED TRANSRECTAL ULTRASOUND GUIDANCE FOR ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: A 20 PATIENT STUDY

You have accessJournal of UrologyTechnology & Instruments: Robotics - Benign & Malignant Disease1 Apr 2014MP37-17 INTRAOPERATIVE REGISTERED TRANSRECTAL ULTRASOUND GUIDANCE FOR ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: A 20 PATIENT STUDY Omid Mohareri, Joseph Ischia, Peter Black, Larry Goldenberg, Julio Lobo, Caitlin Schneider, and Septimiu Salcudean Omid MohareriOmid Mohareri More articles by this author , Joseph IschiaJoseph Ischia More articles by this author , Peter BlackPeter Black More articles by this author , Larry GoldenbergLarry Goldenberg More articles by this author , Julio LoboJulio Lobo More articles by this author , Caitlin SchneiderCaitlin Schneider More articles by this author , and Septimiu SalcudeanSeptimiu Salcudean More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1254AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This work demonstrates, for the first time, the clinical application of a robotic transrectal ultrasound (TRUS) system calibrated to the da Vinci surgical system, for real-time monitoring of the prostate and periprostatic anatomy from the surgeon’s console during robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS Twenty patients (60.27±4.6 years of age; 33.16±11.78 cc prostate volume) with organ-confined prostate cancer undergoing RALRP at our institution agreed to participate in this CREB-approved (clinical research ethics board) study. Before docking the da Vinci system, our robotic TRUS system was attached to the foot of the operating table and a TRUS transducer was placed and adjusted to provide optimal transverse and sagittal images of the prostate and its surrounding structures. Furthermore, once the anterior surface of the prostate was visible to the surgeon, a registration technique was performed between the TRUS transducer and the da Vinci instrument, to enable the TRUS imaging plane to automatically track the tip of the da Vinci instrument. The mean duration of calibration procedure was 137.1 ± 29.59 sec. After the registration, movements of the instrument tip was constantly visible in the ultrasound image, showing the location of the tools relative to the target anatomy. RESULTS During each procedure, the TRUS robot was used to remotely control the rotation angle and insertion depth of the TRUS transducer and real-time TRUS images were relayed to the surgeon at the console using the TilePro feature of the da Vinci. No major complications occurred and the TRUS remained in place until the end of procedures. The TRUS imaging was found useful in the following stages: identifying urethra while passing the dorsal venous complex suture, defining the prostate-bladder interface during posterior and anterior bladder neck dissection, identifying the lateral edges of the seminal vesicles and their location with respect to the rectal wall, and identifying the prostate boundary at the apex. Automatic tool tracking was activated during all critical stages of the surgery to facilitate real-time TRUS navigation using the same instruments being used during the procedure. CONCLUSIONS We conclude that real-time TRUS imaging can be deployed and used easily during surgery, can be registered to the da Vinci surgical system instruments with high accuracy in a short time for remote control from the surgeon console, and it can provide the console surgeon with valuable anatomic information, aiming to improve procedure outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e398-e399 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Omid Mohareri More articles by this author Joseph Ischia More articles by this author Peter Black More articles by this author Larry Goldenberg More articles by this author Julio Lobo More articles by this author Caitlin Schneider More articles by this author Septimiu Salcudean More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP40-02 INCREASED UPTAKE OF RENAL TUMOUR BIOPSIES FOR SMALL RENAL MASSES – RESULTS OF A MULTICENTRE CANADIAN EXPERIENCE

You have accessJournal of UrologyKidney Cancer; Evaluation/Staging IV1 Apr 2014MP40-02 INCREASED UPTAKE OF RENAL TUMOUR BIOPSIES FOR SMALL RENAL MASSES – RESULTS OF A MULTICENTRE CANADIAN EXPERIENCE Jaimin R. Bhatt, Simon Tanguay, Zhihui Liu, Patrick O. Richard, Anil Kapoor, Ricardo Rendon, Louis Lacombe, Peter Black, Stephen Pautler, Rodney Breau, Ronald Moore, Michael Jewett, and Antonio Finelli Jaimin R. BhattJaimin R. Bhatt More articles by this author , Simon TanguaySimon Tanguay More articles by this author , Zhihui LiuZhihui Liu More articles by this author , Patrick O. RichardPatrick O. Richard More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Ricardo RendonRicardo Rendon More articles by this author , Louis LacombeLouis Lacombe More articles by this author , Peter BlackPeter Black More articles by this author , Stephen PautlerStephen Pautler More articles by this author , Rodney BreauRodney Breau More articles by this author , Ronald MooreRonald Moore More articles by this author , Michael JewettMichael Jewett More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1337AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Renal tumour biopsy (RTB) has become increasingly important in the management of the small renal mass (SRM) especially over the last decade. We aim to evaluate the uptake of RTB across Canadian centres using the Canadian Kidney Cancer Information System (CKCis) - a centralised database of kidney tumour patients. Methods A review of the CKCis database on RTB recorded from 6 provinces across Canada was performed. The database was started in 2011 and preceding data has been entered retrospectively. We analyzed patient demographics, biopsy diagnostic rates, histological subtype, tumour grade specifically in clinical T1a tumours, and determined concordance rates compared with surgical pathology. Results Of 2927 patients and 882 biopsies recorded on the CKCis database, 616 were RTBs of 552 patients between 1994 and 2013. There was a significant increase in the uptake of renal tumour biopsies (15% in 2010, 22% in 2011 and 42% in 2013) when compared to overall new diagnoses. Left and right renal biopsies were roughly equal. Mean age was 64 years. There was a male preponderance of 65%. Ninety per cent had one biopsy, while 10% had 2 or more. Of 470 patients with a recorded clinical T-stage, 259 or 55% were cT1a tumours, with 45% biopsies performed for lesions > 4cm. For the cT1a sub-group of 259 patients, a diagnosis was available in 236 or 91%. Of these, a malignant diagnosis was made in 80.4% while 19.6% were benign. Histological subtype was available in 88% of diagnostic biopsies (208/236) with 190 malignant (117 conventional clear cell, 44 papillary and 29 chromophobe) and 18 benign (2 angiomyolipoma and 16 oncocytoma). Grade was available in 67% of malignant cases. Of 259 cT1a tumours, 116 underwent surgery with partial nephrectomy in 78% and radical nephrectomy in 22%. Of all lesions recorded with a final surgical pathology, there was a 100% malignancy concordance rate. Histological subtype concordance rates varied between 80-85%. Grade concordance was lower at 65%. Conclusions Our findings confirm an increased uptake of RTB in diagnosis of SRMs of <4cm over time with excellent diagnostic rates and overall malignancy concordance rates. There is however need to improve concordance rates for both grade and histological subtype as centres increase their uptake of renal tumour biopsies with the opportunity for enhanced experience and skills transfer. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e434 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jaimin R. Bhatt More articles by this author Simon Tanguay More articles by this author Zhihui Liu More articles by this author Patrick O. Richard More articles by this author Anil Kapoor More articles by this author Ricardo Rendon More articles by this author Louis Lacombe More articles by this author Peter Black More articles by this author Stephen Pautler More articles by this author Rodney Breau More articles by this author Ronald Moore More articles by this author Michael Jewett More articles by this author Antonio Finelli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD10-12 CLINICAL OUTCOMES FOLLOWING LAPAROSCOPIC MANAGEMENT OF PT3 RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-12 CLINICAL OUTCOMES FOLLOWING LAPAROSCOPIC MANAGEMENT OF PT3 RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS Jasmir Nayak, Premal Patel, Kamaljot Kaler, Zhihui Liu, Anil Kapoor, Ricardo Rendon, Simon Tanguay, Peter Black, Jun Kawakami, Rodney Breau, Antonio Finelli, Laurence Klotz, and Darrel Drachenberg Jasmir NayakJasmir Nayak More articles by this author , Premal PatelPremal Patel More articles by this author , Kamaljot KalerKamaljot Kaler More articles by this author , Zhihui LiuZhihui Liu More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Ricardo RendonRicardo Rendon More articles by this author , Simon TanguaySimon Tanguay More articles by this author , Peter BlackPeter Black More articles by this author , Jun KawakamiJun Kawakami More articles by this author , Rodney BreauRodney Breau More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Laurence KlotzLaurence Klotz More articles by this author , and Darrel DrachenbergDarrel Drachenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.488AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Technological advances and improved experience have resulted in advanced renal masses being treated by minimally invasive techniques. We report on the oncological outcomes of patients with non-metastatic renal masses with vascular invasion (pT3) who were treated with laparoscopic nephrectomy (LN) and/or caval thrombectomy. METHODS Institutional databases on patients treated surgically for renal cell carcinoma (RCC) were obtained from 14 centres across 6 Canadian provinces forming the Canadian Kidney Cancer Information System (CKCis) database. Data were collected on 2204 patients and included patient characteristics, peri-operative information, as well as pathological and oncological outcomes. RESULTS Of the 2204 patients, 498 (22.6%) patients had pT3 disease according to the 2009 TNM staging system. 173 (35%) patients underwent laparoscopic management, of which 135 (27%) did not have evidence of metastatic disease at the time of surgery. Mean age was 65 (range 35-88) with a higher propensity of male patients (n=87, 64%). Median tumor size was 6.5 cm (range 1 - 15 cm). The pre-operative clinical stage ranged from cT1-cT4. Average blood loss was 266 ml (range 0-4000 ml) with a mean operative time of 146 minutes (range 73-360 minutes). The majority of lesions were clear cell RCC (68%). Of the pT3 lesions, there were no peri-operative deaths (<30 days). After a median follow-up of 1.4 years, 31 (23%) patients developed metastatic disease, the vast majority being of pulmonary origin (97%). At the end of our follow-up period 130 (96%) patients were alive. CONCLUSIONS For properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable oncological outcomes. Although encouraging, longer follow-up is required to further delineate its role. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e286 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jasmir Nayak More articles by this author Premal Patel More articles by this author Kamaljot Kaler More articles by this author Zhihui Liu More articles by this author Anil Kapoor More articles by this author Ricardo Rendon More articles by this author Simon Tanguay More articles by this author Peter Black More articles by this author Jun Kawakami More articles by this author Rodney Breau More articles by this author Antonio Finelli More articles by this author Laurence Klotz More articles by this author Darrel Drachenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD12-03 ACTIVE SURVEILLANCE IN 853 MEN WITH LOW AND INTERMEDIATE RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2014PD12-03 ACTIVE SURVEILLANCE IN 853 MEN WITH LOW AND INTERMEDIATE RISK PROSTATE CANCER Jonathan Aning, Michael Peacock, Homi Zargar, David Harriman, Michael McKenzie, Peter Black, Alan So, Larry Goldenberg, and Martin Gleave Jonathan AningJonathan Aning More articles by this author , Michael PeacockMichael Peacock More articles by this author , Homi ZargarHomi Zargar More articles by this author , David HarrimanDavid Harriman More articles by this author , Michael McKenzieMichael McKenzie More articles by this author , Peter BlackPeter Black More articles by this author , Alan SoAlan So More articles by this author , Larry GoldenbergLarry Goldenberg More articles by this author , and Martin GleaveMartin Gleave More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.975AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is gaining increasing acceptance as an alternative primary treatment option to curative therapy in men with ‘low risk’ organ confined prostate cancer. The aim of this study was to evaluate short and medium term outcomes of a large cohort of men from a single institution with low and intermediate risk prostate cancer managed with AS and to identify risk factors predicting for progression. METHODS All men managed with AS as a primary therapy were identified from a prospectively maintained institutional database. All men were less than 75 years old, had undergone restaging prostate biopsy and had at least 6 months follow up. AS involved 6 monthly PSA and DRE reviews in addition to rebiopsy of the prostate, with planned repeat biopsies every 2 years. Prostate cancer risk status was defined by National Comprehensive Cancer Network guideline criteria. Kaplein–Meier and Cox logistic regression were applied to estimate survival and risk factors of progression for the whole cohort. RESULTS In total 853 men with a mean age of 65 years and mean PSA at diagnosis of 6.5ng/ml met inclusion criteria. Mean follow up was 5 years. Of the cohort 50%, 27% and 23% were classified as very low, low or intermediate risk prostate cancer, respectively. Progression to active treatment occurred in 309 patients, most commonly due to grade progression at re-biopsy (62%), while patient choice and PSA progression accounted for 10% and 8% respectively. Actuarial probability of remaining on AS for the whole cohort at 1, 2, 5, 8 years was 95%, 81%, 60%, 47% respectively. There was a significant difference in the risk of progression to treatment between very low risk and other groups (p = 0.002), but not between low and intermediate risk groups (p= 0.481). Multivariate analysis determined increasing number of positive biopsy cores at diagnosis and PSA density as significant predictors of progression to treatment (p= <0.001). Negative prostate biopsies prior to diagnosis was a significant negative predictor of progression to treatment (p=0.01). Of those treated 4% (n=15) had biochemical recurrence. Overall survival of the cohort was 97% and only 1 patient died of prostate cancer. CONCLUSIONS AS has the lowest risk of progression in very low risk prostate cancer, and is also an acceptable mode of initial treatment in selected men with low and low-tier intermediate risk prostate cancer. Further studies should be directed specifically at the low and intermediate risk groups to better risk stratify who needs intervention. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e347 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jonathan Aning More articles by this author Michael Peacock More articles by this author Homi Zargar More articles by this author David Harriman More articles by this author Michael McKenzie More articles by this author Peter Black More articles by this author Alan So More articles by this author Larry Goldenberg More articles by this author Martin Gleave More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Renovascular Hypertension after Laparoscopic Partial Nephrectomy

No AccessJournal of UrologyRadiology Page1 May 2014Renovascular Hypertension after Laparoscopic Partial Nephrectomy Homayoun Zargar, Jonathan Aning, Gerald Legiehn, and Peter Black Homayoun ZargarHomayoun Zargar More articles by this author , Jonathan AningJonathan Aning More articles by this author , Gerald LegiehnGerald Legiehn More articles by this author , and Peter BlackPeter Black More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.01.103AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Blunt renal trauma-induced hypertension: prevalence, presentation, and outcome. Am J Hypertens2006; 19: 500. Google Scholar 2 : Malignant hypertension due to renal artery stenosis after open partial nephrectomy in a solitary kidney. Urology2007; 69: 385. Google Scholar 3 : Intimal injury of ultrasonically skeletonized internal thoracic artery by a vessel clamp: morphological analysis. Interact Cardiovasc Thorac Surg2007; 6: 331. Google Scholar 4 : Studies on experimental hypertension: I. The production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med1934; 59: 347. Crossref, Medline, Google Scholar 5 : Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int1998; 53: 735. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 191Issue 5May 2014Page: 1418-1420 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information Homayoun Zargar More articles by this author Jonathan Aning More articles by this author Gerald Legiehn More articles by this author Peter Black More articles by this author Expand All Advertisement PDF downloadLoading ...

Expanding the role of dental nurses

Dental Nursing February 2014 Vol 10 No 2 67 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Arissa Ames arissa.ames@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Chief Executive Officer Ben Allen

Looking through the crystal ball

Dental Nursing January 2014 Vol 10 No 1 5 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Arissa Ames arissa.ames@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Chief Executive Officer Ben Allen

Cosmetic dentistry: striving for perfection

Dental Nursing December 2013 Vol 9 No 12 679 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Arissa Ames arissa.ames@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Chief Executive Officer Ben Allen

Out of work

Dental Nursing October 2013 Vol 9 No 10 555 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Fenella Wenham fenella.wenham@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Chief Executive Officer Ben Allen

Moving up a gear

Dental Nursing September 2013 Vol 9 No 9 493 Editor-in-Chief Tessa Meese Editor/Publisher Peter Black peter.black@markallengroup.com Commercial Manager Fenella Wenham fenella.wenham@markallengroup.com Classified Sales Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com Group Production Manager Jon Redmayne Production Assistant Larry Oakes Digital and Marketing Director Matt Cianfarani Chief Executive Officer Ben Allen