Strict Selection Criteria Research Articles

Follicular fluid from infertile women with mild endometriosis may compromise the meiotic spindles of bovine metaphase II oocytes

What is the potential impact of follicular fluid (FF) from infertile women with mild endometriosis (ME) on oocyte quality, especially on nuclear maturation and the meiotic spindle? FF from infertile women with ME may compromise nuclear maturation and the meiotic spindles of in vitro matured bovine oocytes. Controversial studies have suggested that impaired oocyte quality may be involved in the pathogenesis of endometriosis-related infertility. Moreover, some studies have demonstrated alterations in the composition of FF from infertile women with endometriosis. However, to date no study has evaluated the effect of FF from infertile women with ME on the genesis of meiotic oocyte anomalies. We performed an experimental study. Samples of FF were obtained from February 2009 to February 2011 from 22 infertile women, 11 with ME and 11 with tubal or male factors of infertility (control group), who underwent ovarian stimulation for ICSI at our university IVF Unit. From March 2011 to February 2012 we performed in vitro maturation (IVM) experiments using immature bovine oocytes as described below. FF free of blood and containing a mature oocyte was obtained from 22 infertile women during oocyte retrieval for ICSI. Immature bovine oocytes underwent IVM in the absence of FF (No-FF) and in the presence of four concentrations (1, 5, 10 and15%) of FF from infertile women without endometriosis (C-FF) and with ME (ME-FF). Eleven replicates were performed, each one using FF from a control patient and a patient with ME. Each FF sample was used in only one experiment. After 22-24 h of IVM, oocytes were denuded, fixed and immunostained for morphological visualization of microtubules and chromatin by confocal microscopy. A total of 1324 cumulus-oocyte complexes were matured in vitro. Of these, 1128 were fixed and 1048 were analyzed by confocal microscopy. The percentage of meiotically normal oocytes was significantly higher for oocytes that underwent IVM in the absence of FF (No-FF; 76.5%) and in the presence of 1% (80.9%), 5% (76.6%), 10% (75%) and 15% (76.2%) C-FF than in oocytes that underwent IVM in the presence of 1% (44.4%), 5% (36.7%), 10% (45.5%) and 15% (51.2%) ME-FF (P < 0.01). No differences were observed among FF concentrations within each group. When the four concentrations from each group were pooled, the number of oocytes in metaphase I stage was significantly higher in the ME-FF (50 oocytes) than in the C-FF (29 oocytes) group and the percentage of meiotic abnormalities was significantly higher when oocytes were matured with ME-FF (55.8%) than with C-FF (23.1%), P < 0.01. Owing to the strict selection criteria for FF donors, this study had a small sample size (11 cases and 11 controls), and thus further investigations using a large cohort of patients are needed to confirm these results. In addition, data obtained from studies using animal models may not necessarily be extrapolated to humans and studies evaluating in vivo matured oocytes from infertile women with ME are important to confirm our results. Our results open new insights into the pathogenic mechanisms of infertility related to mild endometriosis, suggesting that FF from infertile women with mild endometriosis may be involved in the worsening of oocyte quality of these women. This study was supported by the National Council for Scientific and Technological Development (CNPq), Brazil. The authors declare no conflicts of interest.

A mathematical model for optimizing the indications of liver transplantation in patients with hepatocellular carcinoma.

BackgroundThe criteria for organ sharing has developed a system that prioritizes liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) who have the highest risk of wait-list mortality. In some countries this model allows patients only within the Milan Criteria (MC, defined by the presence of a single nodule up to 5 cm, up to three nodules none larger than 3 cm, with no evidence of extrahepatic spread or macrovascular invasion) to be evaluated for liver transplantation. This police implies that some patients with HCC slightly more advanced than those allowed by the current strict selection criteria will be excluded, even though LT for these patients might be associated with acceptable long-term outcomes.MethodsWe propose a mathematical approach to study the consequences of relaxing the MC for patients with HCC that do not comply with the current rules for inclusion in the transplantation candidate list. We consider overall 5-years survival rates compatible with the ones reported in the literature. We calculate the best strategy that would minimize the total mortality of the affected population, that is, the total number of people in both groups of HCC patients that die after 5 years of the implementation of the strategy, either by post-transplantation death or by death due to the basic HCC. We illustrate the above analysis with a simulation of a theoretical population of 1,500 HCC patients with tumor size exponentially. The parameter λ obtained from the literature was equal to 0.3. As the total number of patients in these real samples was 327 patients, this implied in an average size of 3.3 cm and a 95% confidence interval of [2.9; 3.7]. The total number of available livers to be grafted was assumed to be 500.ResultsWith 1500 patients in the waiting list and 500 grafts available we simulated the total number of deaths in both transplanted and non-transplanted HCC patients after 5 years as a function of the tumor size of transplanted patients. The total number of deaths drops down monotonically with tumor size, reaching a minimum at size equals to 7 cm, increasing from thereafter. With tumor size equals to 10 cm the total mortality is equal to the 5 cm threshold of the Milan criteria.ConclusionWe concluded that it is possible to include patients with tumor size up to 10 cm without increasing the total mortality of this population.

Alternative birthing ways: the neonatologist's point of view

A recent Cochrane review [1] showed that “there is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women”. However, in this review only one trial (involving 11 women) contributed data. This did not allow conclusions to be drawn about safety. More information emerges from another recent review [2] that assessed babies’ mortality differences between home birth and hospital birth in studies published between 1996 and 2011; they selected 11 studies, with no evidence of an increase of deaths in either group. However, these studies only included low-obstetrical-risk women from western countries. A wide metaanalysis [3] considered all studies in this field published in 1947–2010 (Table 1); 12 studies were retrieved and their conclusions were that, though perinatal mortality was similar between the two groups, “the overall neonatal death rate was almost twice as high in planned home vs planned hospital births, and almost tripled among nonanomalous neonates”. On these bases, the American college of obstetricians and gynecologists [4] affirmed that “reports suggesting that planned home births are safe involved only healthy pregnant women. Recent cohort studies reporting lower perinatal mortality rates with planned home birth describe the use of strict selection criteria for appropriate candidates (. . .). Failure to adhere to such criteria (because of postterm pregnancy, twins, or breech presentation) is clearly associated with a higher risk of perinatal death”. And added: “Another factor influencing the safety of planned home birth is the availability of safe and timely intrapartum transfer of the laboring patient”. The American Academy of Pediatrics agreed with this statement adding: “Geography also may adversely affect the safety of planned home birth, because travel times >20 minutes have been associated with increased risk of adverse neonatal outcomes, including mortality”. AAP requires for these babies the same guarantees given to hospital births, with regard to birth assessment and resuscitation, due

Unveiling new members in five nearby young moving groups

In the last decade many kinematic groups of young stars (<100 Myr) were discovered in the solar neighbourhood. Since the most interesting period of planet formation overlaps with the age of these groups, their well dated members are attractive targets for exoplanet searches by direct imaging. We combined astrometric, photometric and X-ray data, and applied strict selection criteria to explore the stellar content of five nearby moving groups. We identified more than 100 potential new candidate members in the {\ss} Pic moving group, and in the Tucana-Horologium, Columba, Carina, and Argus associations. In order to further assess and confirm their membership status, we analysed radial velocity data and lithium equivalent widths extracted from high-resolution spectra of 54 candidate stars. We identified 35 new probable/possible young moving group members: 4 in the {\ss} Pic moving group, 11 in the Columba association, 16 in the Carina association, and 4 in the Argus association. We found serendipitiously a new AB Dor moving group member as well. For four Columba systems Hipparcos based parallaxes have already been available and as they are consistent with the predicted kinematic parallaxes, they can be considered as secure new members.

Prospective, Multicenter, Single-Arm Study of Mechanical Thrombectomy Using Solitaire Flow Restoration in Acute Ischemic Stroke

Mechanical thrombectomy using stent retriever devices have been advocated to increase revascularization in intracranial vessel occlusion. We present the results of a large prospective study on the use of the Solitaire Flow Restoration in patients with acute ischemic stroke. Solitaire Flow Restoration Thrombectomy for Acute Revascularization was an international, multicenter, prospective, single-arm study of Solitaire Flow Restoration thrombectomy in patients with large vessel anterior circulation strokes treated within 8 hours of symptom onset. Strict criteria for site selection were applied. The primary end point was the revascularization rate (thrombolysis in cerebral infarction ≥2b) of the occluded vessel as determined by an independent core laboratory. The secondary end point was the rate of good functional outcome (defined as 90-day modified Rankin scale, 0-2). A total of 202 patients were enrolled across 14 comprehensive stroke centers in Europe, Canada, and Australia. The median age was 72 years, 60% were female patients. The median National Institute of Health Stroke Scale was 17. Most proximal intracranial occlusion was the internal carotid artery in 18%, and the middle cerebral artery in 82%. Successful revascularization was achieved in 79.2% of patients. Device and procedure-related severe adverse events were found in 7.4%. Favorable neurological outcome was found in 57.9%. The mortality rate was 6.9%. Any intracranial hemorrhagic transformation was found in 18.8% of patients, 1.5% were symptomatic. In this single-arm study, treatment with the Solitaire Flow Restoration device in intracranial anterior circulation occlusions results in high rates of revascularization, low risk of clinically relevant procedural complications, and good clinical outcomes in combination with low mortality at 90 days. http://www.clinicaltrials.gov. Unique identifier: NCT01327989.

Steroids for idiopathic sudden sensorineural hearing loss

This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2006 and previously updated in 2009.Idiopathic sudden sensorineural hearing loss (ISSHL) is a clinical diagnosis characterised by a sudden deafness of cochlear or retrocochlear origin in the absence of a clear precipitating cause. Steroids are commonly prescribed to treat this condition. There is no consensus on their effectiveness. To determine whether steroids in the treatment of ISSHL a) improve hearing (primary) and b) reduce tinnitus (secondary).To determine the incidence of significant side effects from the medication. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 22 April 2013. We identified all randomised controlled trials (with or without blinding) in which steroids were evaluated in comparison with either no treatment or a placebo. We considered trials including the use of steroids in combination with another treatment if the comparison control group also received the same other treatment. The two authors reviewed the full-text articles of all the retrieved trials of possible relevance and applied the inclusion criteria independently. We graded trials for risk of bias using the Cochrane approach. The data extraction was performed in a standardised manner by one author and rechecked by the other author. Where necessary we contacted investigators to obtain the missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the populations studied and the differences in steroid formulations, dosages and duration of treatment. We analysed and reported the quality of the results of each study individually. A narrative overview of the results is presented. Only three trials, involving 267 participants, satisfied the inclusion criteria and all three studies were at high risk of bias. One trial showed a lack of effect of oral steroids in improving hearing compared with the placebo control group. The second trial showed a significant improvement of hearing in 61% of the patients receiving oral steroid and in only 32% of the patients from the control group (combination of placebo-treated group and untreated control group). The third trial also showed a lack of effect of oral steroids in improving hearing compared with the placebo control. However, this trial did not follow strict inclusion criteria for participant selection and analysis of data was limited by significant exclusion of participants from the final analysis and lack of participant compliance to the treatment protocol. No clear evidence was presented in two trials about any harmful side effects of the steroids. Only one study declared that no patients suffered from adverse effects of the steroid treatment. The value of steroids in the treatment of idiopathic sudden sensorineural hearing loss remains unclear since the evidence obtained from randomised controlled trials is contradictory in outcome, in part because the studies are based upon too small a number of patients.

Enhancement of probiotic activity by S-layer protein of Lactobacillus plantarum D6 strain in coculture with L. plantarum D13

Among numerous lactic acid bacteria strains isolated from autochthonous smoked fresh cheeses, potential probiotic strains were selected according to strict probiotic selection criteria. Further research revealed that the strain MCD6 was actually a coculture of two Lactobacillus plantarum strains which were identified as L. plantarum D13 and L. plantarum D6, where L. plantarum D6 expresses surface S-layer proteins of approximately 45 kDa. Since S-layer proteins, to our knowledge, have never been identified among representatives of L. plantarum species, it was of our great interest to further characterise and study its functional role in probiotic activity. Hence, the S-layer functional role in probiotic activity of coculture L. plantarum D6 and L. plantarum D13 through the comparison of important functional activities of probiotic strains was evaluated. Aggregation and coaggregation abilities, adhesion to intestinal epithelial cells in vitro, pathogen exclusion and survival in simulated conditions of gastrointestinal tract and during freeze drying, before and after guanidine hydrochloride extraction of S-layer proteins were examined in coculture and monocultures of L. plantarum D13 and L. plantarum D6, respectively. As a result it was established that coculture of two L. plantarum strains enhances their probiotic activity due to the S-layer protein of L. plantarum D6 strain.

Is V–Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.

Preservación vesical electiva en tumor vesical músculo invasivo

ObjetivesRadical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/− Chemotherapy+Radiotherapy to selected patients as an alternative. Material and methodsWe analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. ResultsThe mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. ConclusionsAlthough radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results.

A brief comment on liver resection for hepatocellular carcinoma

Although only 30–40% of patients with hepatocellular carcinoma (HCC) are eligible for surgery, it remains the most feasible and efficient treatment [1, 2]. The three most important factors that have led to reduce mortality, with a 70% expectation of 5-year survival, are: i) better liver function assessment, ii) understanding of the segmental liver anatomy through more accurate imaging studies and iii) technical advances in surgical procedures [3]. Hepatic resection is the treatment of choice for HCC, especially in non-cirrhotic patients. Major resections can be carried out with low rates of life-threatening complications. Conversely, among patients who have cirrhosis, strict selection criteria are required to avoid treatment-related complications.

SU‐E‐I‐91: The Role of Diagnostic Reference Levels in the Optimization of Patient Protection

Purpose: The concept of Diagnostic Reference Levels (DRLs) has been around for over 20 years and is part of the regulatory framework of many countries. The International Basic Safety Standards (BSS) requires both the establishment and the use of DRLs for imaging procedures. However, the level of implementation around the world varies considerably, with many countries yet to establish DRLs for common procedures. This paper discusses the current experiences with DRLs and their strengths and limitations.Method and Materials: The published experiences of several countries are analyzed and discussed. Points considered include whether there is a need for strict criteria for patient selection or not, whether clinical purpose must be considered or whether body habitus is sufficient, whether DRLs should be set according to the technology used or not, and whether there is a role for international DRLs. Results: Countries that have had several cycles of DRLs have clearly demonstrated their effectiveness in optimization of protection. The initially held belief that the weight of patients included in samples needed to be carefully controlled may not be strictly necessary. DRL values should be based on the then current practice in a given country, and a priori, encompass all technologies and techniques in use. While clinical purpose ultimately determines the signal to noise ratio needed for imaging, for the purposes of DRLs as a blunt tool for identifying outliers, perhaps body habitus based DRLs are sufficient. Impediments to the establishment and use of DRLs include lack of resources, e.g. personnel, dosimeters, and custodians for a national patient dose database. Conclusion: DRLs are an important tool for optimization of protection, and the level of implementation around the world needs to improve. However they are not the only tool for optimization and parallel initiatives need to take place.

Evaluation of domino liver transplantations in Germany

A retrospective multicenter study has been conducted to evaluate domino liver transplantations (DLTs) in Germany. The study provides insight into survival and features having an impact on the assessment of neuropathy after DLT. In addition, a neurologic follow-up program with a scheme to estimate the likelihood of de novo amyloidosis is presented. A series of 61 DLTs at seven transplant centers in Germany was enrolled. The mean age of domino recipients at the time of transplantation was 58 years, 46 of them being men, and 15 being women. The median follow-up was 46 months. The overall 1-, 3-, and 5-year survival of domino recipients was 81.6%, 70.8% and 68.8%, respectively. Causes of death were primarily not related to familial amyloidosis. The main indication of DLT was hepatocellular carcinoma. Two of the reported domino recipients developed symptoms and signs of de novo amyloidosis within 10 years after transplantation. A total of 30 domino graft recipients (49.18%) presented with diabetes post transplantation. In conclusion, an advanced follow-up program is crucial to evaluate the risk of transmitting familial amyloidosis by DLT and to establish more strict selection criteria for domino recipients.

Comparative Effectiveness Research It Is Not

Comparative Effectiveness Research It Is Not

Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest

AimsAcute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients MethodsFindings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG) ResultsNinety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p=0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p<0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively) ConclusionsElectrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest

Patients with hepatitis C infection and normal liver function: an evaluation of cognitive function

Purpose of the studyHepatitis C virus (HCV) is associated with neuropsychiatric complaints. Previous studies have associated cognitive alterations with HCV infection but have often included confounding factors in their samples....

Abstract 2044: Down-regulation of YAP sensitizes lung cancer cells to platinum and ionizing radiation.

Abstract Platinum compounds are the foundation of chemotherapy regimens for non-small cell lung cancer despite poor response rates and limited response duration. In order to identify novel target genes the modulation of which could influence drug sensitivity of lung cancer cells in response to cisplatin, we performed a high-throughput RNAi screen targeting the majority of genes in the human genome. We first transfected PC9 lung cancer cells with an shRNA library containing ∼60,000 individual shRNAs, then identified depleted versus enriched shRNAs following two weeks of cisplatin treatment versus vehicle in surviving cells. Standard quality control studies suggested good correlation among triplicates. After using strict selection criteria, we selected a narrow list of highly depleted genes- genes the activity of which is expected to be required for cell survival in the face of cisplatin therapy, including YAP (Yes associated protein). YAP shRNAs were depleted 80 fold in the cisplatin screen. YAP was initially identified as a protein interacting with the non-receptor tyrosine kinase c-Yes and is considered a nuclear effector of the Hippo pathway that promotes cell growth as a transcription co-activator. To validate this promising target identified in our screen, we first confirmed that an siRNA pool targeting YAP can efficiently knockdown YAP protein expression in multiple lung cancer cell lines, then next examined the effects of YAP knockdown on drug responses. YAP knockdown indeed quite prominently improved sensitivities not only to cisplatin, but also to ionizing radiation in several cell lines. Furthermore, YAP knockdown also induces prominent apoptosis as measured by induction of PARP cleavage concurrent with platinum therapy. Our findings indicate the YAP inhibition is potentially relevant to improve sensitivities to platinum-based chemotherapy and chemoradiation in lung cancer. Citation Format: Haiying Cheng, Zhenfeng Zhang, Ruth Rodriguez-Barrueco, Jiyang Yu, Jose M. Silva, Simon Cheng, Roman Perez-Soler, Balazs Halmos. Down-regulation of YAP sensitizes lung cancer cells to platinum and ionizing radiation. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2044. doi:10.1158/1538-7445.AM2013-2044

New archaeointensity data from Italy and geomagnetic field intensity variation in the Italian Peninsula

We present new archaeointensity results from three Italian kilns situated at Ascoli Satriano, Vagnari and Fontanetto Po obtained with the Thellier modified by Coe double heating method. These data complement the directional results previously published. All sites are dated on the basis of archaeological information and/or thermoluminescence dating. The results are corrected for the anisotropy of the thermoremanent magnetization and the cooling rate effects. The new data are compared with previously published archaeointensity data from Italy and nearby countries within 900 km radius from Viterbo. An initial data set including archaeointesity data mainly coming from Italy, France, Switzerland, Czech Republic, Slovakia, Hungary, Greece and Bulgaria has been compiled. After the application of strict selection criteria, the most reliable data have been used for the calculation of a preliminary Italian intensity secular variation (SV) curve for the last 3000 yr. The new curve covers the 300 BC–400 AD and 1200–1900 AD periods. It is established by means of sliding windows of 200 yr shifted by 100 yr. The lack of reliable data for the 1000–200 BC and 400–1200 AD time intervals does not permit the calculation of a continuous curve. Clearly, more high-quality archaeointensity data from Italy and Europe are still needed to draw a robust intensity SV curve for the Italian Peninsula that could be used for archaeomagnetic dating in combination with the directional data.

Editorial Comment to Characterization and risk stratification of prostate cancer in patients undergoing radical cystoprostatectomy

Radical cystoprostatectomy (RPE) with bilateral lymph node dissection and urinary diversion is the treatment of choice in muscle-invasive bladder cancer. Standard cystectomy includes en bloc prostatectomy providing the best oncological control, but is associated with substantial reduction of quality of life. The two main concerns regarding the functional results of this surgical method are affected continence and sexual function. Therefore, various modifications to standard cystectomy have been used to improve functional outcomes. All of these techniques aim to minimize dissection near the urinary sphincter and neurovascular bundles during cystectomy by partial or complete sparing of the prostate, seminal vesicles and vasa deferentia. These methods provided a remarkable improvement of functional results. 1 In contrast, leaving whole or part of the prostate behind raises concerns on oncological results.The two main risks of prostate-sparing cystectomy are overseeing a possible prostatic urothelial carcinoma and/or occult primary prostate cancer (PCA) in these patients. The rationale for this is that both urothelial carcinoma and PCA were reported to be frequent incidental findings in RPE specimens. In the absence of randomized clinical trials, the direct comparison of oncological risks between RPE and prostate-sparing cystectomy is not possible. Therefore, critical analysis of single risk factors and their combinations described in different retrospective studies remains the only way to draw conclusions regarding the risks of various cystectomy methods. This present study 2 is the largest to date assessing the prevalence and risk of occult PCA in patients treated with RPE. Buse et al. found PCA in 18% of RPE specimens, which is at the lower end of the PCA prevalence published so far. The rate of high-risk PCA was <2% over the whole patient cohort, and is ~10% of all detected PCAs, showing that most identified PCA in RPE specimens are clinically indolent. Formerly, Thomas et al. showed that preoperatively available predictors, such as serum prostate-specific antigen level and digital rectal examination are able to sensitively identify clinically significant PCA before radical surgery. 3 However, others drew different conclusions. 4 Therefore, as oncological results have to overweigh functional outcomes, careful selection for prostate-sparing surgery remains important. Using strict selection criteria for prostate-sparing cystectomy, de Vries et al. were able to reach comparable oncological results to that of standard RPE. 5 However, such strict inclusion criteria substantially reduce the availability of this technique. More accurate risk stratification is therefore required to increase availability with maintained oncological efficacy. A further interesting finding of the study by Buse et al. 2 was the independent and unfavorable prognostic value of the presence of PCA in RPE specimens. Unfortunately, data on cause of death were not available; therefore, the authors were not able to conclude whether the additional risk by PCA is a result of the PCA-related deaths. However, the low prevalence of high-risk PCA found in the present study suggests that the additional risk by the presence of PCA is independent from PCA-related deaths. Based on this, it can be presumed that concomitant PCA supports bladder cancer progression. However, more convincing clinical and molecular evidence is required to confirm this hypothesis.

Two thousand years of archeointensity from West Africa

This study presents 17 archeointensity estimates from Senegal and Mali, two neighboring countries in West Africa, for the period 1000 BCE to 1000 CE. The archeological artifacts used in this study were collected during the course of two separate projects, together spanning 22 years and across 8 separate excavations. A primary objective of this study was to get accurate dates, hence, only samples with independent age constraints from pottery style, detailed stratigraphy and 14C dates were used. A total of 236 specimens from 63 samples were subjected to a double heating paleointensity experiment (IZZI method) from which 95 specimens were selected using a set of very strict selection criteria. The paleointensity results were corrected for differential cooling rate effects and remanence anisotropy. Additionally, we demonstrate the equivalence of using tensors derived from anhysteretic and thermal remanences for correcting remanent anisotropy of the specimens and use the former for the anisotropy correction. Our data show good agreement with the most recent paleosecular variation model but are lower than the pre-existing data, which are mostly from Egypt and Morocco. The presence of substantial non-axial-dipolar contributions in the region is evident when virtual axial dipole moments (VADMs) from the published literature are calculated for 20° latitudinal bands and compared with our data—the average VADM values show a distinct latitudinal gradient. A prominent feature of this dataset is an intensity high observed prior to 700 CE in both Senegal and Mali. Comparing this peak with existing records from regions further to the north suggests a small but significant temporal offset and is interpreted to be additional evidence for a geomagnetic field with a significant and rapidly changing non-axial-dipolar contribution.

70 Years of Macromolecular Chemistry and Physics – Past, Present and Future

Dear Readers, To start in the past: we are happy and proud to be able to celebrate the 70th anniversary of the mother journal of the Macromolecular Journals family in 2013. As many of you might know, the journal was launched in 1943 under its original name “Die Makromolekulare Chemie” by one of the pioneers in polymer science, Herrmann Staudinger, whose work and scientific achievements were recognized in 1953 with the Nobel Prize in Chemistry. The history of Macromolecular Chemistry and Physics (the name fully adopted in the mid-1990s) and its sister journals has been presented in detail on previous occasions. Therefore, for the purpose of the present Editorial it should suffice to refer interested readers to our comprehensive Essay (DOI: 10.1002/macp.200290078), written in 2003 by Rolf Mülhaupt and Ingrid Meisel on the occasion of the journal's 60th anniversary. Back to the present, the long established reputation of Macromolecular Chemistry and Physics as one of the leading and most recognized titles in the field of general polymer science results in a much higher number of submissions than that which can possibly be published. Therefore, we need to apply strict selection criteria and at present only less than a third of all submitted contributions can be accepted. Some examples of work published throughout 2012 that attracted the highest interest with our readership are collected in Table 1. As you can see, these publications not only were contributed by a wide range of well-known authors from different fields and institutions, but they also cover a wide variety of topics: from recent original work and a critical investigation of current trends in the area of self-healing materials, all the way to carbon nanoribbons and functional carbon materials, as well as synthetic work using click chemistry or ATRP and block copolymer systems - to name only a few examples. Give a brief outlook into the future: we will not only continue to publish invited Talent Articles, Trend Articles, and the special series on functional polymers (guest-edited by Wai-Yeung Wong and Ben Zhong Tang), but we have also planned a special issue on “Shape-Memory Effects in Polymers”, guest-edited by Andreas Lendlein, for summer 2013. Today, however, it is my great pleasure to present the Special Anniversary Issue of Macromolecular Chemistry and Physics, dedicated to the journal's 70th birthday in 2013. All of the articles of the issue have been authored by members of the Macromolecular Journal's executive advisory board, and these contributions present original work by some of the leading experts in polymer science as well as several thought-provoking, personal views on recent developments in the field. We hope and trust that you will enjoy reading these fascinating publications! Of course, I cannot close this Editorial without thanking those people indispensable for Macromolecular Chemistry and Physics: our authors for their fascinating research and interest in the journal, as well as our referees for helping us to identify the best articles. Last but not least, I thank the members of the advisory boards for their encouraging support, and would like to welcome Shiyong Liu (University of Science and Technology of China, Hefei, China) and Sabine Ludwigs (University of Stuttgart, Germany), who very recently accepted the invitation to join the international advisory board of Macromolecular Chemistry and Physics.