Bacillus Calmette-Guérin Failure in Patients with Non-Muscle-invasive Urothelial Carcinoma of the Bladder May Be Due to the Urologist's Failure to Detect Urothelial Carcinoma of the Upper Urinary Tract and Urethra

BACKGROUND: Various reasons exist for so-called bacillus Calmette-Guérin (BCG) failure in patients with non-muscle-invasive urothelial bladder carcinoma (NMIBC). OBJECTIVE: To explore whether urothelial carcinoma of the upper urinary tract (UUT) and/or prostatic urethra may be a cause for BCG failure. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 110 patients with high-risk NMIBC repeatedly treated with intravesical BCG, diagnosed with disease recurrence, and followed for a median time of 9.1 yr. INTERVENTION: Two or more intravesical BCG induction courses without maintenance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was pattern of disease recurrence (BCG failure) within the urinary tract categorised into UUT and/or urethral carcinoma (with or without intravesical recurrence), and intravesical recurrence alone. Secondary outcome was survival. Predictors of UUT and/or urethral carcinoma and the effect of pattern of disease recurrence on cancer-specific survival were assessed with multivariable Cox regression analysis adjusting for multiple clinical and tumour characteristics. RESULTS AND LIMITATIONS: Of the 110 patients, 57 (52%) had UUT and/or urethral carcinoma (with or without intravesical recurrence), and 53 (48%) had intravesical recurrence alone. In patients with UUT and/or urethral carcinoma, bladder carcinoma in situ (Tis) before the first and second BCG course was present in 42 of 57 (74%) and 47 of 57 (82%) patients, respectively. On multivariable analysis, bladder Tis before the first and/or second BCG course was the only independent predictor of UUT and/or urethral carcinoma. Of the 110 patients, 69 (63%) were alive at last follow-up visit, 18 (16%) had died due to metastatic urothelial carcinoma, and 23 (21%) had died of other causes. Pattern of disease recurrence within the urinary tract was not an independent predictor of cancer-specific survival. Main study limitations were retrospective design and limited power for survival analysis. CONCLUSIONS: In our patients with high-risk NMIBC failing after two or more courses of intravesical BCG, UUT and/or urethral carcinoma was detected in >50% of the cases during follow-up. The vast majority of these patients had bladder Tis before the first and/or second BCG course. In patients experiencing the so-called BCG failure, a diagnostic work-up of UUT and prostatic urethra should always be performed to exclude urothelial carcinoma before additional intravesical therapy or even a radical cystectomy is considered.

(Table 1) Presence of sublittoral macroalgae in the investigated profiles in Potter Cove, King George Island, Antarctica

The vegetation of a small fjord and its adjacent open shore was documented by subaquatic video. The distribution of individual species of macroalgae and the composition of assemblages were compared with gradients of light availability, hydrography, slope inclination, substratum, and exposition to turbulence and ice. The sublittoral fringe is usually abraded by winterly ice floes and devoid of large, perennial algae. Below this zone, the upper sublittoral is dominated by Desmarestia menziesii on steep rock faces, where water movements become irregular, or by Ascoseira mirabilis and Palmaria decipiens on weakly inclined slopes with steady rolling water movements. In the central sublittoral above 15 m, where turbulence is still active, Desmarestia anceps is outcompeting all other species on solid substratum, However, the species is not able to persist on loose material under these conditions. Instead, Himantothallus grandifolius may occur. Deeper, where turbulence usually is negligible, Desmarestia anceps also covers loose material. The change of dominance to Himantothallus grandifolius in the deep sublittoral cannot completely be explained at present. Himantothallus grandifolius also prevails in a mixed assemblage under the influence of grounding icebergs. Most of the smaller algae are opportunists with different degrees of tolerance for turbulence, but some apparently need more stable microhabitats and thus are dependent from continuing suppression of competitive large phaeophytes.

Meteorological measurements from the Fourcade and Polar Club Glacier, Warszawa Icefield, King George Island, West Antarctica

The South Shetland Islands are located at the northern tip of the AP which is among the fastest warming regions on Earth. The islands are especially vulnerable to climate change due to their exposure to transient low-pressure systems and their maritime climate. Surface air temperature increases (2.5K in 50 years) are concurrent with retreating glacier fronts, an increase in melt areas, ice surface lowering and rapid break-up and disintegration of ice shelves. We have compiled a unique meteorological data set for the King George Island (KGI)/Isla 25 de Mayo, the largest of the South Shetland Islands. It comprises high-temporal resolution and spatially distributed observations of surface air temperature, wind directions and wind velocities, as well as glacier ice temperatures in profile with a fully equipped automatic weather station on the Warszawa Icefield, from November 2010 and ongoing. In combination with two long-term synoptic datasets (40 and 10 years, respectively) and NCEP/NCAR reanalysis data, we have looked at changes in the climatological drivers of the glacial melt processes, and the sensitivity of the inland ice cap with regard to winter melting periods and pressure anomalies. The analysis has revealed, a positive trend of 5K over four decades in minimum surface air temperatures for winter months, clearly exceeding the published annual mean statistics, associated to a decrease in mean monthly winter sea level pressure. This concurs with a positive trend in the Southern Annular Mode (SAM) index, which gives a measure for the strength and extension of the Antarctic vortex. We connect this trend with a higher frequency of low-pressure systems hitting the South Shetland Islands during austral winter, bringing warm and moist air masses from lower latitudes. Due to its exposure to the impact of transient synoptic weather systems, the ice cap of KGI is especially vulnerable to changes during winter glacial mass accumulation period. A revision of seasonal changes in adiabatic air temperature lapse rates and their dependency on exposure and elevation has shown a clear decoupling of atmospheric surface layers between coastal areas and the higher-elevation ice cap, showing the higher sensitivity to free atmospheric flow and synoptic changes. Observed surface air temperature lapse rates show a high variability during winter months (standard deviations up to ±1.0K/100 m), and a distinct spatial variability reflecting the impact of synoptic weather patterns. The observed advective conditions bringing warm, moist air with high temperatures and rain, lead to melt conditions on the ice cap, fixating surface air temperatures to the melting point. This paper assesses the impact of large-scale atmospheric circulation variability and climatic changes on the atmospheric surface layer and glacier mass accumulation of the upper ice cap during winter season for the Warszawa Icefield on KGI.

Illustrations of manganese nodules dredged from the Upper Jarvis Inlet

Manganese-iron oxide concretions are presently forming on Patrick Sill in upper Jervis Inlet. The marine geology of Patrick Sill and the adjoining basins (Queen's Reach and Princess Royal Reach) was studied to define the environment in which the concretions form. The river at the inlet head is the principal source of sediment to the upper basin. The average grain size of surficial bottom sediments within this basin decreases uniformly with distance from the source. Patrick Sill separates the upper from the lower basin. The sediment distribution pattern within the lower basin differs markedly from the upper basin as there is no dominant source of material but rather many localized sources. Abundant shallow marine faunal remains recovered in deep water sediment samples indicate that sediments deposited as deltas off river and stream mouths periodically slump to the basin floors. Geologic and optical turbidity information for the upper basin can best be explained by slumping from the delta at the inlet head with the initiation of turbidity or density currents. Patrick Sill appears to create a downstream barrier to this flow. The mineralogy of the bottom sediments indicates derivation from a granitic terrain. If this is so, the sediments presently being deposited in both basins are reworked glacial materials initially derived by glacial action outside the present watershed. Upper Jervis Inlet is mapped as lying within a roof pendant of pre-batholithic rocks, principally slates. Patrick Sill is thought to be a bedrock feature mantled with Pleistocene glacial material. The accumulation rate of recent sediments on the sill is low especially in the V-notch or medial depression. The manganese-iron oxide concretions are forming within the depression and apparently nowhere else in the study area. Also forming within the depression are crusts of iron oxide and what are tentatively identified as glauconite-montmorillonoid pellets. The concretions are thought to form by precipitation of manganese-iron oxides on pebbles and cobbles lying at the sediment water interface. The oxide materials are mobile in the reducing environment of the underlying clayey-sand sediment but precipitate on contact with the oxygenating environment of the surficial sediments. The iron crusts are thought to be forming on extensive rocky surfaces above the sediment water interface. The overall appearance and evidence of rapid formation of the crusts suggests they formed from a gel in sea water. Reserves of manganese-iron concretions on Patrick Sill were estimated to be 117 metric tons. Other deposits of concretions have recently been found in other inlets and in the Strait of Georgia but, to date, the extent of these has not been determined.

A practical guide for emigrants to North America, including the United States, Lower and Upper Canada, and Newfoundland; with full information respecting ... matters requisite for the emigrant to become acquainted with before embarking ...

Howes N54.

The parish register of Kingston, Upper Canada, 1785-1811,

The first such register in Upper Canada, kept by the Rev. John Stuart, the first missionary of the Church of England in this province.

Documentary history of education in Upper Canada,

Mode of access: Internet.

The Journal of education for Upper Canada.

Editors: 1848-75, Egerton Ryerson, J.G. Hodgins. 1876-77, Adam Crooks, J.G. Hodgins.

The traditional potter in nineteenth-century Illinois : archaeological investigations at two kiln sites in upper Alton /

"In cooperation with the Illinois Department of Transportation."

Canada, as it is : comprising details relating to the domestic policy, commerce and agriculture, of the Upper and Lower Provinces : comprising matters of general information and interest, especially intended for the use of settlers and emmigrants /

Reproduction of original in: Public Archives of Canada. Library.

Strontium isotopes and sedimentology of a marine Triassic succession (upper Ladinian) of the westernmost Tethys, Spain

Chemical Stratigraphy, or the study of the variation of chemical elements within sedimentary sequences, has gradually become an experienced tool in the research and correlation of global geologic events. In this paper 87Sr/ 86Sr ratios of the Triassic marine carbonates (Muschelkalk facies) of southeast Iberian Ranges, Iberian Peninsula, are presented and the representative Sr-isotopic curve constructed for the upper Ladinian interval. The studied stratigraphic succession is 102 meters thick, continuous, and well preserved. Previous paleontological data from macro and micro, ammonites, bivalves, foraminifera, conodonts and palynological assemblages, suggest a Fassanian-Longobardian age (Late Ladinian). Although diagenetic minerals are present in small amounts, the elemental data content of bulk carbonate samples, especially Sr contents, show a major variation that probably reflects palaeoenvironmental changes. The 87Sr/86Sr ratios curve shows a rise from 0.707649 near the base of the section to 0.707741 and then declines rapidly to 0.707624, with a final values rise up to 0.70787 in the upper part. The data up to meter 80 in the studied succession is broadly concurrent with 87Sr/86Sr ratios of sequences of similar age and complements these data. Moreover, the sequence stratigraphic framework and its key surfaces, which are difficult to be recognised just based in the facies analysis, are characterised by combining variations of the Ca, Mg, Mn, Sr and CaCO3 contents