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Pham J, Neilsen BK, Liu H, Cao M, Yang Y, Sheng K, Ma TM, Kishan AU, Ruan D. Dosimetric predictors for genitourinary toxicity in MR-guided stereotactic body radiation therapy (SBRT): Substructure with fraction-wise analysis. Med Phys 2024; 51:612-621. [PMID: 38055353 DOI: 10.1002/mp.16878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND MR-guided radiation therapy (MRgRT) systems provide superior soft tissue contrast than x-ray based systems and can acquire real-time cine for treatment gating. These features allow treatment planning margins to be reduced, allowing for improved critical structure sparing and reduced treatment toxicity. Despite this improvement, genitourinary (GU) toxicity continues to affect many patients. PURPOSE (1) To identify dosimetric predictors, potentially in combination with clinical parameters, of GU toxicity following SBRT by leveraging MRgRT to accurately monitor daily dose, beyond predicted dose calculated during planning. (2) Improve awareness of toxicity-sensitive bladder substructures, specifically the trigone and urethra. METHODS Sixty-nine prostate cancer patients (NCT04384770 clinical trial) were treated on a ViewRay MRIdian MRgRT system, with 40 Gy prescribed to 95% of the PTV in over five fractions. Overall, 17 (24.6%) prostate patients reported acute grade 2 GU toxicity. The CTV, PTV, bladder, bladder wall, trigone, urethra, rectum, and rectal wall were contoured on the planning and daily treatment MRIs. Planning and daily treatment DVHs (0.1 Gy increments), organ doses (min, max, mean), and organ volumes were recorded. Daily dose was estimated by transferring the planning dose distributions to the daily MRI based on the daily setup alignment. Patients were partitioned into a training (55) and testing set (14). Dose features were pre-filtered using a t-test followed by maximum relevance minimum redundancy (MRMR) algorithm. Logistic regression was investigated with regularization to select dosimetric predictors. Specifically, two approaches: time-group least absolute shrinkage and selection (LASSO), and interactive grouped greedy algorithm (IGA) were investigated. Shared features across the planning and five treatment fractions were grouped to encourage consistency and stability. The conventional flat non-temporally grouped LASSO was also evaluated to provide a solid benchmark. After feature selection, a final logistic regression model was trained. Dosimetric regression models were compared to a clinical regression model with only clinical parameters (age, baseline IPSS, prostate gland size, ADT usage, etc.) and a hybrid model, combining the best performing dosimetric features with the clinical parameters, was evaluated. Final model performance was evaluated on the testing set using accuracy, sensitivity, and specificity determined by the optimal threshold of the training set. RESULTS IGA had the best testing performance with an accuracy/sensitivity/specificity of 0.79/0.67/0.82, selecting 12 groups covering the bladder (V19.8 Gy, V20.5 Gy), bladder wall (19.7 Gy), trigone (15.9, 18.2, 43.3 Gy), urethra (V41.4 Gy, V41.7 Gy), CTV (V41.9 Gy), rectum (V8.5 Gy), and rectal wall (1.2, 44.1 Gy) dose features. Absolute bladder V19.8 Gy and V20.5 Gy were the most important features, followed by relative trigone 15.9 and 18.2 Gy. Inclusion of clinical parameters in the hybrid model with IGA did not significantly change regression performance. CONCLUSION Overall, IGA feature selection resulted in the best GU toxicity prediction performance. This exploratory study demonstrated the feasibility of identification and analysis of dosimetric toxicity predictors with awareness to sensitive substructures and daily dose to potentially provide consistent and stable dosimetric metrics to guide treatment planning. Further patient accruement is warranted to further assess dosimetric predictor and perform validation.
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Affiliation(s)
- Jonathan Pham
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Beth K Neilsen
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Hengjie Liu
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Minsong Cao
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ke Sheng
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Dan Ruan
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
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Frara N, Barbe MF, Giaddui D, Braverman AS, Amin M, Yu D, Ruggieri MR. Dog and human bladders have different neurogenic and nicotinic responses in inner versus outer detrusor muscle layers. Am J Physiol Regul Integr Comp Physiol 2022; 323:R589-R600. [PMID: 36062901 PMCID: PMC9722258 DOI: 10.1152/ajpregu.00084.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 01/02/2023]
Abstract
The aim of this study was to investigate layer and species variations in detrusor muscle strip responses to myogenic, neurogenic, and nicotinic, and muscarinic receptor stimulations. Strips from bladders of 9 dogs and 6 human organ transplant donors were dissected from inner and outer longitudinal muscle layers, at least 1 cm above urethral orifices. Strips were mounted in muscle baths and maximal responses to neurogenic stimulation using electrical field stimulation (EFS) and myogenic stimulation using potassium chloride (KCl, 120 mM) determined. After washing and re-equilibration was completed, responses to nicotinic receptor agonist epibatidine (10 μM) were determined followed by responses to EFS and muscarinic receptor agonist bethanechol (30 μM) in continued presence of epibatidine. Thereafter, strips and full-thickness bladder sections from four additional dogs and three human donors were examined for axonal density and intramural ganglia. In dog bladders, contractions to KCl, epibatidine, and bethanechol were 1.5- to 2-fold higher in the inner longitudinal muscle layer, whereas contractions to EFS were 1.5-fold higher in the outer (both pre- and post-epibatidine). Human bladders showed 1.2-fold greater contractions to epibatidine in the inner layer and to EFS in the outer, yet no layer differences to KCl or bethanechol were noted. In both species, axonal density was 2- to 2.5-fold greater in the outer layer. Dogs had more intramural ganglia in the adventitia/serosa layer, compared with more internal layers and to humans. These findings indicate several layer-dependent differences in receptor expression or distribution, and neurogenic responses in dog and human detrusor muscles, and myogenic/muscarinic differences between dog versus humans.
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Affiliation(s)
- Nagat Frara
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mary F Barbe
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Dania Giaddui
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alan S Braverman
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mamta Amin
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Daohai Yu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Michael R Ruggieri
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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Yalcin A, Gultekin MH, Erdogan A, Cankaya BY. Signal abnormalities of the bladder wall detected by native T 1 mapping in patients with overactive bladder. NMR Biomed 2022; 35:e4748. [PMID: 35466455 DOI: 10.1002/nbm.4748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECT Native T1 mapping provides tissue-specific T1 relaxation times, which can be used to identify structural changes in the various organs. The object of this article was to evaluate the bladder wall of patients with overactive bladder using native T1 mapping and compare the relaxation times of patients and healthy controls. MATERIAL AND METHODS Seventeen patients with a diagnosis of overactive bladder and 15 healthy controls were enrolled in this prospective study. All participants underwent pelvic MRI and T1 maps were acquired. Native T1 relaxation times were calculated via regions of interest acquired from the anterosuperior wall of the bladder in all participants. Mean T1 relaxation times of the overactive bladder patients were compared with those of controls. RESULTS Overactive bladder patients had statistically significantly higher T1 relaxation times compared with controls (p = 0.004). In the subgroup analysis, there was no statistically significant difference between males (1113.42 ± 62.4) and females (1176.70 ± 100.9) regarding the T1 relaxation times (p = 0.165). There were no correlations between age and T1 relaxation times in patient or control groups (r = 0.057, p = 0.825, and r = 0.052, p = 0.932, respectively). CONCLUSION Native T1 mapping can identify structural changes in the bladder wall of patients with overactive bladder. This technique has a promising role in the diagnosis of patients with suspected overactive bladder.
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Affiliation(s)
- Ahmet Yalcin
- Faculty of Medicine, Department of Radiology, Ataturk University, Erzurum, Turkey
| | - Mehmet Hamza Gultekin
- Faculty of Medicine, Department of Urology, Istanbul Cerrahpaşa University, Istanbul, Turkey
| | - Abdullah Erdogan
- Section of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bahar Yilmaz Cankaya
- Faculty of Medicine, Department of Radiology, Ataturk University, Erzurum, Turkey
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Gorji KE, Sadat-Mirkazemi M, Banaei A, Abedi-Firouzjah R, Afkhami-Ardekani M, Ataei G. Dosimetric comparison of artificial walls of bladder and rectum with real walls in common prostate IMRT techniques: Patient and Monte Carlo study. J Xray Sci Technol 2020; 28:59-70. [PMID: 31904002 DOI: 10.3233/xst-190592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Rectum and bladder are hallow structures and considered as critical organs in prostate cancer intensity modulated radiotherapy (IMRT). Therefore, dose received by these organ walls must be considered for prediction of radiobiological effects. Contouring the real organ walls is quite difficult and time consuming in CT/MRI images, so the easy contouring artificial walls with uniform thickness could be appropriated alternatives. OBJECTIVE To compare reconstructed artificial walls with real walls of bladder and rectum in common prostate IMRT techniques based on dose volume-histograms (DVHs) derived from artificial and real walls. METHODS Artificial walls were reconstructed with 2-10 mm and 2-8 mm thicknesses for bladder and rectum, respectively. Four common IMRT techniques were applied to each patient. Spearman correlation was used to find the relation between the DVHs of true walls with artificial walls and whole organs. Monte Carlo (MC) simulations of the IMRT techniques and dosimetric comparison were also performed on a standard patient data. RESULTS The 2 mm thickness artificial walls showed the minimum differences with the true bladder and rectum walls based on absolute evaluations (the maximum difference < 10cc and standard deviation < 15cc). However, relative evaluations showed that all the artificial walls had high correlations with real walls for selecting dose volume parameters. There was also good agreement between the treatment planning system and MC simulations results. CONCLUSION The DVH of whole organs was not a good surrogate of the true wall. The 2 mm artificial walls can be regarded as good alternatives for both of rectum and bladder. However, in relative dose evaluations all studied artificial walls were appropriate.
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Affiliation(s)
- Kourosh Ebrahimnejad Gorji
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Amin Banaei
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- Department of Radiology, Faculty of Paramedical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | - Razzagh Abedi-Firouzjah
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mahdieh Afkhami-Ardekani
- Department of Radiology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Gholamreza Ataei
- Department of Radiology Technology, Faculty of Paramedical Sciences, Babol University of Medical Science, Babol, Iran
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Gordon MN, Hadjiiski LM, Cha KH, Samala RK, Chan HP, Cohan RH, Caoili EM. Deep-learning convolutional neural network: Inner and outer bladder wall segmentation in CT urography. Med Phys 2019; 46:634-648. [PMID: 30520055 DOI: 10.1002/mp.13326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/30/2018] [Accepted: 11/15/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We are developing a computerized segmentation tool for the inner and outer bladder wall as a part of an image analysis pipeline for CT urography (CTU). MATERIALS AND METHODS A data set of 172 CTU cases was collected retrospectively with Institutional Review Board (IRB) approval. The data set was randomly split into two independent sets of training (81 cases) and testing (92 cases) which were manually outlined for both the inner and outer wall. We trained a deep-learning convolutional neural network (DL-CNN) to distinguish the bladder wall from the inside and outside of the bladder using neighborhood information. Approximately, 240 000 regions of interest (ROIs) of 16 × 16 pixels in size were extracted from regions in the training cases identified by the manually outlined inner and outer bladder walls to form a training set for the DL-CNN; half of the ROIs were selected to include the bladder wall and the other half were selected to exclude the bladder wall with some of these ROIs being inside the bladder and the rest outside the bladder entirely. The DL-CNN trained on these ROIs was applied to the cases in the test set slice-by-slice to generate a bladder wall likelihood map where the gray level of a given pixel represents the likelihood that a given pixel would belong to the bladder wall. We then used the DL-CNN likelihood map as an energy term in the energy equation of a cascaded level sets method to segment the inner and outer bladder wall. The DL-CNN segmentation with level sets was compared to the three-dimensional (3D) hand-segmented contours as a reference standard. RESULTS For the inner wall contour, the training set achieved the average volume intersection, average volume error, average absolute volume error, and average distance of 90.0 ± 8.7%, -4.2 ± 18.4%, 12.9 ± 13.9%, and 3.0 ± 1.6 mm, respectively. The corresponding values for the test set were 86.9 ± 9.6%, -8.3 ± 37.7%, 18.4 ± 33.8%, and 3.4 ± 1.8 mm, respectively. For the outer wall contour, the training set achieved the values of 93.7 ± 3.9%, -7.8 ± 11.4%, 10.3 ± 9.3%, and 3.0 ± 1.2 mm, respectively. The corresponding values for the test set were 87.5 ± 9.9%, -1.2 ± 20.8%, 11.9 ± 17.0%, and 3.5 ± 2.3 mm, respectively. CONCLUSIONS Our study demonstrates that DL-CNN-assisted level sets can effectively segment bladder walls from the inner bladder and outer structures despite a lack of consistent distinctions along the inner wall. However, even with the addition of level sets, the inner and outer walls may still be over-segmented and the DL-CNN-assisted level sets may incorrectly segment parts of the prostate that overlap with the outer bladder wall. The outer wall segmentation was improved compared to our previous method and the DL-CNN-assisted level sets were also able to segment the inner bladder wall with similar performance. This study shows the DL-CNN-assisted level set segmentation tool can effectively segment the inner and outer wall of the bladder.
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Affiliation(s)
- Marshall N Gordon
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Kenny H Cha
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Ravi K Samala
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Heang-Ping Chan
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Richard H Cohan
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
| | - Elaine M Caoili
- Department of Radiology, The University of Michigan, Ann Arbor, MI, 48109-0904, USA
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Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition associated with intense pelvic pain and bladder storage symptoms. Since diagnosis is difficult, prevalence estimates vary with the methodology used. There is also a lack of proven imaging tools and biomarkers to assist in differentiation of IC/BPS from other urinary disorders (overactive bladder, vulvodynia, endometriosis, and prostatitis). Current uncertainty regarding the etiology and pathology of IC/BPS ultimately impacts its timely and successful treatment, as well as hampers future drug development. This review will cover recent developments in imaging methods, such as magnetic resonance imaging, that advance the understanding of IC/BPS and guide drug development.
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Affiliation(s)
- Pradeep Tyagi
- Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
| | - Chan-Hong Moon
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
| | | | | | | | - Naoki Yoshimura
- Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
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Mikhail AS, Negussie AH, Pritchard WF, Haemmerich D, Woods D, Bakhutashvili I, Esparza-Trujillo J, Brancato SJ, Karanian J, Agarwal PK, Wood BJ. Lyso-thermosensitive liposomal doxorubicin for treatment of bladder cancer. Int J Hyperthermia 2017; 33:733-740. [PMID: 28540814 PMCID: PMC7676871 DOI: 10.1080/02656736.2017.1315459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate lyso-thermosensitive liposomal doxorubicin (LTLD, ThermoDox®) in combination with loco-regional mild hyperthermia (HT) for targeted drug delivery to the bladder wall and potential treatment of bladder cancer. MATERIAL AND METHODS Porcine in vivo studies were performed with the following groups: (i) intravenous (IV) LTLD with hyperthermia (LTLD + HT); (ii) IV doxorubicin (DOX) with hyperthermia (IV DOX + HT) and (iii) IV LTLD without hyperthermia (LTLD - HT). Drug formulations were delivered via 30 min IV infusion coinciding with 1-h bladder irrigation (45 °C water for HT groups, 37 °C for non-HT group), followed by immediate bladder resection. DOX concentrations were measured in consecutive sections parallel to the bladder lumen by liquid chromatography following drug extraction. Computer models were developed to simulate tissue heating and drug release from LTLD. RESULTS Comparing mean DOX concentrations at increasing depths from the lumen to outer surface of the bladder wall, the ranges for LTLD + HT, IV DOX + HT and LTLD - HT, respectively, were 20.32-3.52 μg/g, 2.34-0.61 μg/g and 2.18-0.51 μg/g. The average DOX concentrations in the urothelium/lamina and muscularis, respectively, were 9.7 ± 0.67 and 4.09 ± 0.81 μg/g for IV LTLD + HT, 1.2 ± 0.39 and 0.86 ± 0.24 μg/g for IV DOX + HT, and 1.15 ± 0.38 and 0.62 ± 0.15 μg/g for LTLD - HT. Computational model results were similar to measured DOX levels and suggest adequate temperatures were reached within the bladder wall for drug release from LTLD. CONCLUSIONS Doxorubicin accumulation and distribution within the bladder wall was achieved at concentrations higher than with free IV doxorubicin by mild bladder hyperthermia combined with systemic delivery of LTLD.
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Affiliation(s)
- Andrew S Mikhail
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Ayele H Negussie
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - William F Pritchard
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Dieter Haemmerich
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Woods
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Juan Esparza-Trujillo
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Sam J Brancato
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - John Karanian
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
| | - Piyush K Agarwal
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814 USA
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Gregorini F, Knüpfer SC, Liechti MD, Schubert M, Curt A, Kessler TM, Mehnert U. Sensory evoked potentials of the bladder and urethra in middle-aged women: the effect of age. BJU Int 2015; 115 Suppl 6:18-25. [PMID: 25626360 DOI: 10.1111/bju.13066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate feasibility, reproducibility and age dependency of sensory evoked cortical potentials (SEPs) after electrical stimulation of different locations in the lower urinary tract (LUT) in a cohort of middle-aged healthy women. SUBJECTS AND METHODS In a group of 10 healthy middle-aged women [mean (sd) height 165 (5) cm and age 43 (6) years), electrical stimulation (0.5 and 3 Hz) was applied to the bladder dome, trigone, and proximal and distal urethra. SEPs were recorded at the Cz electrode with reference to Fz. All measurements were repeated three times with an interval of 3-5 weeks. Current perception thresholds (CPT), SEP latencies and amplitudes were analysed. Results were compared with a group of younger women published previously. RESULTS LUT SEPs demonstrated two positive (P1, P2) and one negative peak (N1). The mean (sd) N1 latency was 108.9 (7.8), 116.2 (10.7), 113.2 (13.4) and 131.3 (35.6) ms for the bladder dome, trigone, proximal and distal urethra, respectively. N1 latencies, except for the distal urethra, were significantly shorter than those in younger women. Taking all data, i.e. young and middle-aged women, into account, there was a significant negative correlation between the variable age and CPT/dome (r = -0.462, P = 0.04) and N1 latency/dome (r = -0.605, P = 0.005) and a significant positive correlation between the variable age and N1P2 amplitude/dome (r = 0.542, P = 0.014). CONCLUSION LUT SEPs can be induced in middle-aged women with reliable N1 responses. Unexpectedly, N1 responses reveal a shortening with increasing age particularly when compared with younger women. Changes in sensory afferents may be explained by age-related qualitative reorganisations within the urothelium and suburothelium potentially altering afferent nerve excitability, which may have an impact on the development of non-neurological LUT symptoms (LUTS, e.g. overactive bladder) in women.
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Affiliation(s)
- Flavia Gregorini
- Department of Neuro-Urology, Spinal Cord Injury Centre and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Abstract
During laser treatment of prostate, urological surgeons occasionally experience fiber-cap failure due to concentration of thermal stress on the fiber tip. Upon the cap breakage, laser light becomes forward-propagating and may adversely affect the bladder tissue such as perforation. The purpose of the current study was to identify any bladder perforation with forward-propagating laser light (λ = 532 nm) at 80 and 120 W with an assumption of fiber-cap failure. Perforation time was measured and compared in terms of fiber distance. The results showed that 80 and 120 W perforated the tissue up to 2 and 2.5 cm, respectively with perforation threshold of 17.2 kW/cm(2), and the minimum perforation time was approximately 7 s. No perforation occurred at the distance of 3 cm for 1-min irradiation at both power levels, but severely carbonized lesions were generated around the irradiated tissue. Although equivalent ablation speed was found between the two power levels, 120 W created up to 20 % wider craters regardless of fiber distance. With consideration of dense collagen fibers in bladder structure and long surgical distance, direct incidence of laser perforation on bladder wall could be unlikely to happen upon fiber-cap failure during laser surgery.
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Affiliation(s)
- Hyun Wook Kang
- Department of Biomedical Engineering, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan 608-737, South Korea
| | - Jeehyun Kim
- School of Electrical Engineering and Computer Science, Kyungpook National University, 1370 Sankyuk-dong, Buk-gu, Daegu 702-701, South Korea
| | - Junghwan Oh
- Department of Biomedical Engineering, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan 608-737, South Korea
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SALEM SA, HWIE ANM, SAIM A, CHEE KONG CH, SAGAP I, SINGH R, YUSOF MR, MD ZAINUDDIN Z, HJ IDRUS R. Human adipose tissue derived stem cells as a source of smooth muscle cells in the regeneration of muscular layer of urinary bladder wall. Malays J Med Sci 2013; 20:80-87. [PMID: 24044001 PMCID: PMC3773357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/06/2013] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Adipose tissue provides an abundant source of multipotent cells, which represent a source of cell-based regeneration strategies for urinary bladder smooth muscle repair. Our objective was to confirm that adipose-derived stem cells (ADSCs) can be differentiated into smooth muscle cells. METHODS In this study, adipose tissue samples were digested with 0.075% collagenase, and the resulting ADSCs were cultured and expanded in vitro. ADSCs at passage two were differentiated by incubation in smooth muscle inductive media (SMIM) consisting of MCDB I31 medium, 1% FBS, and 100 U/mL heparin for three and six weeks. ADSCs in non-inductive media were used as controls. Characterisation was performed by cell morphology and gene and protein expression. RESULT The differentiated cells became elongated and spindle shaped, and towards the end of six weeks, sporadic cell aggregation appeared that is typical of smooth muscle cell culture. Smooth muscle markers (i.e. alpha smooth muscle actin (ASMA), calponin, and myosin heavy chain (MHC)) were used to study gene expression. Expression of these genes was detected by PCR after three and six weeks of differentiation. At the protein expression level, ASMA, MHC, and smoothelin were expressed after six weeks of differentiation. However, only ASMA and smoothelin were expressed after three weeks of differentiation. CONCLUSION Adipose tissue provides a possible source of smooth muscle precursor cells that possess the potential capability of smooth muscle differentiation. This represents a promising alternative for urinary bladder smooth muscle repair.
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Affiliation(s)
- Salah Abood SALEM
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | - Angela Ng Min HWIE
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | - Aminuddin SAIM
- Department of Otolaryngology (ENT), Ampang Putri Specialist Hospital, Ampang 68000 Kuala Lumpur, Malaysia
| | - Christopher Ho CHEE KONG
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | - Ismail SAGAP
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | - Rajesh SINGH
- Department of Orthopedic, UKM Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | | | - Zulkifili MD ZAINUDDIN
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
| | - Ruszymah HJ IDRUS
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia
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