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When patients with testicular cancer undergo lymph node removal surgery there is a risk that their fertility will be affected if proper nerve sparing techniques are not used. Up to 75 per cent of men will not be able to father children if they receive the surgery without these techniques.

Lawson’s Internal Research Fund (IRF) has awarded a grant to Dr. Nicholas Power, a researcher at Lawson and urologic oncologist at London Health Sciences Centre (LHSC), who is leading a study to identify the nerves involved in fertility that are affected in lymph node removal surgery for testicular cancer.

“Sometimes patients go through a lot to be cured of testicular cancer only to be left dealing with long-term survivorship issues such as fertility. We hope to gain new insights into how fertility can be preserved after these men receive lymph node removal surgery,” says Dr. Power, who is also an assistant professor at Western University’s Schulich School of Medicine & Dentistry.

In collaboration with Schulich assistant professors Dr. Marjorie Johnson and Dr. Brian Allman, and PhD candidate Tyler Beveridge, Dr. Power published initial results in The Journal of Urology announcing their discovery of a brand new anatomic structure, the pre-hypogastric ganglion, which needs to be spared in surgery to maintain fertility. They were also able to describe the first roadmap of retroperitoneal neuroanatomy – the anatomy of nerves in the space where surgeons locate lymph nodes most commonly affected by testicular cancer that has spread.

“There has never been a definitive anatomic study of the nerves of the retroperitoneum so it was our goal to provide the first comprehensive study of the nerves as they relate directly to patients who have testicular cancer,” explains Dr. Power. “After we published the initial results we were approached by textbook authors to use our data in upcoming editions of anatomy and surgical atlases. This will help to provide insight into nerve sparing techniques for surgeons who have not been trained at high-volume centers and ultimately improve the quality of care in testicular cancer patients overall.”

Already Dr. Power has found that using this knowledge when he performs lymph node removal surgery for testicular cancer has led to a 95 per cent success rate of preserving fertility.

The IRF will go towards their research to further investigate the actual function and physiology of the retroperitoneal neuroanatomy using a pig model.

“Lawson’s IRF provides incredible support for a field of study such as ours that is not yet at the stage of applying for a large grant. Receiving the funding gives us the independence to test out novel yet important hypotheses that will then lead us to further grants,” says Dr. Power.

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Above: Dr. Nicholas Power

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph's Health Care Foundation).

Researchers at Lawson Health Research Institute (Lawson) have launched a new study to investigate the use of bovine lipid extract surfactant suspension (BLES^®) for treating severe cases of COVID-19. They hope to improve COVID-19 outcomes, and reduce the time needed on mechanical ventilation for severe cases.

Surfactant is made of lipids and proteins. Its primary function is to reduce surface tension in the alveoli in the lungs, helping us to exchange gases and breathe more efficiently. Alveoli can be described as tiny, balloon-like air sacs that exchange oxygen and carbon dioxide to and from the blood stream. When there is less surfactant being produced, or the surfactant is dysfunctional, alveolar walls can stick together, making it difficult to breathe.

Lung analyses from patients with severe COVID-19-induced respiratory failure indicate there is a change in their alveolar type-II cells; the cells which secrete surfactant. This suggests a change to the surfactant being produced, and a decrease in its functional efficacy.

Dr. Jim Lewis, Lawson Scientist and Respirologist at St. Joseph’s Health Care London, and his colleague, Lawson Scientist Dr. Ruud Veldhuizen, are studying whether the use of BLES^®, an exogenous surfactant, given at the time of intubation, will help improve outcomes such as gas exchange, need for mechanical ventilation, systemic inflammatory response, and length of ICU and hospital stay in patients with severe COVID-19.

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BLES® is a pulmonary surfactant, manufactured in London, Ontario. It is currently used worldwide to help improve lung function in premature babies. Researchers are confident that it can help adults who develop lung disease and acute respiratory distress syndrome (ARDS).

Dr. Jim Lewis explains, “BLES® has been studied in pediatric and adult populations with ARDS, and we have found that it improves outcomes in patients with direct lung injury when compared to patients receiving standard treatment. We have proven this treatment effective in the past, and COVID-19 seems to be another prototypic case that we think will respond well.”

“Mechanical ventilation, while sometimes necessary, can cause damage to the lungs,” says Dr. Veldhuizen. “In previous studies, we’ve been able to show that if you give the surfactant early, prior to ventilation, you can prevent some of this damage from occurring.”

“The world is focused on finding good treatments for COVID-19. This kind of research is only possible through strong partnerships, and we are thankful for the collaboration that is possible here in London. Many different experts are involved in this study, including scientists and research staff, physicians, nurses, respiratory therapists, pharmacists, and staff at BLES® Biochemicals,” adds Dr. Veldhuizen.

Researchers hope to recruit ten patients to receive the exogenous surfactant, with another ten serving as the control group.