BACKGROUND: Bladder cancer recurrence following cystectomy remains a significant cause of bladder cancer-specific mortality. Residual cancer cells (RCCs) contribute to cancer recurrence due either to tumor spillage or undetectable pre-existing micrometastatic tumor clones. We sought to detect and quantify RCCs in pelvic washing using ultra-deep targeted sequencing (UTS) and compare the levels of RCCs with clinical variables and cancer recurrence.

METHODS: 17 patients underwent robotic-assisted radical cystectomy (RARC) with primary tumor specimen available. All tumors had negative surgical margins. Pelvic washes and blood were collected intra-operatively: before RARC, after RARC, after pelvic lymph node dissection (PLND), and in the suction fluid collected during the procedure. A two-step sequencing, including whole-exome sequencing (WES) followed by UTS (>50,000X), was used to quantify RCCs in each sample. Eight patients were excluded due to sample quality issues. The final analysis cohort included nine patients. RCC level was quantified for each sample as the relative cancer cell fraction (RCCF), and compared between different time points. The peak RCCF (pRCCF) of each patient was correlated with clinical and pathological variables.

RESULTS: RCCs were detected in approximately half of the pelvic washing specimens during or after RARC, but not before it. Higher levels of RCCs were associated with aggressive variant histology and cancer recurrence. Verifying the feasibility of using RCCs as a novel biomarker for recurrence requires larger cohorts.

CONCLUSIONS: Detection of RCCs in intra-operative peritoneal washes of bladder cancer patients undergoing radical cystectomy may represent a robust biomarker of tumor aggressiveness and metastatic potential.

The implantable miniaturized telescope (IMT) is the first intraocular magnifying system proposed for optical correction in patients with age-related macular degeneration (ARMD). The optical component is embedded in a carrying device designed as an intraocular lens that is implanted after cataract surgery. In this study, we report findings on an IMT that was explanted because of aqueous infiltration into its optic and describe the configuration of this device and the surgical technique required for its implantation. The patient, a 75-year-old male with bilateral cataract and nonexudative ARMD, underwent phacoemulsification with implantation of an IMT in the right eye. The rigid device, weighing 46.1 mg in aqueous, has an overall diameter of 13.5 mm and requires implantation through a large limbal incision. It is fixated at the 6 to 12 o'clock meridian. Follow-up examination revealed the presence of numerous droplets inside the IMT optic. The device was explanted and sent to our center for evaluation. A large fissure was found on the carrying device. However, it was unlikely the site for aqueous infiltration. Microdefects at the level of the sealing of the optical cylinder appeared to provide the opening for the inflow of aqueous that formed droplets. Based on the findings of this report the manufacturer has modified the sealing technique to avoid this complication. Current clinical trials are now ongoing to assess the efficacy of this device in providing visual rehabilitation for ARMD patients.

OBJECTIVE: To evaluate the degree of anterior capsule opacification (ACO) in human eyes obtained postmortem containing various rigid and foldable posterior chamber intraocular lens (PC-IOL) designs and compare the findings with clinical sequelae of capsular shrinkage.

DESIGN: Comparative autopsy tissue study with clinicopathologic correlations.

MATERIALS: Three hundred formalin-fixed human eyes containing the following PC-IOL styles were analyzed: (1) one-piece polymethyl methacrylate (PMMA) optic-PMMA haptic (n = 50), one-piece silicone-plate IOL, with large (2) or small (3) fixation holes (n = 35), (4) three-piece PMMA optic-Prolene haptic (n = 50), (5) three-piece acrylic optic-PMMA haptic (n = 55), three-piece silicone optic with PMMA (6) or polyimide (7) haptics (n = 30), and (8) three-piece silicone optic-Prolene haptic (n = 80) lenses.

TESTING: The eyes were sectioned in the equatorial plane for gross examination of the capsular bag from a posterior view. The cornea and iris were then excised for evaluation from an anterior view.

MAIN OUTCOME MEASURES: ACO was scored in each eye from 0 to IV, according to the degree/area of capsule opacification. Capsulorrhexis size and IOL decentration were measured with calipers.

RESULTS: The overall differences among the IOL groups regarding the three parameters were significant (ACO score: P < 0.001; capsulorrhexis diameter: P = 0.036; IOL decentration: P = 0.012). Mean ACO scores were highest with the large- and small-hole one-piece silicone-plate lenses (2.543 +/- 0.950) and lowest with the three-piece acrylic optic-PMMA haptic lenses (0.600 +/- 0.710). Of 10 cases of capsulorrhexis phimosis observed in the study, 7 cases were associated with three-piece silicone optic-Prolene haptic lenses, which also presented the highest mean decentration (0.375 +/- 0.601 mm).

CONCLUSIONS: Our results confirm previous histopathologic observations that the rate of ACO is the lowest with acrylic lenses and higher with plate-haptic silicone IOLs. Nevertheless, clinical sequelae of capsular shrinkage are also very important with three-piece silicone optic-Prolene haptic designs. Thus, IOL material and design are significant factors in the development of ACO, but they ultimately also influence the clinical presentation of capsular shrinkage.

Objectives:To examine associations between urinary bladder cancer risk and polymorphisms of the gene encoding the catechol estrogen-metabolizing enzyme, catechol-O-methyltransferase (COMT), among Egyptian women and men. Materials and methods:We used questionnaire and genotype data from a case-control study in Egypt. This analysis focused on South Egypt cases with confirmed urothelial (UC) or squamous cell (SCC) carcinoma of the bladder, and controls frequency-matched on sex, 5-year age-group, and residence governorate. Real-time PCR on blood specimen DNA was used to determine COMT genotypes encoding for Val/Val, Val/Met, and Met/Met, the enzyme forms associated with high, intermediate, or low activity, respectively. ResultsThe study sample, which included 255 women and 666 men, consisted of 394 cases with histologically confirmed UC (225) or SCC (n = 169), and 527 controls. The odds of having either type of bladder cancer were lower among men with genotypes encoding Val/Met or Met/Met than among those with the genotype encoding Val/Val, even after adjustment for other factors, such as smoking and schistosomiasis history [adjusted odds ratio (AOR): 0.64; 95% confidence interval (CI): 0.43, 0.96]; however, the association was statistically significant for SCC (AOR 0.57; 95% CI: 0.34, 0.96) but marginal for UC (AOR: 0.64; 95% CI: 0.39, 1.02). No significant associations were detected between bladder cancer risk and COMT genotypes among postmenopausal women.: Conclusions:These findings suggest that even after controlling for established risk factors, the involvement of COMT genotypes in bladder cancer risk differs among men compared with women in South Egypt. © 2012.

OBJECTIVES: To examine associations between urinary bladder cancer risk and polymorphisms of the gene encoding the catechol estrogen-metabolizing enzyme, catechol-O-methyltransferase (COMT), among Egyptian women and men.

MATERIALS AND METHODS: We used questionnaire and genotype data from a case-control study in Egypt. This analysis focused on South Egypt cases with confirmed urothelial (UC) or squamous cell (SCC) carcinoma of the bladder, and controls frequency-matched on sex, 5-year age-group, and residence governorate. Real-time PCR on blood specimen DNA was used to determine COMT genotypes encoding for Val/Val, Val/Met, and Met/Met, the enzyme forms associated with high, intermediate, or low activity, respectively.

RESULTS: The study sample, which included 255 women and 666 men, consisted of 394 cases with histologically confirmed UC (225) or SCC (n = 169), and 527 controls. The odds of having either type of bladder cancer were lower among men with genotypes encoding Val/Met or Met/Met than among those with the genotype encoding Val/Val, even after adjustment for other factors, such as smoking and schistosomiasis history [adjusted odds ratio (AOR): 0.64; 95% confidence interval (CI): 0.43, 0.96]; however, the association was statistically significant for SCC (AOR 0.57; 95% CI: 0.34, 0.96) but marginal for UC (AOR: 0.64; 95% CI: 0.39, 1.02). No significant associations were detected between bladder cancer risk and COMT genotypes among postmenopausal women.

CONCLUSIONS: These findings suggest that even after controlling for established risk factors, the involvement of COMT genotypes in bladder cancer risk differs among men compared with women in South Egypt.