What is osteoarthritis? Osteoarthritis is a disease in which the articular cartilage degenerates over time, causing pain and inflammation in the affected joint. Find our full video library only on Osmosis: http://osms.it/more.

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What are non-urothelial cell bladder cancers? These are a small subset of bladder cancers that, confusingly, often arise from the urothelium, and include squamous cell carcinomas and adenocarcinomas.

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Medical disclaimer: Knowledge Diffusion Inc (DBA Osmosis) does not provide medical advice. Osmosis and the content available on Osmosis’s properties (Osmosis.org, YouTube, and other channels) do not provide a diagnosis or other recommendation for treatment and are not a substitute for the professional judgment of a healthcare professional in diagnosis and treatment of any person or animal. The determination of the need for medical services and the types of healthcare to be provided to a patient are decisions that should be made only by a physician or other licensed health care provider. Always seek the advice of a physician or other qualified healthcare provider with any questions you have regarding a medical condition.

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Dan Reznicek MD, a Urologist in Bellingham Washington, covers the basics of bladder cancer. Bladder cancer is common and is one of the top 5 cancers diagnosed every year in the US. In addition to this video, see resources available at www.nccn.org, www.bcan.org, and visit our website at www.pacificnorthwesturology.com.

Basics:
What is bladder cancer?
How does bladder cancer happen?
What are the symptoms?
What is the workup?
How is it treated?

What is bladder cancer?
Bladder cancer is a the development of a group of cells in the lining of the bladder that begin to grow and divide uncontrollably. They are in the urothelium of the bladder.

What is the urothelium
This layer prevents you from reabsorbing the salts in the urine and the waste products that have been excreted. It is also a barrier from bacteria and infection.

The vast majority of bladder cancers in this country come from the lining of the urothelium and are known as urothelial carcinoma. Historically, it was also called transitional carcinoma.
The other bladder cancers that will not be covered in this video are small cell carcinoma, adenocarcinoma, and squamous cell carcinoma. These are quite rare, and their outcomes and treatments are different from urothelial carcinoma.

Risk factors include smoking, male sex, and exposures to certain chemicals used in the dye and textile industry.

What are symptoms of bladder cancer?

Most people are diagnosed with bladder cancer after seeing blood in the urine (also called hematuria). Sometimes your urine may look normal, but blood is seen on a urine test at your doctor’s office and that is called microscopic hematuria. See a doctor if you note blood in your urine.

Usually there is no pain with bladder cancer in early stages. In some people, they can develop irritative voiding symptoms such as burning with urination, more frequent urination, difficulty urinating or a weak stream, and the sudden urge to urinate. These symptoms will seem like a urinary tract infection but no bacteria is seen on a culture. These symptoms are less common but can occur.

If bladder cancer is caught late and spread to other areas of the body, patients may experience back pain, weight loss, tiredness, swelling, bone pain, and other symptoms.

What is the workup?

A medical history and perform a physical exam. Other tests that may be performed include urine tests with a culture, cancer markers, or microscopic exam. Imaging tests such as a CT scan, Ultrasound, or MRI may be recommended. A cystoscopy should be performed if bladder cancer is suspected or possible.

How is it treated?
Treatment depends on the stage of the cancer. TNM staging of bladder cancer is covered in the video.

Cancers that are in the lining of the bladder alone are known as non-muscle invasive bladder cancer (NMIBC). These are treated with endoscopic removal (transurethral resection of a bladder tumor [TURBT]) and may require further local therapies with drugs instilled into the bladder.

Some cancers involve the muscle of the bladder and require further treatment. Muscle invasive bladder cancer is treated with surgery, chemoradiation, or a combination of therapies. If left untreated, muscle invasive bladder cancer can be deadly and we highly recommend treatment.

Metastatic cancer is less common and describes bladder cancer that has spread beyond the bladder and into other organs. 4% of cancers are diagnosed at this stage. At this point in time, metastatic bladder cancer is incurable, but new treatments are being discovered each year. Treatments at this stage are focused on slowing the cancer growth and lengthening survival.

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This video “Juvenile Idiopathic Arthritis (Part 1)” is part of the Lecturio course “Pediatrics” ► WATCH the complete course on http://lectur.io/jia1

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– Juvenile idiopathic arthritis – a case study
– Pathology of JIA
– Several very different types of JIA
– JIA characteristics
– Progression of symptoms
– Types of JIA
– Chronic destruction of knee joints
– Historical findings

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Your tutor is Brian Alverson, MD. He is the Director for the Division of Pediatric Hospital Medicine at Hasbro Children’s Hospital and Associate Professor of Pediatrics at Brown University in Providence, RI. He has been active in pediatric education and research for 15 years and has won over 25 teaching awards at two Ivy League Medical Schools. Dr. Alverson has extensive experience in preparing students for the USMLE exams and has test writing experience as well.

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Get to know the science behind what causes the stiff, creaky joints of the most common forms of arthritis and what you can do to prevent it.

—

The bad backs, elbow pain, and creaky knees so common in older people often aren’t just “old age.” In fact, the source of this stiffness plagues many young people as well. The culprit is arthritis: a condition that affects over 90 million people in the U.S. alone. What makes arthritis so pervasive, and why haven’t we found a cure for it? Kaitlyn Sadtler and Heather J. Faust investigate.

Lesson by Kaitlyn Sadtler and Heather J. Faust, directed by CUB Animation.

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Here is the narration exactly as it is in the video:
Unfortunately, some genetic factors, bacterial or viral infection or smoking can induce mutation in the collagen II.
This mutation results in replacement of arginine amino acid with citrulline amino acid.
This little change has devastating lifelong sequences on the affected people.
The antigen presenting cells APCs such as dendritic cells which patrol our tissues recognize this new mutated collagen.
These antigen presenting cells have specific detecting molecules on their outer cell membranes called HLA molecules.
Specific types of these HLA molecules which are HLA DR1 and HLA DR4 become confused and deal with the new collagen as foreign body.
“phagocyte them now, phagocyte them now”
As a result, the antigen presenting cells phagocyte this mutated collagen.

After digesting the citrullinated collagens the APCs present some parts of the protein on their outer surface as foreign bodies
On the other hand, T helper cells in our body work as security detectors who search all antigen presenting cells for any suspicious foreign molecules.
Once T helper CD4+ cells meet HLA molecules connected to citrullinated collagen they become activated.
This activation results in production and release of cytokines IL-2 which have autocrine effects as they come back to bind and activate their releasing T helper cells.
IL-2 induces T helper cell proliferation into 2 new cellular lines, T helper 1 abbreviated as Th1 and T helper 2 cells abbreviated as Th2.
The Th2 stimulate the production of various antibodies
whereas Th1 are directed toward cell mediated immunity and later production of interferon gamma and IL-17.

Now we will focus on antibody production
Once Th2 binds to B cell it activates it.
This activation results in sequence of B cell proliferations ended up with 2 new cell lines, Plasma cells and memory cells.
Plasma cells produce various types of antibodies.
Whereas memory cells keep records of all foreign antigens in our bodies and provide long lasting immunological memory.
Now we will focus on the antibodies

The first type of antibodies are the IgG antibodies with attack the cyclic citrullinated peptides abbreviated as CCP.
The anti CCP antibodies are specific markers for diagnosis of rheumatoid arthritis.
The second type of antibodies are the IgM antibodies which attack our IgG antibodies.
So, they are antibodies against our antibodies.
They are called rheumatoid factor and they are very common in the serum of patients with rheumatoid arthritis.
Now both types of antibodies travel through blood to the joints, and even to other tissues.
Remember rheumatoid arthritis is joint disease with systematic manifestations.
Now let’s focus on joints, where antibody complexes accumulation activates phagocytes and complement system.
The activated phagocytes will release inflammatory cytokines such as TNF alpha which play important role in mediating the inflammatory damage to the joints.
They also secrete IL-1, IL-6.
We have also IL-17 and interferon gamma produced by T cells.
Additionally, complement enzymes activate the neutrophils in the joint synovial fluids.
Cytokines stimulate synovial membrane proliferation and swelling which is a remarkable pathological sign of rheumatoid arthritis.
Additionally, they activate osteoclast cells which induce bone erosions.
Angiogenesis also stimulated by cytokines.
Together cytokines released by activated macrophages and activated neutrophils induce the production of protease and collagenase enzymes which progressively erode and destroy the cartilage layer of the joints.
Happy reading (or enjoy your reading, it is up to you Carla)
Narration reading Carla Tordoff Gibson
Pharmacology and Therapeutic department
Kings College London KCL University

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What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune condition where the immune system attacks the joints.

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