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Introduction: Studies that assessed the efficacy of pre-operative immune checkpoint blockade (ICB) in locally advanced urothelial cancer of the bladder showed encouraging pathological complete response rates, suggesting that a bladder-sparing approach may be a viable option in a subset of patients. Chemoradiation is an alternative for radical cystectomy with similar oncological outcomes, but is still mainly used in selected patients with organconfined tumors or patients ineligible to undergo radical cystectomy. We propose to sequentially administer ICB and chemoradiation to patients with (locally advanced) muscle-invasive bladder cancer. Methods: The INDIBLADE trial is an investigator-initiated, single-arm, multicenter phase 2 trial. Fifty patients with cT2-4aN0-2M0 urothelial bladder cancer will be treated with ipilimumab 3 mg/kg on day 1, ipilimumab 3 mg/kg plus nivolumab 1 mg/kg on day 22, and nivolumab 3 mg/kg on day 43 followed by chemoradiation. The primary endpoint is the bladder-intact event-free survival (BI-EFS). Events include: local or distant recurrence, salvage cystectomy, death and switch to platinum-based chemotherapy. We will also evaluate the potential of multiparametric magnetic resonance imaging of the bladder to identify non-responders, and we will assess the clearance of circulating tumor DNA as a biomarker for ICB treatment response. Discussion: This is the first trial in which the efficacy of induction combination ICB followed by chemoradiation is being evaluated to provide bladderpreservation in patients with (locally advanced) urothelial bladder cancer. [ABSTRACT FROM AUTHOR]

The post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. In order to better understand the pathogenesis of this complication we undertook a prospective, triple blind study of consecutive long term survivors of cardiac surgery. We followed 82 patients and determined anti-heart antibodies (AHA), circulating immune complexes (CIC) and anti-viral antibodies (AVA) on sera pre-operatively and serially post-operatively. According to the clinical features of pericarditis, fever and leucocytosis, patients were divided into three groups: (I) complete PPS with all three symptoms, (2) incomplete PPS with two symptoms and (3) no PPS with one or no symptoms. Clinical PPS was found in 16 patients (19.6%). All of these patients had positive AHA, 12 patients (75%) had increased CIC and five patients (31 %) had a four-fold or greater rise in titre to viruses studied. Twenty-four patients (29.2%) had an incomplete PPS. It was accompanied by positive AHA in 17 patients (70.8%), increased CIC in 14 patients (58.3%) and a four-fold rise or greater in virus titre in seven patients (29.2%). No PPS was found in forty-two patients (51.2%). It was accompanied by positive AHA in eight patients (19%), increased CIC in 10 patients (24%) and a four-fold or greater rise in virus titre in 12 patients (28.6%). There was a good correlation between the presence of PPS, AHA, CIC and the type of operation. Heart valve replacement surgery was more frequently complicated by PPS. Development of post-operative AHA and increased CIC were also more frequently found. We found a good correlation between PPS, positive AHA and increased CIC. No correlation was found between PPS and virus serology. [ABSTRACT FROM AUTHOR]

The MN blood group has been linked with blood pressure levels and sodium-lithium counter-transport in red blood cells of normotensives. The aim of the study was to compare the distribution of MN phenotypes according to age at diagnosis of essential hypertension and to investigate the relationship between MN phenotypes, severity of complications and therpeutic needs. MN blood group polymorphism was studied in 386 Caucasians with established essential arterial hypertension, treated for at least one year. In 285 healthy normotensive blood donors, blood pressure was measured and MN blood group was typed. MN blood groups were typed with polyclonal antisera and confirmed with monoclonal antisera. MN blood group phenotype frequencies in hypertensives were 0.207 (MM), 0.601 (MN), and 0.192 (NN), which differs (P<0.000002) from the distribution in the controls: 0270 (MM), 0.540 (MN) and0.189 (NN). The relative MN phenotype frequency was strongly over-represented (P<0.05). Age at detection of hypertension was significantly lower for MN patients (P<0.0005). With increasing age of detection, the relative frequency of MN phenotype gradually decreases from 0.73 in those detected before age 40 to 0.50 for patients detected after age 60. This observation holds true for both male and female hypertensives. Furthermore, hypertensives with an MM blood group had a lower (P<0.05) prevalence of cerebrovascular accidents. In controls, blood pressure was comparable for the three MN phenotypes. The present study suggests that the MN phenotype is a genetic factor associated with early detection of essential hypertension. [ABSTRACT FROM PUBLISHER]